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Community-Based Rehabilitation for People with Disabilities in Low- And Valentina Iemmi Lorna Gibson Community-based rehabilitation Karl Blanchet for people with disabilities in low- K Suresh Kumar and middle-income countries Santosh Rath Sally Hartley A systematic review Gudlavalleti VS Murthy Vikram Patel September 2015 Joerg Weber et al. Systematic Health Review 18 About 3ie The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, for whom, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people’s lives. 3ie systematic reviews 3ie systematic reviews appraise and synthesise the available high-quality evidence on the effectiveness of social and economic development interventions in low- and middle- income countries. These reviews follow scientifically recognised review methods, and are peer- reviewed and quality assured according to internationally accepted standards. 3ie is providing leadership in demonstrating rigorous and innovative review methodologies, such as using theory-based approaches suited to inform policy and programming in the dynamic contexts and challenges of low- and middle-income countries. About this review Community-based rehabilitation for people with disabilities in low- and middle-income countries: a systematic review, was submitted in partial fulfilment of the requirements of grant SR3.1143 issued under Systematic Review Window 3. 3ie is publishing this report as received from the authors; it has been formatted to 3ie style. This review is available on the 3ie website. This review has also been published in the Campbell Collaboration Library and is available http://www.campbellcollaboration.org/lib/project/244/. 3ie has published a summary report of this review, designed for use by decision-makers, which is available here. All content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors are also the sole responsibility of the authors. Comments or queries should be directed to the corresponding author, Valentina Iemmi, [email protected] Major funding for this systematic review was provided by UK aid, the Bill & Melinda Gates Foundation and the Hewlett Foundation. A complete listing of all of 3ie’s donors can be found on the 3ie website. Suggested citation: Iemmi, V, Gibson, L, Blanchet, K, Kumar, KS, Rath, S, Hartley, S, Murthy, GVS, Patel, V, Weber, J and Kuper H, 2015, Community based rehabilitation for people with disabilities in low- and middle-income countries: a systematic review, 3ie Systematic Review 18. London: International Initiative for Impact Evaluation (3ie). 3ie systematic review executive editors: Philip Davies and Beryl Leach Managing editor: Deepthy Menon Technical editor: Hugh Waddington Production manager: Pradeep Singh Cover design: John F McGill and Akarsh Gupta © International Initiative for Impact Evaluation (3ie), 2015, 2016 Community-based rehabilitation for people with disabilities in low- and middle-income countries: a systematic review Valentina Iemmi International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine (LSHTM) Health and Social Care, London School of Economics and Political Science Lorna Gibson LSHTM Karl Blanchet International Centre for Eye Health, LSHTM K Suresh Kumar LSHTM Santosh Rath International Centre for Evidence in Disability, LSHTM The George Institute for Global Health, University of Oxford Sally Hartley International Centre for Evidence in Disability, LSHTM Gudlavalleti VS Murthy Indian Institute of Public Health Vikram Patel Centre for Global Mental Health, LSHTM Joerg Weber International Centre for Evidence in Disability, LSHTM Hannah Kuper International Centre for Evidence in Disability, LSHTM 3ie Systematic Review 18 September 2015 Plain Language Summary Community-based rehabilitation for people with disabilities in low- and middle-income countries: a systematic review. Review question We reviewed the evidence about the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. Background People with disabilities include those who have long-term physical, mental, intellectual or sensory impairments, which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. There are estimated to be over one billion people with disabilities globally and 80% of them live in low- and middle- income countries. They are often excluded from education, health, and employment and other aspects of society leading to an increased risk of poverty. Community-based rehabilitation interventions are the strategy endorsed by the World Health Organization and other international organisations (e.g. ILO, IDDC) for addressing the needs of this group of people in low- and middle-income countries. These interventions aim to enhance the quality of life of people with disabilities and their carers, by trying to meet their basic needs and ensuring inclusion and participation using predominantly local resources. These interventions are composed of up to five components: health, education, livelihood, social and empowerment. Currently only few people who need them benefit from these interventions, and so it is important to assess the available evidence to identify how to best implement these programmes. Study characteristics The evidence in this review is current to July 2012. This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical (stroke, arthritis, chronic obstructive pulmonary disease) and mental disabilities (schizophrenia, dementia, intellectual impairment). Key results Overall, randomised controlled trials suggested a beneficial effect of community-based rehabilitation interventions in the lives of people with physical disabilities (stroke and chronic obstructive pulmonary disease). Similar results were found for non-randomised studies for physical disabilities (stroke and arthritis) with the exception of one non-randomised study on stroke showing community-based rehabilitation was less favourable than hospital-based rehabilitation. Overall, randomised controlled trials suggested a modest beneficial effect of community-based rehabilitation interventions for people with mental disabilities (schizophrenia, dementia, intellectual impairment), and for their carers (dementia). Similar results were found for non-randomised studies for mental disabilities (schizophrenia). However, the methodological constraints of many of these studies limit the strength of our results. In order to build stronger evidence, future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations. i Réadaptation à base communautaire pour les personnes handicapées dans les pays à faible revenu et revenu moyen: une revue systématique Ojectif Nous avions conduit une revue systématique sur l'impact de la réadaptation à base communautaire sur la vie des personnes handicapées et de leurs familles dans les pays à faible revenu et revenu moyen. Contexte Les personnes handicapées sont des personnes qui ont des déficiences physiques, mentales, intellectuelles ou sensorielles à long terme, dont leur environnement peut constituer un obstacle à leur pleine et effective participation dans la société. On estime que plus d’un milliard de la population mondiale présente un handicap, dont 80% vivant dans des pays à faible revenu et revenu moyen. Les personnes handicapées sont souvent exclues du système éducatif, de la santé, de l'emploi et d'autres aspects de la société, conduisant à un risque d’appauvrissement accru. La réadaptation à base communautaire est une stratégie approuvée par l'Organisation Mondiale de la Santé et d'autres organisations internationales (telles que OIT, IDDC) pour répondre aux besoins des personnes handicapées et de leurs familles dans les pays à faible revenu et à revenu moyen. Ces interventions visent à améliorer la qualité de vie des personnes handicapées et de leurs familles, satisfaire leurs besoins de base et favoriser l'inclusion et la participation, principalement par l'utilisation de ressources locales. Ces interventions sont composées de cinq composantes: santé, éducation, moyens de subsistance, social et autonomisation. Actuellement, dans les pays a faible revenu et revenu moyen, seulement une faible proportion des personnes qui pourraient bénéficier de la réadaptation à base communautaire ont accès a ces interventions, et il est donc important d'évaluer la littérature disponible pour identifier comment mettre en œuvre au mieux ces programmes. Characteristiques des éudes Les études de cette révue systématique arrivent jusqu’à Juillet 2012. Cette revue systématique a identifié 15 études qui ont évalué l'impact de la réadaptation à base communautaire sur la vie des personnes handicapées et de leurs familles dans les pays à faible revenu et revenu moyen. Les études inclues dans la revue systématique utilisent différents types d'interventions de réadaptation à base communautaire
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