To evaluate the feasibility of a digital rehabilitation approach with task shifting in low- and middle-income countries to increase access to rehabilitation in primary healthcare.
After phase one of the research, which included the assessment of the needs, barriers, and possibilities for digital rehabilitation in Kenya and Rwanda, the industry partner developed a mobile solution for community-based rehabilitation. Content was created for each location with local professionals to offer evidence-based no-harm exercise programs for the most common reasons for seeking rehabilitation services, such as back, knee, shoulder, and neck pain. The solution was launched in 2023 in three test beds in Rwanda, two in Kenya, and five in Indonesia, which are located mainly in rural areas. Community health workers (CHWs) were trained to use solution to share programs for people in need. In phase two, usability and feasibility testing of the application were performed from one to six months after launch. These included surveys of usability, attitudes, and competencies, interviews, and focus group discussions for rehabilitation service users, people in need of rehabilitation, CHWs (Rwanda n=40, Kenya n=15, and Indonesia n=31), and rehabilitation professionals, physiotherapists. Follow-up studies and evaluations of the second version of the application will be conducted by the end of 2024.
The solution was found to be easy to use among all user groups, even though CHWs and service users had low to moderate competence in technology use. The number of service users needing a referral to healthcare was low. Physiotherapists acknowledged the solution’s potential to enhance rehabilitation service delivery and access but highlighted their own professionalism in exercise program delivery. CHWs are willing to receive more training, especially in identifying the rehabilitation needs in their community.
Community health workers can increase access to rehabilitation services using digital solutions for the most common needs.
Considering the important role of CHWs in the public health workforce, their competence in using digital rehabilitation technology is essential to integrating rehabilitation services into primary care and scaling them for all. In the future, technology solutions should support CHWs and service users in the rehabilitation process, from assessment to goal setting, intervention, and re-evaluation. Limited physiotherapy resources could be targeted to ensure evidence-based content in digital services and offer in-person services when needed.
exercise therapy
mobile applications
