File
Kusuwo P.1, Myezwa H.1, Pilusa S.1, Mkumbuzi V.1
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa
Background: Community-based rehabilitation (CBR) is a community development strategy used to equalise opportunities for people with disabilities which has been in use since 1978 and is implemented in more than 90 countries. Reports are being produced that describe the process rather than evaluate the effectiveness of CBR programmes leading to a dearth in literature on the effectiveness of CBR. There is little evidence in the form of randomised control trials or systematic reviews, hence the field of CBR has been described as 'data rich but evidence poor'. Literature points to the need for indicators that can be used facilitate the evaluation of CBR. Critics of the common set of indicators for CBR evaluation have singled out the heterogeneity of CBR programmes as a limitation to their use. Others, however, acknowledge that there are different areas of focus in CBR but suggest a comprehensive set of indicators from which one can choose to enable the evaluation of the different components of CBR. There are different aspects of CBR that can be evaluated which include the system, impact on the individual and on the community.
Purpose: To identify the system-related elements that can be used to evaluate CBR programmes.
Methods: A qualitative systematic review was done. A systematic search was conducted on four data bases (SCOPUS, PubMed, PsychINFO, Medline) and on the WHO website for the period between 2005 and 2015. Articles in English pertaining to CBR evaluation from all over the world were included. Systematic reviews were excluded. The Evans (2003) appraisal tool was used to determine the level of evidence for the included articles. Methodological quality was assessed using the Critical Appraisal Skills Programme for qualitative studies and the Strengthening The Reporting of Observational Studies checklist for observational studies.
Results: 1734 titles were perused after which 49 abstracts were obtained. Thirty-four were excluded for various reasons and 16 full articles were obtained. Duplicates were removed leaving nine articles for inclusion in the review. Three articles were obtained from the reference lists of the included studies bringing the total studies for possible review to twelve. The level of evidence for studies was good for three studies, fair for seven and poor for two. Two studies were excluded because of poor ranking on the hierarchy of evidence resulting in a sample size of ten. The included studies focussed on the health, social and empowerment domains of the CBR matrix and only a few elements covered livelihoods. Forty-four elements were identified for evaluation of CBR with twenty-five elements evaluating the system under four subheadings namely Policy, Service delivery, Community participation and Management.
Conclusion(s):
There still is a paucity of literature on CBR evaluation with qualitative methods being predominantly used. The quality of CBR literature is generally fair. Twenty five system evaluation elements were identified focussing on health, empowerment and social domains of the CBR matrix.
Implications: There is need to validate the identified system elements through further research and also expand CBR services to include the education and livelihood domains of the CBR matrix so programmes are more holistic.
Funding acknowledgements: No funding was obtained for this systematic review.
Topic: Disability & rehabilitation
Ethics approval: Exemption obtained from University of the Witwatersrand Human Research and Ethics Board (Medical) on 16/10/15 reference W-CJ-151016-1.
All authors, affiliations and abstracts have been published as submitted.
