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

Background

Objective

To develop a Package of Rehabilitation Interventions that support ministries of

health in planning, budgeting and integrating rehabilitation interventions

into health systems






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.






Methods

Costs associated with the provision of rehabilitation interventions

Assistive products and consumables

Workforce

Equipment






Methods

Evidence-based as one component of quality health services

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

18

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


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


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


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

5. External peer review

To review the draft version of the PRI

External peer reviewers

6. Development of the Alpha version

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

Implementation•Integration into „UHC menu“•Open source online tool

Future implementation

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.



Package of Rehabilitation Interventions

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.

Thank you!

Parallel session: Package of rehabilitation interventions

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Transcript of Parallel session: Package of rehabilitation interventions