Shayo Mathew J, Shayo Pendo, Haukila Kelvin F, Norman Katherine, Burke Colleen, Ngowi Kennedy, Goode Adam P, Allen Kelli D, Wonanji Vivian Timothy, Mmbaga Blandina T, Bettger Janet Prvu
Kilimanjaro Christian Medical Center, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Population Health Sciences, Duke University School of Medicine, Durham, United States.
Front Rehabil Sci. 2023 Jan 6;3:982175. doi: 10.3389/fresc.2022.982175. eCollection 2022.
Musculoskeletal (MSK) disorders such as low back pain and osteoarthritis are a leading cause of disability and the leading contributor to the need for rehabilitation services globally. This need has surpassed the availability of trained clinicians; even in urban areas where services and providers are thought to be more abundant, access can be challenged by transportation options and financial costs associated with travel, care and lost time from work. However, continuing standard of fully in-person rehabilitation care for MSK-associated pain and disability may no longer be necessary. With increased ownership or access to even a basic mobile phone device, and evidence for remote management by trained clinicians, some individuals with MSK disorders may be able to continue their rehabilitation regimen predominantly from home after initial evaluation in primary care or an outpatient clinic.
This manuscript describes application of a framework we used to culturally and contextually adapt an evidence-based approach for leveraging digital health technology using a mobile phone (mHealth) to expand access to rehabilitation services for MSK-associated pain and disability. We then conducted a multi-level analysis of policies related to the adapted approach for rehabilitation service delivery to identify opportunities to support sustainability.
Our study was conducted in Tanzania, a lower-middle income country with their first National Rehabilitation Strategic Plan released in 2021. Lessons learned can be applied even to countries with greater infrastructure or fewer barriers. The seven-step adaptation framework used can be applied in other regions to improve the likelihood of local mHealth adoption and implementation. Our practice and policy assessment for Tanzania can be applied in other regions and used collaboratively with government officials in support of building or implementing a national rehabilitation strategic plan.
The work described, lessons learned and components of the plan are generalizable globally and can improve access to rehabilitation services using mHealth to address the significant and increasing burden of disability.
肌肉骨骼（MSK）疾病，如腰痛和骨关节炎，是导致残疾的主要原因，也是全球康复服务需求的主要促成因素。这种需求已经超过了训练有素的临床医生的可提供量；即使在被认为服务和提供者更为丰富的城市地区，交通选择以及与出行、护理和误工相关的财务成本也可能对获得服务构成挑战。然而，对于与MSK相关的疼痛和残疾继续采用完全面对面的康复护理标准可能不再必要。随着个人拥有或能够使用哪怕是基本的移动电话设备，以及有证据表明经过培训的临床医生可以进行远程管理，一些患有MSK疾病的人在初级保健或门诊诊所进行初步评估后，可能能够主要在家中继续他们的康复方案。
本手稿描述了一个框架的应用，我们使用该框架在文化和背景方面对一种基于证据的方法进行调整，以利用移动电话数字健康技术（移动健康，mHealth）来扩大针对与MSK相关的疼痛和残疾的康复服务的可及性。然后，我们对与调整后的康复服务提供方法相关的政策进行了多层次分析，以确定支持可持续性的机会。
我们的研究在坦桑尼亚进行，该国是一个中低收入国家，于2021年发布了首个国家康复战略计划。所吸取的经验教训甚至可以应用于基础设施更完善或障碍更少的国家。所使用的七步调整框架可应用于其他地区，以提高当地采用和实施移动健康的可能性。我们对坦桑尼亚的实践和政策评估可应用于其他地区，并与政府官员合作使用，以支持制定或实施国家康复战略计划。
所描述的工作、吸取的经验教训以及该计划的组成部分在全球具有普遍性，并且可以利用移动健康改善康复服务的可及性，以应对日益严重的残疾负担。
