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Adhikari SP1, Bimali I1, Baidhya S1, Shakya NR1
1Kathmandu University School of Medical Sciences, Department of Physiotherapy, Dhulikhel, Nepal
Background: Large-scale natural disasters like the earthquake are not only the cause of significant loss of life but are also sources of mental, emotional and physical disabilities. An earthquake of 7.8 magnitudes hit Nepal and injured more than 18,500 people in 2015. Due to lack of rehabilitation centers and poor economic status, those victims were bound to return to their community as soon as they were medically and surgically stable. Therefore, they were prone to develop long-term disability if rehabilitation was not provided at that moment. In the meantime, there were no evidence-based structured protocols to rehabilitate earthquake victims of various injuries at the community level to prevent life-long disabilities and to reduce public health burden.
Purpose: We aimed to structure community-based rehabilitation protocols for physically impaired earthquake victims and to investigate the immediate effect of the intervention.
Methods: The rehabilitation needs were analyzed as per the result of the survey. Then, rehabilitation protocols for various injuries were structured with respect to victims' impairment, functional level, and environmental condition based on literature evidence and Physiotherapists' experience gained during early post-earthquake rehabilitation. The interventions were patient-centered, individually tailored, reproducible, progressive and feasible at the community level. The protocols were administered to thirteen victims of one of the most affected community sites, for 60 minutes/day, twelve days in two weeks at their own doors. Local resources were used to make the protocols sustainable. On-site health workers were trained for progressive treatment. An immediate effect of the protocols was evaluated within the group. The World Health Organization Disability Assessment Schedule (WHODAS) 2.0, numerical pain rating scale, and time up and go test (TUG) were used to measure disability level, pain, and mobility status respectively. The Wilcoxon signed rank test was used to analyze pre-post data.
Results: All participants completed the rehabilitation without any difficulties and adverse effects. The locally trained health workers were able to guide victims during intervention administration. Maximum victims had extremity injuries followed by chest and spinal injuries. Treatment demonstrated significant reduction in WHODAS 2.0 score (a decrease of median score from 17 to 12, Z = -3.196, p 0.001, effect size = 0.63). The pain level was significantly reduced (Z = -2.72, p = 0.007). Even though a decrease in time during TUG test from pre to post was seen, it was not significantly different.
Conclusion(s): Evidence-based rehabilitation protocols were structured that were feasible and appropriate for earthquake victims living in the community. The interventions demonstrated immediate benefits in improving their quality of life. On-site health workers were trained and local resources were used. Those strategies strengthened feasibility as well as accessibility of the protocols. Follow up is required to explore the long-term effect of the interventions. Large-scaled clinical trials are recommended to establish interventions effectiveness.
Implications: The findings indicated benefits of the interventions in the rehabilitation of the earthquake victims at the community level. Use of local resources strengthens the feasibility and accessibility of the protocol.
Keywords: Community rehabilitation, Disaster, Earthquake
Funding acknowledgements:
The authors acknowledge Nepal Physiotherapy Association and Dhulikhel hospital for supporting this study
Purpose: We aimed to structure community-based rehabilitation protocols for physically impaired earthquake victims and to investigate the immediate effect of the intervention.
Methods: The rehabilitation needs were analyzed as per the result of the survey. Then, rehabilitation protocols for various injuries were structured with respect to victims' impairment, functional level, and environmental condition based on literature evidence and Physiotherapists' experience gained during early post-earthquake rehabilitation. The interventions were patient-centered, individually tailored, reproducible, progressive and feasible at the community level. The protocols were administered to thirteen victims of one of the most affected community sites, for 60 minutes/day, twelve days in two weeks at their own doors. Local resources were used to make the protocols sustainable. On-site health workers were trained for progressive treatment. An immediate effect of the protocols was evaluated within the group. The World Health Organization Disability Assessment Schedule (WHODAS) 2.0, numerical pain rating scale, and time up and go test (TUG) were used to measure disability level, pain, and mobility status respectively. The Wilcoxon signed rank test was used to analyze pre-post data.
Results: All participants completed the rehabilitation without any difficulties and adverse effects. The locally trained health workers were able to guide victims during intervention administration. Maximum victims had extremity injuries followed by chest and spinal injuries. Treatment demonstrated significant reduction in WHODAS 2.0 score (a decrease of median score from 17 to 12, Z = -3.196, p 0.001, effect size = 0.63). The pain level was significantly reduced (Z = -2.72, p = 0.007). Even though a decrease in time during TUG test from pre to post was seen, it was not significantly different.
Conclusion(s): Evidence-based rehabilitation protocols were structured that were feasible and appropriate for earthquake victims living in the community. The interventions demonstrated immediate benefits in improving their quality of life. On-site health workers were trained and local resources were used. Those strategies strengthened feasibility as well as accessibility of the protocols. Follow up is required to explore the long-term effect of the interventions. Large-scaled clinical trials are recommended to establish interventions effectiveness.
Implications: The findings indicated benefits of the interventions in the rehabilitation of the earthquake victims at the community level. Use of local resources strengthens the feasibility and accessibility of the protocol.
Keywords: Community rehabilitation, Disaster, Earthquake
Funding acknowledgements:
The authors acknowledge Nepal Physiotherapy Association and Dhulikhel hospital for supporting this study
Topic: Disaster management; Disability & rehabilitation; Education: clinical
Ethics approval required: Yes
Institution: Kathmandu University School of Medical Sciences
Ethics committee: Institutional review committee
Ethics number: approval number: 83/15
All authors, affiliations and abstracts have been published as submitted.
