Parallel session: Package of rehabilitation interventions
Transcript of Parallel session: Package of rehabilitation interventions
Development of the Package of Rehabilitation
InterventionsBackground, methods, current state of the development, and future implementation
Dr Alexandra Rauch, MPH
Universal Health Coverage (UHC)
“All people receiving quality health services
that meet their needs without being exposed to financial hardship in
paying for the services. It includes the full spectrum of essential, quality health services,
from health promotion to prevention, treatment, rehabilitation, and palliative care.”
Background
Background
Reha-bilitation
UHC
Rehabilitation Category Persons YLDs Average DW
All Rehabilitation 2,366,148,316 316,610,171 0.13
Musculoskeletal disorders 1,596,649,206 140,965,008 0.09
Neurological disorders 296,277,078 70,010,964 0.24
Sensory impairments 649,151,912 48,921,965 0.08
Mental disorders 181,442,646 37,424,682 0.21
Chronic respiratory diseases 155,073,573 30,475,420 0.20
Cardiovascular diseases 42,787,394 7,206,280 0.17
Neoplasms 14,383,164 1,729,380 0.12
A call for action
Objective
To develop a Package of Rehabilitation Interventions that support ministries of
health in planning, budgeting and integrating rehabilitation interventions
into health systems
Universal Health Coverage (UHC)
“All people receiving quality health services
that meet their needs without being exposed to financial hardship in
paying for the services. It includes the full spectrum of essential, quality health services,
from health promotion to prevention, treatment, rehabilitation, and palliative care.”
Methods
Methods
„All people“
People with health conditions experiencing limitations in functioning- At all ages- Along the continuum of care
Rehabilitation
Rehabilitation is a set of interventions designed to optimize functioning and
reduce disability in individuals with health
conditions in interaction with their environment.
Rehabilitation thus maximizes people’s ability
to live, work and learn to their best potential.
Universal Health Coverage (UHC)
“All people receiving quality health services
that meet their needs without being exposed to financial hardship in
paying for the services. It includes the full spectrum of essential, quality health services,
from health promotion to prevention, treatment, rehabilitation, and palliative care.”
Methods
Costs associated with the provision of rehabilitation interventions
Assistive products and consumables
Workforce
Equipment
Universal Health Coverage (UHC)
“All people receiving quality health services
that meet their needs without being exposed to financial hardship in
paying for the services. It includes the full spectrum of essential, quality health services,
from health promotion to prevention, treatment, rehabilitation, and palliative care.”
Methods
The PRI will provide information on
•available effective interventions for rehabilitation•costs associated with the provision of these interventions
Information on required competencies of the workforce will be supplemented from the Rehabilitation Competency Framework
Methods
Methods
Stakeholder involvement Rehabilitation professional organizations, rehabilitation associationsProject partner Cochrane RehabilitationAdvisory board Different WHO departments, including WHO‘s Guideline Review committee Secretariat
Overall Guidance: WHO advisory board
Guidance of development: WHO rehabilitation programme
8. Production of the
Final version of the PRI
7. Testing and
adaptation of the Alpha Version of the
PRI
WHO RP External
Part
II:Te
stin
gan
d p
rodu
c-tio
nof
the
PRI
9. Awareness raising
for the PRI
10. Launch of the PRI
11. Integration of PRI
into OneHealth tool
WHO RP WHO RP
Part
III:
Dis
sem
inat
ion
of
th
ePR
I
WHO RP/UHC
WHO RP TWG DG DG
Part
I:D
evel
opm
ento
f the
cont
ento
f the
PRI 1.
Selection of health
conditions
2. Identification of evidence-based
rehabilitation interventions
4.Description of
resource requirements for
interventions
5. External Peer
Review
3. Confirmation of interventions/Assignment to service delivery
platforms
6. Production of Alpha Version of the PRI
PRG WHO RP
Overall Guidance: WHO advisory board
Guidance of development: WHO rehabilitation programme
WHO RP TWG DG DG
Part
I:D
evel
opm
ento
f the
cont
ento
f the
PRI 1.
