International stakeholder consultation on models of rehabilitation service delivery to foster healthy ageing: results of a cross-sectional survey involving 124 countries and all World Health Organization regions.

Abstract

Background: Rehabilitation is an essential service for healthy ageing. Scoping reviews have described how rehabilitation is delivered to older people, however, their evidence is overwhelmingly derived from research published in high-income countries (HICs).

Aim: To a) assess whether descriptions of rehabilitation service delivery models derived from the literature reflect real-world practice, and b) gather knowledge about the use of different rehabilitation service delivery models in different settings and countries, including availability and implementation status.

Design: Observational study.

Setting: International online survey conducted in eight languages.

Population: Healthcare workers involved in the provision of rehabilitation for people over 60.

Methods: A 33-question questionnaire on the characteristics of rehabilitation service delivery models, their availability and implementation in different regions of the world was distributed globally using a three-layer stakeholder mapping approach. The CHERRIES checklist guided the reporting.

Results: The survey was completed by 1285 highly experienced health workers from 124 countries, representing all income levels and all WHO regions. The availability and implementation status of rehabilitation delivery models (inpatient, outpatient, telerehabilitation, home, community, and eldercare) was lower in low- and middle-income countries (LMICs) than in HICs, but none of the models was fully available or implemented nationwide in any region or income level. Physiotherapists, occupational therapists, speech-language therapists, nurses, and rehabilitation physicians are the most common healthcare workers providing rehabilitation in all models and regions. Rehabilitation is often fragmented and multidisciplinary teams are often only available in the inpatient model. Assistive technology is almost always provided in HICs, but only half the time in LMICs, while environmental adaptations are not fully reimbursed by any health system and are not prescribed in some regions.

Conclusions: Our findings validate and complement previous reviews by incorporating insights from healthcare workers with real-world experience across income levels and regions. Older people in LMICs have less access to quality rehabilitation services than those in HICs. Globally, rehabilitation services are partially responsive and adequate for supporting healthy ageing.

Clinical rehabilitation impact: Rehabilitation stakeholders and policymakers can use this study to (re)design services to better support healthy ageing.