Service guidelines, models, and protocols for integrating rehabilitation services in primary healthcare in Brazil, Russia, India, China, and South Africa: a scoping review.
Lebogang Maseko, Hellen Myezwa, Natalie Benjamin-Damons and 2 others
PMID 38069782WHAT IT FOUND
Rehabilitation is rarely integrated into primary care in BRICS countries.
Most models rely on community health workers, often without proper supervision by therapists. This limits access and quality, particularly for speech and physical therapy services in remote areas.
Key findings
01The review found no Level I research among the included records, with most evidence classified as expert opinion or low-level studies.
02Community-based rehabilitation models frequently use community health workers to deliver services, but these workers often lack supervision from qualified rehabilitation professionals.
03Service guidelines in several countries exclude rehabilitation professionals from training and supervising community health workers, undermining interdisciplinary care.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review included only English-language publications, potentially missing relevant guidelines from countries where English is not the primary language of publication. Most included records were low-level evidence, such as expert opinions or case studies, limiting the strength of conclusions about what works. The review did not critically appraise the quality of the included records, as is typical for scoping reviews.
Declared interests
One author was supported by the Consortium for Advanced Research Training in Africa (CARTA), funded by the Carnegie Corporation, Sida, and Wellcome Trust. No commercial conflicts related to the interventions were reported.
The easy way to misread this
Do not interpret the prevalence of community-based rehabilitation models as evidence that community health workers can independently deliver complex rehabilitation. The review found that these models often lack proper supervision by qualified therapists, which may reduce the effectiveness of care.