2013-2014Conducted by: Rune Nilsen (CPO), Pia Nolstedt (CPO, MSc), Thomas Glott (MD)

Rehabilitation Science Organisation (ReSciO)

Peer group training

among people with a spinal cord injury in Cambodia

A pilot project

Disability in the world

• More than one billion people

• 80% in low income countries

• Poor

• The largest humanitarian crisis in the world

• No coordinated aid

Cambodia Population 15 million

Old culture

40 years of conflict

Khmer Rouge 1975-79

Killed all educated people

2 generations without proper education

Breakdown of society, education, health, politics trade.

Many very poor people

People with disabilities experience

social discrimination and stigma

Spinal cord injury rehabilitation center in Battambang

Built 1993 by HI Handed over to

government in 2008 Center about to be

closed 2009

- We established Rehabilitation Science Organisation (ReSciO) in 2009. (Brønnøysund Register).

ReSciO is a non-governmental organization with the aim to promote, organize and support cross-cultural international projects in the area of rehabilitation science.

Project background

- Quality of life study in Cambodia and Norway 2010 (WHOQOL-Bref)

- Nutritional study in 2011 Battambang

- Report on pressure ulcers in Battambang 2011

- Qualitative study of the life situation among people with spinal cord injuries in Cambodia 2012

-Continued QOL study -2014

WHOQOL-Bref results 2010

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Para Cambodia Control Cambodia Para Norway Control Norway

Physical health

Psychological

Social relationships

Environment

Project backgroundfrom the villages

Project background

• Results from previous studies suggested a peer group training project could address important issues.

• Previous studies also decided topics in the training

Peer group training project

A six month pilot project 3 men and 3 women Battambang province 3 meetings, each

meeting lasted for 2 days, (27-28 November 2013, 5-6 January 2014, 5-6 Mars 2014).

3 topics

Peer group training project topics

1. Health: prevention and treatment of pressure ulcers, bladder and bowel management.

2. Mobility: transfer techniques in wheelchair; using ramps and stairs; physical activities.

3. Social activities: going to a local market, buy food, cooking and games.

Peer group training projectFirst meeting

Medical examination Mobility practice and

tests Health related

information and discussion

WHOQOL-Bref questionnaire

Social activities

Second meeting

• Mobility practice and test

• Health related information and discussion

• Social activities

Third meeting

• Mobility tests

• Medical examination

• WHOQOL-Bref questionnaire

• Social activities

Topic: Health

1. Physical examination by a medical doctor at 1st and 3rd meeting

2. Discussion and information about pressure ulcers and bladder management.

3. WHOQOL-Bref questionnaire

HealthPhysical examination

Common finding: Pressure ulcers Contractures Pain Spasticity Bladder and bowel

problems.

HealthPhysical examination

Example of referral made by the medical doctor:

- severe headache and depression

- surgery of the pressure ulcer is needed

- ultrasonography exam to check urine residue and infections,

Results: Comparison between the 1st and 2nd medical examination:

- The conditions was the same, no improvements at all. Suggested treatment and referral was not completed.

- Reason: poor financial and transport possibilities among the participants.

Health Discussion and information

All three meeting included session with discussion and information about prevention and treatment of pressure ulcers, bladder and bowel management.

Learned about: Causes, consequences, treatment, and prevention.

And the important of adequate bladder and bowel management, how to do it, hygiene, Intermittent catheter.

Results: increased awareness among the participants about pressure ulcers and bladder and bowel management.

HealthWHOQOL-Bref

WHOQOL-Bref, 4 domains: Physical health Psychological Social relationships Environment The four domain scores perception of quality of life in each

particular domain.

Establishing a baseline score, and then after interventions,

Looking at changes in quality of life over the course of interventions.

Mobility

Eight mobility tasks: Three wheels on smooth floor(100 m)

Two wheels on smooth floor ( 30 m )

Two wheels descending the ramp (5 m)

Three wheels on rough ground (10 m)

Descending one step

Transfer from wheelchair to chair

Transfer from wheelchair to toilet

Transfer from wheelchair to floor

Mobility results

Almost everyone improved their performance in all eight tasks between the first and third meeting.

Main reason for not completing a task was fear.

One participant had severe spasticity and was not able to perform all tasks.

Social activities

Transportation to a local market

Cooking Games Not easy to measure the

effect of those activities, but they were considered important, as previous studies showed an increased amount of depression and social isolation among this group of people.

Challenges

Project management from Norway

Teach the local team about the importance of accurate data collection

Misunderstandings and cultural differences

Going to the market

Challenges

• Only one intervention at a time would make it easier to evaluate results

Continuation of the project

Phase 2. Evaluate the pilot project in detail, adjust and optimize.

We will do it one more time in 2015.

Need to assure that the activities are adapted to the individual capacity of the participants to avoid fear.

Questions?