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Physical therapy roles in community-based rehabilitation : a case study in rural areas of north eastern Thailand

NUALNETR, Nomjit
2009

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his action research aimed to explore how physical therapists could enhance the quality of life for persons with disabilities via a community-based rehabilitation (CBR) strategy. The study was conducted in two rural sub-districts in northeastern Thailand. In each sub-district, several group meetings were arranged for persons with disabilities and their families, and various community members. Participants were encouraged to discuss their perception of problems of the current rehabilitation services for persons with disabilities. Strategies to manage all problems were collaboratively identified and were implemented in order of priority according to the importance of the problem. The outputs of CBR were evaluated by interviews and observation. The findings revealed that physical therapists had numerous roles in CBR, depending on the community’s circumstances. They need a high degree of flexibility and a wide range of skills to contribute to CBR. The preparation of such physical therapists requires development of a more client-centered community-oriented education programme.

 

 

Asia Pacific Disability Rehabilitation Journal, Vol 20, No 1

Disability among clients attending Taif Rehabilitation Centre, Saudi Arabia

AL-SHEHRI, Abdul-Salam A
ABDEL-FATTAH, Moataz M
2008

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This is a cross-sectional study of hospital records of people who were admitted to Rehab Armed Forces Rehabilitation Center, Taif, Saudi Arabia from 1999- 2005. Eight hundred and fifty records were reviewed. Data were collected on age, sex, nationality, data of admission and discharge and type of disability. Univariate and multivariate logistic regression analysis were performed to determine predictors of long stay at the hospital. Trauma as an etiology of disability was more common than non-traumatic incidents among male and middle aged clients (16-45 years). Traumatic accidents mostly result in quadriplegia (72.8%). Male, single, less than 45 years old, people with traumatic accidents and people with paralytic types of disability were significantly more likely to stay longer at the hospital. Home care programme should be expanded to minimize duration of stay at the rehabilitation centres. Health education of the public would help in encouraging disabled people to adapt to daily life activities.

Exclusion of disabled people from microcredit in Africa and Asia : a literature study

CRAMM, J M FINKENFLUGEL, H
2008

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People with disabilities are barred from microcredit schemes. A literature search on the participation of people with disabilities in microcredit schemes resulted in 16 documents. The statements, recommendations and generalisations in these documents are not supported with strong evidence and are 'expert opinions' at best. Inclusion of people with disabilities within institutional schemes and self-helping schemes is recommended throughout the world. However, these seem most affected by excluding mechanisms and inclusion numbers lag behind. The absence of people with disabilities from these two schemes makes them a less attractive option. To fulfil the current needs of people with disabilities; ad-hoc schemes should continue and even expand their work. The pragmatic solution is to work with the available resources in order to change the situation of people with disabilities.

Considerations in the quest for evidence in community based rehabilitation

KUIPERS, Pim
HARKNETT, Steve
2008

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This paper seeks to contribute to current debate on evidence-based practice and appropriate models of disability rehabilitation for people with disabilities in developing countries. Based on the authors' experience in, and evaluation of Community Based Rehabilitation (CBR) projects and research, they provide suggestions for utilising different kinds of evidence at different levels of CBR. The paper proposes four considerations. First, at the micro level of individual rehabilitation techniques, it recommends the judicious co-opting of available evidence from conventional evidence sources. Second, at the level of service planning, it suggests the need for conducting major syntheses of CBR evaluation reports for evidence. Third, it proposes the incorporation of values with research in consideration of issues at the model level. Finally, the paper proposes that in the case of CBR and similar approaches, new conceptualisations and methodologies are required in current understandings of evidence-based research and practice, which highlight the voice of people with disabilities, their family members and communities as key sources of evidence-related data."This paper seeks to contribute to current debate on evidence-based practice and appropriate models of disability rehabilitation for people with disabilities in developing countries...The paper proposes four considerations. First, at the micro level of individual rehabilitation techniques, it recommends the judicious co-opting of available evidence from conventional evidence sources. Second, at the level of service planning, it suggests the need for conducting major syntheses of CBR evaluation reports for evidence. Third, it proposes the incorporation of values with research in consideration of issues at the model level. Finally, the paper proposes that in the case of CBR and similar approaches, new conceptualisations and methodologies are required in current understandings of evidence-based research and practice, which highlight the voice of people with disabilities, their family members and communities as key sources of evidence-related data"

