“<EM >OTHERWISE … HE WILL BE A BEGGAR</EM>”: A FOCUS GROUP STUDY ON MEASURING REHABILITATION OUTCOMES IN LOW-RESOURCE AND CONFLICT SETTINGS

C.A. Barth^1,2, M. Donovan-Hall³, C. Blake², N.J. Akhtar⁴, S. Al-Barawi⁵, C. O'Sullivan²

¹Unisanté Lausanne, Cochrane Switzerland, Lausanne, Switzerland, ²University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland, ³University of Southampton, School of Health Sciences, Faculty of Life and Environmental Sciences, Southampton, United Kingdom, ⁴University of Dhaka, Bangladesh Health Professions Institute, Dhaka, Bangladesh, ⁵Al-Quds University, School of Public Health, Gaza, Palestine

Background: The outcomes ofrehabilitation interventions are important for patients, professionals andpolicy makers. They are measured at individual or population level and involvethe use of outcome measures. Most outcome measures have been developed for ‘Western’contexts and may be inadequate for low-resource and conflict settings, whererehabilitation is poorly developed and where the ability to demonstrate impactwould be critical to strengthening it.

Purpose: This study aimsto understand the perspectives of physiotherapists from low-resource and conflict settings regarding current practices, value to different stakeholders, and barriers and facilitators to measuring rehabilitation outcomes.

Methods: Focus groupdiscussions were held with 35 physiotherapists from 18 countries usingEnglish as a common language. Audio recordings were transcribed verbatim,anonymised and analysed using reflexive thematic analysis.

Results: Four themesemerged illustrating the different levels at which outcomes and measures werediscussed: User (patients and families within their environment), provider(physiotherapists and other rehabilitation workers), application (outcome measures) andstructure (management, health system). Participants provided rich insights intoa broad spectrum of current practices of outcome measurement. They sharedperspectives of diverse patient populations, the utility of various outcome measures and aneglected rehabilitation sector lacking investment, leadership and support. Barriersto progressing outcome measurement included poor patient health literacy, inconsistentrehabilitation provider training, lack of valid outcome measures, and inadequate leadership. Participants suggested an enhanced involvement of patients in the process of measuring and standardised routine outcome measurement procedures. According to participants, this should be achieved by using, developing or adapting simple, context- and stakeholder-relevant outcome measures, and by improved management support.

Conclusions: These insights providerobust recommendations and an evidence-base for context-adapted development ofrehabilitation outcome measurement in a variety of low-resource and conflictsettings.

Implications: Valid outcomesmeasures to demonstrate impact of interventions are key to professionalisationand strengthening of the rehabilitation sector. This is even more important in low-resourceand conflict settings where rehabilitation is often highly neglected. Leadershipand buy-in from health policy makers are required when standardisingrehabilitation outcome measurement in any given context. Different patientpopulations require a cross-cultural adaptation and the development ofcontextualised measures to obtain valid and meaningful outcomes. Physiotherapistsand other rehabilitation professionals need training, practice and skills toreliably measure rehabilitation outcomes and to generate evidence on the impactof rehabilitation interventions.

Funding acknowledgements: -

Keywords:
Outcome measures
Conflict-affected
Reflexive thematic analysis

Topics:
Disaster management
Professional issues
Globalisation: health systems, policies & strategies

Did this work require ethics approval? Yes

Institution: Commission Cantonale d'Ethique de la Recherche

Committee: Swiss Ethics

Ethics number: REQ-2020-00774