Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019

“Rehabilitation might be needed by anyone with a health condition who experiences difficulties in, for example, mobility, vision, or cognition. Therefore, its scope is very broad and people with diverse underlying health conditions or impairments might require rehabilitation at some stage of the course of their disease. There is evidence showing that many rehabilitative interventions are cost-effective. Low-cost rehabilitation interventions requiring minimal resources have been effective in improving functional outcomes in different health conditions in low-income and lower-middle-income countries and can be used in these settings as successful models of care. Rehabilitation can improve functioning outcomes in adults and children with different chronic conditions, such as to manage cognitive decline for people with dementia, improve movement for those with arthritis, and produce motor benefits for children with cerebral palsy. Rehabilitation also has the potential to avoid costly hospitalisation and reduce hospital length of stay. By aiming to optimise functioning, rehabilitation can also support individuals to participate in education and employment and to remain independent at home. Advanced technological and digital solutions have become commonplace and are being increasingly applied in rehabilitation. Online programs or assistive technologies (eg, hearing aids) are successfully used by millions of people around the world.

[..] estimating the need for rehabilitation by presenting the prevalence and years of life lived with disability (YLDs) of 25 disease causes, impairments, and bespoke aggregations of sequelae that would be amenable to rehabilitation at some point in the course of disease using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

[..] we identified the 20 conditions with the highest number of associated YLDs. Second, from these, we excluded conditions for which rehabilitation is not essential and is usually indicated as a secondary intervention (eg, dietary iron deficiency or oral disorders). Lastly, a group of experts in the field of rehabilitation was convened by WHO to discuss the current list and add any health conditions for which rehabilitation is a key intervention as part of an overall management plan. 25 health conditions were selected for the final analysis.

[..] The 25 health conditions comprised 77% of the YLDs. Furthermore, the injuries (ie, amputation, fractures, traumatic brain injury, spinal cord injury, and other injuries) included in our list of 25 health conditions also comprised 89% of all injury YLDs.

[..] Globally in 2019, 2·41 billion (95% UI 2·34–2·50) individuals had conditions that would benefit at some point during the course of disease from rehabilitation services, contributing to 310 million (235–392) YLDs. This number had increased by 63% (61–64), from 1·48 billion (1·43–1·54) in 1990. The age-standardised prevalence and YLDs rates showed modest declines since 1990, indicating that the large increase in cases is due to population growth and population ageing.

[..] Globally, over 1600 million adults aged 15–64 years have a condition that would benefit from rehabilitation in 2019, with musculoskeletal disorders contributing to approximately two-thirds of this number. In children younger than 15 years, sensory impairments, mental disorders, and musculoskeletal disorders accounted for 91% of the 162·3 million prevalent cases. For people older than 65 years, musculoskeletal disorders, neurological disorders, sensory impairments, and chronic respiratory diseases were the largest contributors to the need for rehabilitation, while mental disorders and musculoskeletal disorders accounted for a smaller proportion than in adults younger than 65 years.

[..] The disease area with the highest contribution to prevalence was musculoskeletal disorders (1·71 billion people [95% UI 1·63–1·80] and 149 million [108–199] YLDs). Among musculoskeletal disorders, low back pain caused the highest burden, with 568 million people (505–640) and 64 million (45–85) YLDs globally. In fact, low back pain was the leading health condition contributing to the need for rehabilitation services in 134 of the 204 countries analysed. The second largest disease area was sensory impairments (677 million people [631–723] and 45 million [31–62] YLDs), which is split between vision loss (329 million people [302–358] and 21 million [15–30] YLDs) and hearing loss (403 million people [357–449] and 24 million [16–33] YLDs). The third largest group was neurological disorders (255 million people [242–268] and 51 million [37–65] YLDs), in which stroke represented the highest need for rehabilitation (86 million people [95% UI 79–94] and 18 million [13–23] YLDs).

[..] at least one in every three people in the world needs rehabilitation at some point during the course of their disease or injury. This result counters the common view of rehabilitation as a service for the few. It is also worth noting that our results were an underestimation, as only 25 conditions were selected in the analysis based on their prevalence, associated high levels of disability, and amenability to rehabilitation.

[..] two main implications of including rehabilitation at the primary health-care level. First, the traditional workforce in primary care settings (eg, general practitioners, primary care nurses, and community health workers) need to be trained in assessing rehabilitation needs and in the delivery of rehabilitation interventions that address common health problems, such as back pain, COPD, or cardiac disease. Second, rehabilitation specialists (eg, physiotherapists, occupational therapists, and speech and language therapists) should be included in the primary care workforce. Several simple actions can be taken to ensure this inclusion in communities: rehabilitation competencies can be integrated into general practitioners’ training and certification in accordance with the needs of the population, degree programmes for rehabilitation disciplines can be included in universities, rehabilitation personnel should be paid competitive salaries and have opportunities for career progression, and tele-rehabilitation—the delivery of health-care services via information and communication technologies—can be introduced to support general practitioners.”

Full article, Cieza A, Causey K, Kamenov K et al. The Lancet, 2020.12.1