International Stakeholder Consultation on the Use and Implementation of Rehabilitation Service Delivery Models to Foster Healthy Ageing: Results from a Cross-Sectional Survey Across 124 Countries
Presenter(s):
Roxanne Maritz, Center for Rehabilitation in Global Health Systems (WHO CC), University of Lucerne, Switzerland
Abstract
Rehabilitation is a key component of healthy ageing, ensuring that older adults maintain functional ability, independence, and participation in society. It encompasses a range of interventions designed to optimize functioning and reduce disability in individuals experiencing or at risk of functional decline due to ageing-related conditions and chronic diseases. Despite its importance, rehabilitation remains underprioritized in many health systems, particularly in low- and middle-income countries (LMICs). While existing scoping reviews describe rehabilitation service delivery for older adults, most evidence is derived from high-income countries (HICs), limiting the global applicability of findings. To address this gap, our study explored real-world rehabilitation service delivery models across diverse settings and income levels.
Aims:
a) Assess whether descriptions of rehabilitation service delivery models from the literature reflect actual practice.
b) Gather knowledge on the availability, implementation status, and use of different rehabilitation service delivery models in various countries and settings.
Design:
An observational study based on an international online survey conducted in eight languages (Arabic, Chinese, English, French, German, Portuguese, Russian, Spanish).
Setting and Population:
Healthcare workers involved in providing rehabilitation services to individuals aged 60 and above participated in the study.
Methods:
A 33-question online survey assessing the characteristics, availability, and implementation of rehabilitation service delivery models (inpatient, outpatient, telerehabilitation, home-based, community-based, and eldercare settings) was disseminated globally using a three-layer stakeholder mapping approach. The CHERRIES checklist guided the reporting.
Results:
A total of 1,285 highly experienced healthcare workers from 124 countries, representing all WHO regions and income levels, completed the survey. Findings reveal significant disparities in rehabilitation access, with LMICs reporting lower availability and implementation of rehabilitation services than HICs. However, no model was fully available or implemented nationwide in any region, underscoring a global gap in rehabilitation service provision.
Across all settings, physiotherapists, occupational therapists, speech-language therapists, nurses, and rehabilitation physicians are the most common providers. Rehabilitation services remain fragmented, with multidisciplinary teams predominantly available in inpatient settings. Access to assistive technology is widespread in HICs but only available half of the time in LMICs. Environmental adaptations, which are critical for ageing in place, are not fully reimbursed by any health system and are absent from service delivery in some regions.
Conclusion:
Our findings validate and expand upon existing research by integrating the perspectives of healthcare workers with real-world experience across diverse income levels and regions. Older adults in LMICs have less access to comprehensive rehabilitation services compared to their counterparts in HICs. Globally, rehabilitation services are only partially responsive to the needs of ageing populations. Strengthening rehabilitation systems is essential for ensuring healthy ageing worldwide.
Impact on Healthy Ageing:
Policymakers and rehabilitation stakeholders can use these findings to (re)design services that better support healthy ageing, ensuring older adults receive the rehabilitation needed to maintain functioning, independence, and well-being throughout later life.
Bio(s):
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