Besoaín A.1, Rebolledo J.1, Manríquez M.1, Aliaga V.1
1Universidad de Chile, Department of Physical Therapy, Santiago, Chile
Background: Community-based rehabilitation (CBR) is a worldwide strategy aimed to assure equal opportunities and social inclusion of people with disabilities (PWD). Following the ratification of UN Convention about rights of PWD, CBR has been positioned as a relevant strategy to contribute to remark PWD as subjects with rights and duties. In Chile, public health system has implemented this strategy since 15 year ago, confronting care models and understandings of disability. Physical therapists have been positioned as a key actor in this strategy. However, limited literature about evaluation of CBR has been performed. Experiences description are superficial and do not differentiate between points of view of physical therapist (PT), occupational therapist (OT), PWD, among others.
Purpose: This study is aimed to describe perceptions about social inclusion, disability and CBR interventions of women and men with disabilities and rehabilitation personnel (PT, OT and speech therapist). Contributing to identify barriers and strengths for implementing CBR in Chile.
Methods: A qualitative, exploratory and cross-sectional study was performed. Data production was thorough grupal interviews, 9 PWD interviews (4 with men and 5 with women) and 4 with rehabilitation personnel that works in CBR centers in primary health care of Metropolitan district of Chile. Data analysis was performed through grounded theory with the constant comparison method and achieving saturation of analytic proposed and emerging categories.
Results: CBR personnel corresponds to PT, OT and speech therapist, with a higher proportion of PT. Moreover, this team used to include psychologist and physical education teacher. Women with disabilities used to be adults or elderly, with chronic musculoskeletal or neurological syndromes, meanly housekeeper or non formal workers. Men with disabilities used to are active laboral workers until the development of their impairments (meanly after a stroke or heart attack). From PWD perspective, there is a tension between individual/biomedical model and social model. Individual model is predominant in functional rehabilitation and expectative approaches. Social model appear in collaborative, rights-demanding and aging experiences. This situation is concordant with reports from rehabilitation personnel, who divide their rehabilitation activities in individual (improving functionality, usually by PT) and grupal activities (improving social cohesion, usually by OT and ST).
Experiences of PWD realizes two components of CBR: Health and empowerment. The development of sense of belonging that arises from their participation in CBR activities realizes the conformation of community. For professionals, CBR strategy provide them an interdisciplinary space for achieving integral rehabilitation. Nonetheless, they requires improvements in physical spaces and improvements in intersectoral and communitary network.
Conclusion(s): Across every actor in rehabilitation process, causes of disability are understood from social model, meanwhile consequences and solutions are understood from individual model, limiting impact of strategy. Despite this, PWD that attends to CBR centers, perceive strategy as a successful caring and supporting strategy , a social inclusion space and development of PWD and elderly people.
Implications: CBR in primary health care is identified as a positive and relevant strategy for social inclusion. PT are key actors. It is necessary to improve intersectoral network, especially non-health actors for promotion of social inclusion of PWD.
Funding acknowledgements: This study (FONIS SA15I20121) was funded by the National Commission of Science and Technology (CONICYT)
Topic: Disability & rehabilitation
Ethics approval: This study was approved by the Comité de ética de investigación en seres humanos, Facultad de Medicina, Universidad de Chile
All authors, affiliations and abstracts have been published as submitted.