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 2

Factors shaping attitudes towards physical disability and availability of rehabilitative support systems for disabled people in rural Kenya

MONK, Julie
WEE, Joy
2008

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This study examines the range of attitudes towards persons with physical disability in a rural community in western Kenya. It also evaluates the availability of services for persons with disabilities in the community. Qualitative data analysis of interview material led to the generation of a model describing the attitudes towards people with disabilities. Availability of services was explored through interview questions and document collection. Perceived cause of disability, perceived characteristics and activities of people with disabilities by the community and perceived role of society, appear to shape the attitudes towards people with disabilities in the community studied. The opinions within these categories contribute to enabling and disabling features of the environment in which people with disabilities live. It appears that services available are underused by disabled members of the community due to poor accessibility and financial barriers. The results yielded relatively enabling attitudes towards PWD. The responses suggest that this community may be ready to support increased participation by its members, possibly through a community based rehabilitation programme.

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

Reflections on poverty and disability : a review of literature

KAMPEN, Marlies V
ZIJVERDEN, Ingrid M
EMMETT, Tony
2008

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This study carried out a review of literature describing the relationship between poverty and disability, in order to establish the evidence base for this relationship. Several authors seem to accept the existence of this link, even without a sound research basis. Articles and books were scrutinized to find out what sources were used in these publications to conclude that there was evidence for a strong relationship between disability and poverty. Peer-reviewed articles were used as much as possible.

It was found that cultural determinants play the greatest role in the process of disability leading to poverty. Monetary factors are also essential determinants when it comes to poverty as a result of disability. The relationship between disability and poverty seems to be a vicious circle. Most of the literature concerning poverty and disability is based on non- rigorous (literature) studies.

Relating disability to poverty and vice versa is a complex matter that needs to consider several interdependent factors that influence this process.

 

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

Disability and development: is the rights model of disability valid in the Arab region? An evidence-based field survey in Lebanon and Jordan

NAGATA, Kozue Kay
2008

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This paper reviews the process and outcome of constructing a "rights model of disability" which is culturally specific to Jordan and Lebanon. The objective of the empirical part was, to survey the current level of attitudes of non-disabled people towards their disabled fellows in Jordan, and to compare the attitudes of Lebanon's university students towards five different categories of disabled people (mentally disabled people, psycho-socially disabled people, physically disabled people, hearing impaired people and visually impaired people) to highlight the variations and diversity among them. It also examined the relationship between the attitudes and various demographic and social characteristics of the respondents. The set of findings was further tested and triangulated through meta-analysis of individual views expressed in the qualitative studies.

In Jordan, the attitude of 191 randomly selected non-disabled people was studied, using a Scale of Attitudes towards Disabled Persons (SADP). The participants from 4 communities of Jordan, exhibited overall negative attitudes towards disabled people. Socio-economic-demographic characteristics showed almost no difference regarding their attitudes towards disabled people.

In Lebanon, a more complex scale, composed of four sub-scales, namely a, "Baseline Survey of Student Attitudes towards People with a Disability" was used, to survey 94 university students' attitudes towards five different categories of disabled people, and a set of indices for future comparison was constructed. The results indicated the same pattern of gradations of attitude differences (found in other countries) towards persons with physical or sensory impairments (better), intellectual impairment (middle) and mental illness (worse). The main findings of this empirical field research showed particularly negative public attitudes towards people with intellectual impairment and mental illness in Lebanon.

Finally, the validity of the proposed rights model of disability and the empirical findings of this study, were further examined and co-validated through analysis of the collective views of those who took part in the questionnaire surveys and the participatory focus group discussions, which took place in Lebanon in 2005 and 2007, and in Jordan in 2005, as well as a series of intensive on-line and/or telephone interviews of a few informants comprising of disabled persons and experts. The policy implications of the findings are discussed.

