Upscaling is impossible until we actually get EXACT STROKE PROTOCOLS LEADING TO 100% RECOVERY. Anything else is just accepting the tyranny of low expectations. If you 'professionals' don't understand that get the hell out and let survivors run things.
What would ‘upscaling’ involve? A qualitative study of international variation in stroke rehabilitation
BMC Health Services Research volume 21, Article number: 399 (2021)
Abstract
Background
Demand for stroke rehabilitation is expected to grow dramatically; with the estimated prevalence of stroke survivors rising to 70 million worldwide by 2030. The World Health Organization’s (WHO) report - Rehabilitation 2030: A call for action – has introduced the objective of ‘upscaling’ rehabilitation globally to meet demand. This research explored what upscaling stroke rehabilitation might mean for health professionals from countries at different stages of economic development.
Methods
Qualitative descriptive study design using semi-structured interviews was employed. Purposively sampled, clinical leaders in stroke rehabilitation were recruited for interviews from low through to high-income countries.
Results
Twelve rehabilitation professionals (medicine, physical therapy, occupational therapy, and speech and language therapy) from high (United States of America, Germany, United Kingdom, United Arab Emirates, New Zealand), upper-middle (Colombia and Turkey), lower-middle (Vietnam, Pakistan, Ghana), and low-income countries (Nepal and Sierra Leone) were interviewed. Upscaling was seen as a necessity. Successful scaling up will require initiatives addressing: political governance and managerial leadership, increasing knowledge and awareness of the value of rehabilitation, financial support, workforce developments, physical space and infrastructure, and the development of community services and reintegration.
Conclusion
Although there have been many gains within the development of stroke rehabilitation internationally, further investment is required to ensure that this patient population group continues to receive the best quality services. For the WHO to be successful in implementing their objective to upscale rehabilitation, specific attention will need to be paid to political, professional, economic, and sociocultural issues at global and local levels.
Background
Disability caused by diseases and injuries is a growing challenge, especially in low and middle-income countries (LMIC). Between 1990 and 2010, the total global years lived with disability (YLD) from all causes increased from 583 million to 777 million, largely due to population growth and aging [1]. In 2015, the Global Burden of Disease Study identified that 74% of the total number of YLDs in the world arose from health conditions that would benefit from rehabilitation [2]. As a result of raised awareness for the growing international need for rehabilitation, in 2017 the World Health Organization launched Rehabilitation 2030 - “a call for action to scale up rehabilitation so that countries can be prepared to address the evolving needs of populations up to 2030.” ([3], p.12) What might be required to scale up rehabilitation successfully will differ, however, between countries depending on each country’s economic, political, cultural, and social context. Few data are available about clinician views of what upscaling rehabilitation means for them and the nature of upscaling they think is needed within the services they currently provide.
The main aim of this preliminary qualitative study was to investigate the views and experiences of experts in stroke rehabilitation from 12 different countries regarding what upscaling rehabilitation might mean in their local context. Qualitative research is important for international health strategies such as Rehabilitation 2030 as it “helps policy-makers and program managers to make decisions about how to adapt a given WHO guideline and how to prioritize specific recommendations for implementation.” ([4], p.79) We chose to focus on stroke rehabilitation, as stroke is the second leading cause of death and the third leading cause of disability worldwide [5].
Our research team chose to interview clinicians working on the front line of stroke rehabilitation. The insights from this group may be of interest to other clinicians in similar contexts, and usefully add to the views of others (such as policy-makers and program managers) to provide a picture of what may be required when ‘upscaling’ services.
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