“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

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.

IMPLICATIONS FOR REHABILITATION

• Rehabilitation outcomes are important to show impact in low-resource and conflict settings, but most outcome measures originate from “Western” contexts

• Experience of physiotherapists from low-resource and conflict settings reveals the barriers and facilitators to measuring rehabilitation outcomes in their workplaces

• Participants’ suggest to use or develop simple scales that are contextualised and stakeholder-relevant for standard, routine measurement

• This study highlights the need to improve the measurement of rehabilitation outcomes in challenging contexts and provides guidance on how to do so

Keywords:

• Rehabilitation outcomes
• outcome measures
• physiotherapy
• low-resource
• conflict-affected
• focus group
• reflexive thematic analysis

Acknowledgements

The authors wish to acknowledge all study participants for their contributions. We thank the ICRC for enabling focus group discussion organisation and sponsoring participation. Our thanks go, in particular, to all colleagues involved in running the focus group discussions, transcribing the recordings and providing advice and input, namely, Maarten Abeel, Hasan Al-Agele, Juan Blandon, Solenne Chupin.

Ethics statement

The study protocol was approved by the ICRC physical rehabilitation programme, data protection office and the Swiss Ethics Committee (Reference REQ-2020-00774).

Disclosure statement

No potential conflicts of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.