Community-based rehabilitation for people with disabilities in low- and middle-income countries: A systematic review.

Editor's Abstract:

SEARCH METHODS
The search for studies was not restricted by language or publication status. Searches were limited to studies published after 1976. We searched 23 electronic databases: AIM, CAB Abstract, CENTRAL, CINHAL Plus, Cochrane Database of Systematic Reviews, DARE (The Cochrane Library), EconLit, EMBASE, ERIC, Global Health, HTA Database, IBSS, IMEMR, IMSEAR, LILACS, MEDLINE, NHSEED, PAIS International, PsycINFO, The Campbell Collaboration Library of Systematic Reviews, Web of Science, WHOLIS, and WPRIM. We also searched relevant websites, contacted authors, screened the reference lists and tracked citations of included studies. The latest search for trials was in July 2012.

SELECTION CRITERIA
Controlled studies evaluating the impact of CBR offered to people with physical or mental disabilities and/or their family, their carers, and their community in low- and middle-income countries. The following study designs were eligible: randomised controlled trials, non-randomised controlled trials, controlled before-after studies, controlled interrupted time series studies, and economic studies. We excluded studies where CBR intervention took place only in health facilities or schools.

AUTHORS’ CONCLUSIONS
The evidence on the effectiveness of CBR for people with disabilities in low- and middle-income countries suggests that CBR may be effective in improving the clinical outcomes and enhancing functioning and quality of life of the person with disabilities and his/her carer. However the heterogeneity of the interventions and scarcity of good-quality evidence means that we should interpret these findings with caution. More well-designed and reported randomised controlled trials are needed to build a stronger evidence-base. These studies need to be sufficiently powered, and focus on all different components of the CBR matrix and not only the health component. Furthermore, evidence is needed on a broader client groups including children, and economic evidence must be collected.