 

Asia Pacific Disability Rehabilitation Journal, Vol 19, No 1

A review of community based rehabilitation evaluations : quality of life as an outcome measure for future evaluations

MANNAN, Hasheem
TURNBULL, Ann P
2007

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"This review examines key articles in evaluation of community-based rehabilitation carried out in developing countries and proposes family quality of life as an outcome measure of community-based rehabilitation. The concept of community-based rehabilitation is reviewed, quality of life and family quality of life measurement scale is presented. It presents a practical approach to future evaluations of community-based rehabilitation programmes. This review presents the features of community-based rehabilitation evaluation (i.e., service delivery system, technology transfer, community involvement, and organisation and management), methodology, and findings. Implications are defined for the enhancement of community based rehabilitation through practical suggestions for programme coordinators involved in community development for rehabilitation, equalisation of opportunities, and social inclusion of people with disabilities"

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Evaluation in community based rehabilitation programmes : a strengths, weaknesses, opportunities and threats analysis

SHARMA, Manoj
2007

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The purpose of this article was to qualitatively analyse the extent to which community based rehabilitation programmes have been evaluated over the past thirty years. A framework of strengths, weaknesses, opportunities and threats analysis was used in conducting this analysis. Using an extensive search of MEDLINE, 22 articles were located that described and evaluated one or more dimensions of CBR. Three studies each from Australia, India, Zimbabwe and two studies each from England, Philippines, Vietnam and one each from Finland, Guyana, Jamaica, Japan, Pakistan, Papua New Guinea, Thailand, and United States were included in the analysis. A variety of methods used, most evaluations conducted in community settings, focus on mobility related evaluations by most programmes, and development of new instruments were the strengths of CBR evaluations. Some of the weaknesses were lack of consistency in outcome measures, lack of cost benefit and cost effectiveness studies, small sample size of many studies, and lack of focus on other than mobility related disabilities by most projects. The opportunities for CBR evaluations pertain to training assessments, use of mixed models, using indicators from a standard taxonomy, and focusing on medical rehabilitation. The threats to CBR evaluations are a need to prioritise from multifarious activities and having limited resources for evaluation.

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 1

Impact of socio-economic rehabilitation on leprosy stigma in Northern Nigeria: findings of a retrospective study

EBENSO, Bassey
FASHONA, Aminat
AYUBA, Mainas
IDAH, Mike
ADEYEMI, Gbemiga
S-FADA, Shehu
2007

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This study explored the perceptions of people affected by leprosy regarding impact of socio-economic rehabilitation (SER) on stigma-reduction. The study combined a quantitative questionnaire (the P-scale) with semi-structured interviews of 20 individual SER participants, five focus group discussions and 10 key informant interviews. The P-scale results showed four men suffered significant participation restrictions (scores of >12 points) in finding work and in social integration. The narratives of SER participants, focus groups and key informants showed that SER improved self-esteem, financial independence, acquisition of new skills, and access to public institutions. The authors speculate that through the pathway of improvements in economic and living conditions, SER is beginning to influence the process of social interaction, resulting in positive attitudinal change towards SER participants. The subjective opinions of interviewees suggest that improved self-esteem, positive family and community support for SER participants and increasing participation in community activities are indications of stigma-reduction.

 

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 2

CBR: a participatory strategy in Africa

HARTLEY, Sally
Ed
2002

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This resource provides an important contribution and understanding of how community-based rehabilitation (CBR) operates in Africa. It contains the experiences and reflections of key stakeholders within CBR from 14 African countries. It will contribute to a more mutual and holistic understanding of the concept of CBR and bring about the development of new initiatives. This book is useful tool for CBR planners, policy-makers and managers

Training of CBR personnel : current issues future trends

THORBURN, M J
2000

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This paper reviews the main trends that have taken place in training persons for CBR work in the last twenty years. It stresses the relevance of the Canadian manpower model to CBR and the logical approach to training generated. New trends for the near future are outlined and a need for more research is seen as crucial to future developments

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