" Otherwise … he will be a beggar": a focus group study to understand the Perspectives of physiotherapists about measuring rehabilitation outcomes and impact in low-resource and conflict-affected settings

Cornelia Anne Barth; Maggie Donovan-Hall; Catherine Blake; Noor Jahan Akhtar; Saeda Al-Barawi; Herman Kazibwe; Cliona O'Sullivan

doi:10.1080/09638288.2023.2240706

" Otherwise … he will be a beggar": a focus group study to understand the Perspectives of physiotherapists about measuring rehabilitation outcomes and impact in low-resource and conflict-affected settings

Disabil Rehabil. 2023 Aug 1:1-12. doi: 10.1080/09638288.2023.2240706. Online ahead of print.

Authors

Cornelia Anne Barth^{1

2}, Maggie Donovan-Hall³, Catherine Blake¹, Noor Jahan Akhtar⁴, Saeda Al-Barawi⁵, Herman Kazibwe⁶, Cliona O'Sullivan¹

Affiliations

¹ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
² Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.
³ School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, UK.
⁴ Bangladesh Health Professions Institute, University of Dhaka, Dhaka, Bangladesh.
⁵ School of Public Health, Al-Quds University, Gaza, Palestine.
⁶ Institute of Computer Science, Mbarara University of Science & Technology, Mbarara, Uganda.

PMID: 37528712
DOI: 10.1080/09638288.2023.2240706

Abstract

Purpose: Rehabilitation outcomes are important for patients, professionals and policy makers. Most outcome measures (OMs) were developed for "Western" contexts and may be inadequate for low-resource and conflict settings, where the ability to demonstrate impact would be critical to strengthening the sector. This study aims to understand perspectives of physiotherapists from challenging environments regarding current practices, value, barriers, and facilitators of measuring rehabilitation outcomes.

Materials & methods: Focus group discussions were held in English with 35 physiotherapists from 18 countries. Audio recordings were transcribed verbatim, anonymised, and analysed using reflexive thematic analysis.

Results: Four themes emerged illustrating the levels at which outcomes and measures were discussed: User (patients, families), provider (physiotherapists, rehabilitation workers), application (OMs), and structure (management, health system). Participants discussed diversity in current practices and patient populations, utility of OMs and a neglected rehabilitation sector lacking investment. Barriers to progressing outcome measurement included lacking patient health literacy, rehabilitation provider training, valid OMs, and leadership. Participants suggested improved patient involvement, routine outcome measurement by using, developing, or adapting simple, context- and stakeholder-relevant OMs, and support from management.

Conclusions: These insights illustrate the need of and provide robust recommendations for context-adapted development of rehabilitation outcome measurement in various challenging contexts.

Keywords: Rehabilitation outcomes; conflict-affected; focus group; low-resource; outcome measures; physiotherapy; reflexive thematic analysis.

Plain language summary

Rehabilitation outcomes are important to show impact in low-resource and conflict settings, but most outcome measures originate from “Western” contextsExperience of physiotherapists from low-resource and conflict settings reveals the barriers and facilitators to measuring rehabilitation outcomes in their workplacesParticipants’ suggest to use or develop simple scales that are contextualised and stakeholder-relevant for standard, routine measurementThis study highlights the need to improve the measurement of rehabilitation outcomes in challenging contexts and provides guidance on how to do so.