Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6005, Switzerland.
Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
BMC Health Serv Res. 2024 Jan 23;24(1):123. doi: 10.1186/s12913-023-10387-w.
The world population is ageing rapidly. Rehabilitation is one of the most effective health strategies for improving the health and functioning of older persons. An understanding of the current provision of rehabilitation services in primary care (PC) is needed to optimise access to rehabilitation for an ageing population. The objectives of this scoping review are a) to describe how rehabilitation services are currently offered in PC to older persons, and b) to explore age-related differences in the type of rehabilitation services provided.
We conducted a secondary analysis of a scoping review examining rehabilitation models for older persons, with a focus on PC. Medline and Embase (2015-2022) were searched to identify studies published in English on rehabilitation services for people aged 50 + . Two authors independently screened records and extracted data using the World Health Organization (WHO)'s operational framework, the Primary Health Care Systems (PRIMASYS) approach and the WHO paper on rehabilitation in PC. Data synthesis included quantitative and qualitative analysis.
We synthesised data from 96 studies, 88.6% conducted in high-income countries (HICs), with 31,956 participants and identified five models for delivering rehabilitation to older persons in PC: community, home, telerehabilitation, outpatient and eldercare. Nurses, physiotherapists, and occupational therapists were the most common providers, with task-shifting reported in 15.6% of studies. The most common interventions were assessment of functioning, rehabilitation coordination, therapeutic exercise, psychological interventions, and self-management education. Environmental adaptations and assistive technology were rarely reported.
We described how rehabilitation services are currently provided in PC and explored age-related differences in the type of rehabilitation services received. PC can play a key role in assessing functioning and coordinating the rehabilitation process and is also well-placed to deliver rehabilitation interventions. By understanding models of rehabilitation service delivery in PC, stakeholders can work towards developing more comprehensive and accessible services that meet the diverse needs of an ageing population. Our findings, which highlight the role of rehabilitation in healthy ageing, are a valuable resource for informing policy, practice and future research in the context of the United Nations Decade of Healthy Ageing, the Rehab2030 initiative and the recently adopted WHA resolution on strengthening rehabilitation in health systems, but the conclusions can only be applied to HICs and more studies are needed that reflect the reality in low- and middle-income countries.
世界人口正在迅速老龄化。康复是改善老年人健康和功能的最有效健康策略之一。为了优化人口老龄化人群获得康复的机会，需要了解初级保健（PC）中康复服务的当前提供情况。本研究的目的是 a）描述目前在 PC 中为老年人提供的康复服务，以及 b）探讨与年龄相关的提供的康复服务类型的差异。
我们对一项针对老年人康复模式的范围审查进行了二次分析，重点是 PC。使用 Medline 和 Embase（2015-2022 年）搜索发表在英语的关于 50 岁以上人群康复服务的研究。两名作者独立筛选记录并使用世界卫生组织（WHO）的运营框架、初级卫生保健系统（PRIMASYS）方法和 WHO 关于 PC 康复的论文提取数据。数据综合包括定量和定性分析。
我们综合了来自 96 项研究的数据，其中 88.6%的研究在高收入国家（HIC）进行，涉及 31956 名参与者，并确定了在 PC 中为老年人提供康复的五种模式：社区、家庭、远程康复、门诊和老年人护理。护士、物理治疗师和职业治疗师是最常见的提供者，有 15.6%的研究报告了任务转移。最常见的干预措施是功能评估、康复协调、治疗性运动、心理干预和自我管理教育。环境适应和辅助技术很少被报道。
我们描述了目前在 PC 中提供康复服务的情况，并探讨了接受的康复服务类型与年龄相关的差异。PC 可以在评估功能和协调康复过程方面发挥关键作用，并且也非常适合提供康复干预措施。通过了解 PC 中康复服务提供模式，利益相关者可以努力开发更全面和更易获得的服务，以满足人口老龄化的多样化需求。我们的研究结果强调了康复在健康老龄化中的作用，为在联合国健康老龄化十年、Rehab2030 倡议以及最近通过的关于加强卫生系统康复的世界卫生大会决议的背景下为政策、实践和未来研究提供了有价值的资源，但这些结论只能应用于 HIC，需要更多研究反映低收入和中等收入国家的实际情况。
