What is rehabilitation?
Rehabilitation is a set of interventions needed when a person is experiencing or is likely to experience limitations in everyday functioning due to ageing or a health condition, including chronic diseases or disorders, injuries or traumas. Examples of limitations in functioning include difficulties in thinking, seeing, hearing, communicating, moving around, having relationships or keeping a job. Rehabilitation enables individuals of all ages to maintain or return to their daily life activities, fulfil meaningful life roles and maximize their well-being.
Rehabilitation is a highly person-centred health strategy that may be delivered either through specialised rehabilitation programmes (commonly for people with complex needs), or integrated into other health programmes and services, for example, primary health care, mental health, vision and hearing programmes.
Some examples of rehabilitation include:
- Exercises to regain the ability to swallow or upper-limb retraining to regain coordination, dexterity and movement of an affected limb following a stroke.
- Interventions that improve safety and independence at home and reduce the risk of falls for an older person, such as balance training or modifying their home environment.
- Early interventions to address developmental outcomes of a child with cerebral palsy, such as fitting an orthosis, or providing training in sensory integration and self-care, which in turn can improve participation in education, play, and family and community activities.
- Interventions that optimize surgical outcomes after a hip fracture, including exercise prescription, provision of a walking aid and education about hip movements to avoid during the recovery process.
- Cognitive behavioural therapy and interventions aiming to increase exercise for an individual with depression.
- Interventions that support daily activities and community access for individuals with vision loss, such as providing strategies to complete personal care tasks and training in the use of a white cane.
There are a broad range of health professionals who provide rehabilitation interventions, including physiotherapists, occupational therapists, speech and language therapists, orthotic and prosthetic technicians, and physical medicine and rehabilitation physicians.
The benefits of rehabilitation
Rehabilitation can reduce the impact of a broad range of health conditions, including diseases (acute or chronic), disorders, injuries or trauma. It is a highly integrated form of health care that complements other health interventions, such as medical and surgical interventions, helping to achieve the best outcome possible. For example, rehabilitation can help to prevent complications associated with many health conditions, such as spinal cord injury, stroke, or a fracture. Rehabilitation can also help to minimize or slow down the disabling effects of chronic health conditions, such as cardiovascular disease, cancer and diabetes by equipping people with self-management strategies and the assistive products they require, or by addressing pain or other complications.
Rehabilitation is an investment, with cost benefits for both the individuals and society. It can help to avoid costly hospitalization, reduce hospital length of stay, and prevent re-admissions. Rehabilitation also enables individuals to participate in education and gainful employment, remain independent at home, and minimize the need for financial or caregiver support.
Rehabilitation is an important part of universal health coverage and is a key strategy for achieving Sustainable Development Goal 3 – “Ensure healthy lives and promote well-being for all at all ages”.
Misconceptions about rehabilitation
Rehabilitation is not a disability-specific service for those with long-term impairments. Nor is it a service only for people with physical impairments. Rather, rehabilitation is a core part of effective health care for anyone with a health condition, acute or chronic, impairment or injury that limits functioning, and as such should be available for anyone who needs it.
Rehabilitation is not only delivered in specialized rehabilitation settings, but can also be highly effective when integrated in wider health programmes.
Rehabilitation is not a luxury or optional health service for those who can afford it. Nor is it a fall-back strategy when preventive and curative interventions fail. For the full extent of the social, economic and health benefits of rehabilitation to be realized, timely and affordable rehabilitation interventions should be available to all. In many cases, this means commencing rehabilitation in the early phase of recognition of a health condition and continuing to deliver rehabilitation alongside other health interventions.
Unmet global need for rehabilitation
Current demographic and health trends are placing new demands on the health system, and as such the need for rehabilitation is rapidly growing. There is an increase in ageing populations, with the number of people over 60 years of age predicted to double by 2030. In addition, more people are living with noncommunicable diseases and the consequences of injuries. The prevalence of noncommunicable diseases alone has increased by 18% in the last 10 years. These health conditions often impact on an individual’s functioning and are associated with increased levels of disability.
A 2018 literature review found that there are significant unmet needs for rehabilitation across all world regions, and in some countries more than 50% of people who require rehabilitation services do not receive them. Several studies from Africa, for example, show that between 62.5% and 82.5% of those needing rehabilitation services don’t receive them (Mozambique 62.3%; Malawi 76.2%, Zambia 62.5%; and Lesotho 82.5%).
Today, the demand for rehabilitation is going largely unmet due to a number of factors, including:
- Lack of prioritization, funding, policies and plans for rehabilitation at a national level.
- Lack of available rehabilitation services outside urban areas, and long waiting times.
- High out-of-pocket expenses and non-existent or inadequate funding mechanisms.
- Lack of trained rehabilitation professionals, with less than 10 skilled practitioners per 1 million population in many low- and middle-income settings.
- Lack of resources, assistive technologies and devices.
- The need for more research and data on rehabilitation.
- Ineffective and under-utilized referral pathways to rehabilitation.
How can rehabilitation be better integrated in health systems?
In 2017, WHO launched the Rehabilitation 2030 initiative, which calls for concerted and coordinated global action by all stakeholders to scale up rehabilitation. In order to achieve this, 10 priority areas for action were identified to strengthen health systems to provide rehabilitation. These action areas are:
- Creating strong leadership and political support for rehabilitation at sub-national, national and global levels.
- Strengthening rehabilitation planning and implementation at national and sub-national levels, including within emergency preparedness and response.
- Improving integration of rehabilitation into the health sector and strengthening inter-sectoral links to effectively and efficiently meet population needs.
- Incorporating rehabilitation in universal health coverage.
- Building comprehensive rehabilitation service delivery models to progressively achieve equitable access to quality services, including assistive products, for all the population, including those in rural and remote areas.
- Developing a strong multidisciplinary rehabilitation workforce that is suitable for country context, and promoting rehabilitation concepts across all health workforce education.
- Expanding financing for rehabilitation through appropriate mechanisms.
- Collecting information relevant to rehabilitation to enhance health information systems including system level rehabilitation data and information on functioning utilizing the International Classification of Functioning, Disability and Health (ICF).
- Building research capacity and expanding the availability of robust evidence for rehabilitation.
- Establishing and strengthening networks and partnerships in rehabilitation, particularly between low-, middle- and high-income countries.