Global need: including rehabilitation in health system strengthening

• Authors: Tiago Jesus, Michel Landry
• Publication Year: 2021
• Journal: The Lancet, 397(10275), pp 665-666
• Link: https://doi.org/10.1016/S0140-6736(21)00207-5

CORRESPONDENCE

Apropos «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»

We read with great enthusiasm Alarcos Cieza and colleagues’¹ analysis of data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to estimate that 2·41 billion people (95% uncertainty interval 2·34–2·50 billion) worldwide would benefit from rehabilitation services. This comprehensive work quantifies an increasing burden of non-fatal health losses potentially addressed by rehabilitation services. Cieza and colleagues’ work complements findings from our series of secondary analyses of GBD 2017,^2, 3, 4 in which we focused on an extensive set of health conditions that could benefit from physical rehabilitation (excluding mental health and sensory impairments). In years of life lived with disability (YLDs), we found a 66% global increase from 1990 to 2017 specifically in physical rehabilitation needs,³ whereas Cieza and colleagues¹ found a 69% global increase from 1990 to 2019 for key rehabilitation-sensitive conditions.

Similar to Cieza and colleagues’ results, we found that musculoskeletal conditions largely contributed (ie, by 53%) to physical rehabilitation needs worldwide.⁴ These results underscore the high and increasing global need for rehabilitation services, and the substantial contribution of musculoskeletal conditions to these needs.

Cieza and colleagues¹ also found that global YLDs from rehabilitation-sensitive neurological, cardiovascular, and neoplasm conditions more than doubled between 1990 and 2019 (104%, 106%, and 129% increases, respectively). In turn, we observed substantial increases from 1990 to 2017 for neurological, cardiovascular, and neoplasm conditions in YLD rates (ie, YLDs per 100 000 people; 31%, 23%, and 62% increases, respectively).⁴ Among the five largest emergent economies, rehabilitation needs from neurological conditions grew especially in China (ie, by 113% per capita).² Physical rehabilitation needs per capita grew by 17% worldwide.³

Analogous with the Article by Cieza and colleagues,¹ we found that age-standardised values either did not change or modestly changed with time,^{2, 3, 4} meaning that population growth and ageing are key determinants of rising rehabilitation needs. As the global population ages, this trend will probably endure, adding further rehabilitation needs. Furthermore, in an ecological study across 35 high-income countries, using data on the physical and occupational therapy workforce supply and needs-based data from GBD 2017, we found no relationship among supply and need variables when adjusted for sociodemographic covariates.⁵ Indeed, important supply–need disparities were found even within high-income countries,⁵ and across low-income and middle-income countries where rehabilitation resources are scarce.

Overall, Cieza and colleagues¹ provide an up-to-date and detailed estimation of global rehabilitation needs; we hope that the growing body of data and knowledge on unmet rehabilitation needs can mainstream rehabilitation as a key element of health system strengthening worldwide.

KEYWORDS

rehabilitation needs; rehabilitation services; neurological conditions; cardiovascular conditions; neoplasm conditions; musculoskeletal conditions.