Disability and rehabilitation
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Community-based rehabilitation (CBR) must prove that it is making a significant difference for people with disabilities in low- and middle-income countries. Yet, evaluation is not a common practice and the evidence for its effectiveness is fragmented and largely insufficient. The objective of this article was to review the literature on best practices in program evaluation in CBR in relation to the evaluative process, the frameworks, and the methods of data collection. ⋯ In order to facilitate and improve evaluations in CBR, there is an urgent need to agree on a common framework, such as the CBR matrix, and to develop best practice guidelines based on the literature available and consensus among a group of experts. These will need to demonstrate a good balance between community development and standards for effective evaluations. Implications for Rehabilitation In the quest for evidence of the effectiveness of community-based rehabilitation (CBR), a shared program evaluation framework would better enable the combination of findings from different studies. The evaluation of CBR programs should always include sharing findings and taking action for the sake of the local community. Although qualitative methodologies have dominated the scene in CBR and remain highly relevant, there is also a call for the inclusion of quantitative indicators in order to capture the progress made by people participating in CBR programs. The production of best practice guidelines for evaluation in CBR could foster accountable and empowering program evaluations that are congruent with the principles at the heart of CBR and the standards for effective evaluations.
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Community-based rehabilitation (CBR) must prove that it is making a significant difference for people with disabilities in low- and middle-income countries. Yet, evaluation is not a common practice and the evidence for its effectiveness is fragmented and largely insufficient. The objective of this article was to review the literature on best practices in program evaluation in CBR in relation to the evaluative process, the frameworks, and the methods of data collection. ⋯ In order to facilitate and improve evaluations in CBR, there is an urgent need to agree on a common framework, such as the CBR matrix, and to develop best practice guidelines based on the literature available and consensus among a group of experts. These will need to demonstrate a good balance between community development and standards for effective evaluations. Implications for Rehabilitation In the quest for evidence of the effectiveness of community-based rehabilitation (CBR), a shared program evaluation framework would better enable the combination of findings from different studies. The evaluation of CBR programs should always include sharing findings and taking action for the sake of the local community. Although qualitative methodologies have dominated the scene in CBR and remain highly relevant, there is also a call for the inclusion of quantitative indicators in order to capture the progress made by people participating in CBR programs. The production of best practice guidelines for evaluation in CBR could foster accountable and empowering program evaluations that are congruent with the principles at the heart of CBR and the standards for effective evaluations.
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To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. ⋯ This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults. Implications for Rehabilitation Pain is a common and pervasive problem in community dwelling older adults and can affect an individual's mobility, levels of physical activity and increase their falls risk. Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review. This review provides provisional evidence that pain may increase older adult's risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy. In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.
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To review and summarise the prevalence of chronic back pain (CBP), chronic low back pain (CLBP) and chronic musculoskeletal pain (CMSKP) in people with spinal cord injury (SCI) and evaluate how pain is assessed. ⋯ The main finding is that the prevalence of CMSKP, and more particularly CBP and CLBP are not sufficiently reported in SCI literature. Implications for Rehabilitation There is sufficient evidence, though modest in quality and quantity, to indicate that chronic musculoskeletal pain (CMSKP), back pain (CBP) and low back pain (CLBP) are common in people with spinal cord injury (SCI). This deserves consideration by health professionals treating such patients. Pain assessment, including BP and LBP, for people with SCI should become part of the overall clinical assessment and it is preferable that standardised pain assessment tools are used. Where people with SCI suffer from CMSKP, and particularly CBP and CLBP, further consideration should be made, likely to include posture, strengthening and seating as is referral for pain medication.
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People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. ⋯ For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research. Implications for Rehabilitation People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement. For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce. Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.