Home-based rehabilitation interventions for adults living with HIV: a scoping review

Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings; where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed; involving systematic search techniques and appraisal of appropriate evidence. eng-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases; six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV; the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures; including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular; more research on HBR is required in resource-poor environments; such as sub-Saharan Africa where HIV is endemic; to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most

Inclusion of vulnerable groups in health policies: regional policies on health priorities in Africa

Background: If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. Objectives: This paper reports on an analysis of 11 African Union policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. Method: The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. Results: The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for 'universal'. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. Conclusion: The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all

Stakeholder consultations on community-based rehabilitation guidelines in Ghana and Uganda

Background: The focus of this paper is the new broadened conceptualisation of community-based rehabilitation (CBR); which promotes the empowerment and inclusion of people with disabilities (PWDs) in diverse ways within their communities. New guidelines for CBR were launched in October 2010 by WHO/ILO/UNESCO/IDDC; and this paper describes part of the process by which these were produced using participatory approaches involving International Non-Government Organisations (INGOs) and local partners. The paper reviews the evolution of CBR and describes how grassroots consultation by INGOs working with key stakeholders in the disability arena can influence policy on disability issues; and reciprocally how policy change can inform organisations' practice and research activities. This ongoing bidirectional influence is illustrated with data from the participatory consultation process about the new CBR guidelines carried out by Sightsavers in Uganda and Ghana. Objectives: To consult with key stakeholders in the disability arena in Uganda and Ghana; in order to gain their opinions and suggestions for improvements to the then draft CBR guidelines; as part of a wider global participatory process of consultation on the document. Methods: The INGO Sightsavers gathered qualitative data through focus group discussions and questionnaires in both countries. Results: The participants' critiques of the draft guidelines carried out in multiagency participatory processes were analysed thematically and fed back to the CBR guidelines editorial team. Conclusion: The paper concludes that stakeholders in diverse communities can actively contribute to shaping policy and practice through participatory consultations. Local and national government and non-government organisations and other key informants can inform the development of national and international guidelines and policies. This participatory approach can be successfully facilitated by INGOs. In turn; these processes have prompted organisations to adapt their own policies and programmes in order to be more responsive to the local needs and concerns of PWDs

Frequency of Cognitive Impairment and Depression in Parkinson's Disease: A Preliminary Case-Control Study

Background: This study aimed to determine the frequency of cognitive impairment and depression in our Parkinson's Disease (PD) and their relationship with disease severity and disability. Patients and Methods: A total of 40 PD patients and 40 age-; sex-; and educationally matched controls were studied. The Unified Parkinson Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores and the Hoehn and Yahr (HY) stage were documented. Depression was assessed using the Zung Self-Rating Depression Scale (ZSDS); while cognition was evaluated using a composite score of the mini-mental state examination (MMSE) score and category fluency score. Results: A total of 55 (22/40) of PD and 10 (4 of 40) of controls had depression (P0.001). A total of 60 of PD (24/40) and 5 of controls (2/40) had cognitive impairment (P0.001). Both NMS coexisted in 16 of 40 PD (40) compared with none of the controls (P0.001). UPDRS (motor and ADL) scores and HY stage were significantly worse with impaired ZSDS scores - P 0.001. UPDRS ADL was significantly impaired by the presence of cognitive impairment. Coexisting depression and cognitive impairment were associated with significant worsening of all scores of severity and disability. Conclusion: Cognitive impairment and depression accompany our PD and are related to disability and worsening disease severity

Features of Integrated Professional Training for Physically Disabled People in a Community-Based Rehabilitation Programme in the Rural and Urban Areas of Congo

Background: The rehabilitation of physically disabled people has been explored from the perspectives of patients; health professionals; rehabilitation agencies; etc. However; no study has linked disability types; training programmes and career prospects. In this study; we therefore evaluated the professional integration of trained disabled people. Methods: This retrospective survey included all physically disabled people admitted to two rehabilitation centres in Congo between 1996 and 2005. Data collection used registers from two units; the medical unit and the rehabilitation unit; to obtain information on age; sex; disability type; follow-up training; present living activity and field of training. We defined `professional integration' as being when the current profession matched the training received at the rehabilitation centre. Results: The percentage of participants with integrated training was 96.8(95CI; 92.1-98.7). In the urban setting; 6.7(95CI; 2.6-16.1) of the trainees were not integrated; while all were integrated in the rural setting. Trainees aged between 16 and 25 years and those 51+ years represented 12.5(95CI; 4.9-28) and 50(95CI; 25.3-74.6) of the non-integrated cases respectively. Paralysis from poliomyelitis was the most common [62.9(95CI; 54.3-70.8)] disability; and the non-integrated participants included people with poliomyelitis [1.2(95CI; 0.2-6.7)]; general paralysis [10.5(95CI; 2.9-31.3)] and sight disorders [50(95CI; 9.4-90.5)]. Tailoring was the main field of training [57.4(95CI; 48.7-65.7)]; and high numbers of participants with non-integrated training worked in tailoring; shoe making; welding and computer repair. Conclusions: Despite a high rate of integration in Congo; professional training and subsequent integration would still benefit from a comprehensive approach that considers the type of disability; training and socio-demographic features. Further studies targeting alumni from the training programmes and their ongoing assessment are warranted

Evaluation de la qualite des soins en reeducation fonctionnelle (Cas du service de Medecine physique et de readaptation du CHU de Yopougon)

La prise en charge des patients dans un service public pose en general des problemes d'accueil; de traitement et de suivi. L'activite du service de Option : Medecine physique et de readaptation du CHU de Yopougon a ete analysee du 26 Juin 2000 au 31 Decembre 2000. L'etude s'est proposee d'apprecier l'efficacite de la prise en charge reeducative des patients; a partir des moyens reels du service. Nous avons suivi 136 patients adultes; tout sexe confondu pour divers motifs de consultations. Il ressort de cette etude que : *Les pathologies rencontrees etaient essentiellement chirurgicales d'origine traumatologique (54;4 pour cent) et interessaient l'appareil locomoteur dans 88;2 pour cent des cas avec une frequence de fracture dans 75;7 pour cent des cas; *Seulement 52;2 pour cent des patients ont mene a terme leur programme de reeducation; *97;2 pour cent des patients ayant suivi correctement la reeducation avaient beneficie d'une recuperation partielle ou totale sur le plan des deficiences et des incapacites; *80;3 pour cent des patients avaient atteint une autonomie partielle ou totale pour les activites de la vie quotidienne apres la prise en charge; *L'evolution etait stationnaire dans 2;8 pour cent des cas; *Il y a eu une absence de recidive et d'aggravation en ce qui concerne les deficiences et les incapacites; *70 pour cent des patients ont repris leur activite professionnelle sans amenagement de poste; *La majorite (70 pour cent) des patients a eu une bonne reprise de la vie affective et familiale. L'insuffisance de la qualite de la prise en charge est due: *a des locaux inadaptes; *aux materiels techniques insuffisants surannes et en etat de delabrement; *a un probleme d'organisation du service; *au manque de ressources humaines (personnel qualifie); *au bas niveau socio-economique des Patients