Selection of health
conditions
2. Identification of evidence-based
rehabilitation interventions
4.Description of
resource requirements for
interventions
5. External Peer
Review
3. Confirmation of interventions/Assignment to service delivery
platforms
6. Production of Alpha Version of the PRI
PRG WHO RP
1. Selection of health conditions
To identify health conditions to be included in the first version of the PRI
Criteria for identification•Prevalence rates•Associated level of disability (disability weights)•Expert opinionMethods•Analysis of GBD 2016•Consultation of rehabilitation experts
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Rehabilitation Category Persons YLDs Average DW
Musculoskeletal disorders 1,596,649,206 140,965,008 0.09
Low back pain 575,560,947 64,785,307 0.11
Neck pain 287,109,635 28,469,923 0.10
Fractures 357,204,836 19,611,156 0.05
Other injuries 317,569,217 10,684,469 0.03
Osteoarthritis 181,581,277 9,566,110 0.05
Amputation 133,454,674 5,232,123 0.04
Rheumatoid arthritis 14,436,135 2,615,920 0.18
1. Selection of health conditions
Rehabilitation Category Prevalence YLDs Average DW
Neurological disorders 296,277,078 70,010,964 0.24
Cerebral palsy 92,356,555 29,561,352 0.32
Stroke 88,327,005 18,568,783 0.21
Traumatic brain injury 46,685,325 6,870,105 0.15
Alzheimer’s disease and dementia 45,364,775 6,653,970 0.15
Spinal cord injury 22,398,755 6,607,914 0.30
Parkinson’s disease 8,477,957 1,212,054 0.14
Multiple sclerosis 1,353,722 456,063 0.34
Motor-neuron disease 227,158 50,078 0.22
Guillain-Barré syndrome 103,478 30,644 0.30
1. Selection of health conditions
Rehabilitation Category Prevalence YLDs Average DW
Cardiovascular diseases 42,787,394 7,206,280 0.17Acute myocardial infarction 564,620 52,522 0.09
Heart failure 42,237,091 7,153,759 0.17
Chronic respiratory diseases 155,073,573 30,475,420 0.20Neoplasms 14,383,164 1,729,380 0.12Mental disorders 181,442,646 37,424,682 0.21
Schizophrenia 19,672,459 12,590,347 0.64
Developmental intellectual disability 143,325,200 22,424,453 0.16
Autism spectrum disorders 31,076,539 4,715,544 0.15
Sensory impairments 649,151,912 48,921,965 0.08Hearing loss 346,028,683 24,935,555 0.07
Vision loss 349,134,734 23,986,410 0.07
1. Selection of health conditions
2. Identification of evidence-based rehabilitation interventions
To identify interventions and related evidence from high-quality clinical practice guidelines
Technical Working Groups•Systematic literature searches for rehabilitation guidelines•Criteria for the selection of guidelines High quality of the guidelinePublication date < 10 yearsComprehensivenessMulti-professionalism of the guideline
List of identified
interventions
3. Confirmation of interventions to be included in the PRI
To achieve consensus on interventions to be included in the PRI
Development Groups•Consensus finding process on interventions to be included in the PRIElectronical surveyWeb-conferences
List of
interventions for
PRI
4. Description of required resources for included interventionsTo select Assistive products, equipment and consumables reqiured for the provision of interventions
Assistive products
Equipment
Consumables
List of
interventions for
PRI
Current state
2. Work of TWG in process
2. Data on interventions submitted to WHO
3. Interventions agreed by DG
4. Resources described for selected interventions
5. External peer review process finalized
Menu’ of UHC health interventions•What it is: A comprehensive list of interventions, together with information for each intervention in a standardized format regarding beneficiary groups, effectiveness and resource implications.•Intended audience: Country level planners, who are engaged in discussions around which health services to provide and through which platforms. •To facilitate: Inclusive country discussions around what interventions and services to provide, who will/should benefit, and what the resource and cost implications would be for different service packages.
→The UHC menu will be a global public good that country level actors can draw upon for participatory prioritization and planning.
Future implementation
Health conditions (ICD 11)
ME.
84.2
Z
FB32
.Y
t.b.d
8B11
ND
51.2
8D2Z
CA2
2.Z
2C6Z
BA6Z
Outcome (ICF) ICHI Procedures and Activities Low
bac
k pa
in
Sarc
open
ia
Ampu
tatio
n
Stro
keSp
inal
Cor
d in
jury
Cer
ebra
l pal
sy
Chr
onic
obst
ruct
ive
pulm
onra
ydi
seas
e
Brea
stca
ncer
Isch
emic
hear
tdi
seas
e
Movement functionsb710 Mobility of joint functions MTB.PG.EC Active/passive movement exercises X X X X X X X X
MTB.PG.ED Stretching X X X X X X X XUA1.RD.ZZ Provision of orthosis/braces/splints X X X
b730 Muscle power functions MUB.SC.ZZ Electrical stimulation X X X XMUB.AE.ZZ Strength training X X X X X X X X XMUB.PG.EA Mechanically assisted movement
trainingX X X
b735 Muscle tone functions MUC.DB.?? Drug treatment X X X XMUC.LC.?? Positioning X X X X XMUC.SC.ZZ Vibration therapy X X X
b770 Gait pattern functions MVG.PH.ZZ Task oriented training X X X X X X XMVG.PG.ZZ Auditory cueing X X
d450 Walking SJA.??.?? Mechanically assisted movementtraining
X X X X
SJA.??.?? Virtual reality training X X X XHT2.PH.ZZ Cardiorespiratory training X X X X X X X X X
Access to information on interventions and their evidence: Two entry points (Example)
Search forinterventionsrelated to aspectsof functioning
Search forinterventions related
to a specific healthcondition
Future users and use• Ministries of Health will be able to plan and budget
the integration of rehabilitation interventions in their national health services;
• Researchers will be able to identify rehabilitation research gaps and define a research agenda accordingly
• Academics will be able to develop curricula for the training of rehabilitation professionals;
• Service providers will be able to plan and implement rehabilitation interventions in their rehabilitation programmes.