The national commission for allied and health care professions bill 2020: Implications for occupational therapists and the AIOTA

The new National Commission for Allied and Health Care professions (NCAHCP) bill 2020 is introduced by the Government of India on September 15, 2020, to streamline the cadres in the country for allied and health-care professions within its health systems for the greater public good. It is very pertinent to understand the implications of the NCAHCP bill for All India Occupational therapists Association (AIOTA) and occupational therapists in India. The implications for AIOTA are (1) development of state councils and enabling their functioning in all the states of India, (2) radical revision of the OT curriculum incorporating policies and programs of the Indian health system, and (3) developing and strengthening the existing systems for OT practice. For occupational therapists, the implications are (1) registering to independently practice OT in India and (2) documenting professional practice for ethical integrity. Forming an advisory board to develop strategies for a smooth transition to the opportunities that the NCAHCP bill provides, must hold the top-most priority for AIOTA

Quality of Occupational Therapy Research in India - A Descriptive Review

Background: Occupational therapy (OT) enhances functional independence in the daily activities of people with disabilities and subsequently their quality of life. Research in OT generates evidence to provide safe and effective services to the disabled. However, OT research in India has been shown to have various methodological limitations. These methodological limitations are expected to impact the quality of OT research as well as the evidence derived from this research to inform decision‑making in rehabilitation. The majority of the OT research is disseminated and promoted through the All India Occupational Therapists’ Association’s (AIOTA) annual national conference (ANC). Analyzing the abstracts, selected for the presentation at the ANC could help understand and strategically improve the quality of OT research in India. Objectives: To explore and describe the quality of OT research in India. Study Design: Descriptive analysis. Methods: Descriptive, nonsystematic review and analysis of the key methodological aspects of the conference abstracts submitted for the AIOTA ANC published in the Indian Journal of OT (IJOT) from 2017 to 2021 was carried out. Information related to the methodological aspects of the research abstracts was extracted using a data extraction form and the data were synthesized and reported descriptively. Results: About 218 abstracts had been selected for either poster or oral presentations in the AIOTA ANC. All the abstracts were included for the review. A total of 8055 participants were recruited for the studies conducted from 2017 to 2021. About 5757 (72) of the participants were recruited for cross‑sectional studies. Nearly 72 (33) of the abstracts presented were related to cross‑sectional studies, 52 (24) were case studies and 66 (30) were experimental studies. However, research designs implying highest level of evidence such as systematic reviews were only 4 (2) and randomized controlled trials were only 9 (4) with 297 participants. Notably, 203 (98) of the all the studies evaluating effectiveness of interventions or aiming to investigate associations reported positive results with statistically significant improvements and associations. Conclusion: The review provides invaluable information relatedto the quality of OT research in India. It implies the need to improve the scientific rigor of the evidence generated in relation to OT research in India. This review also implies the need for a radical change and strengthening of OT research within OT education and professional practice in India. National and global OT associations need to prioritize good quality OT research by enhancing the research skills and competencies of OTs in India. This could help promote evidence‑based OT science and develop the OT profession in the world’s second‑most populous country. In addition, it is also expected to encourage those OT researchers who have been striving to build OT research standards in India

Expert consensus for in-hospital neurorehabilitation during the COVID-19 pandemic in low- and middle-income countries

Background: People with neurological dysfunction have been significantly affected by the ongoing coronavirus disease 2019 (COVID-19) crisis in receiving adequate and quality rehabilitation services. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middle-income countries. The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence. Methods: A group of experts in neurorehabilitation consisting of neurologists, physiotherapists and occupational therapists were identified for the consensus groups. A scoping review was conducted to identify existing evidence and recommendations for neurorehabilitation during COVID-19. Specific statements with level 2b evidence from studies identified were developed. These statements were circulated to 13 experts for consensus. The statements that received ≥80% agreement were grouped in different themes and the recommendations were developed. Results: 75 statements for expert consensus were generated. 72 statements received consensus from 13 experts. These statements were thematically grouped as recommendations for neurorehabilitation service providers, patients, formal and informal caregivers of affected individuals, rehabilitation service organizations, and administrators. Conclusions: The development of this consensus statement is of fundamental significance to neurological rehabilitation service providers and people living with neurological disabilities. It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-income countries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future

Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings

Tele-Rehabilitation Systems for Empowering Parents and Their Children with Disabilities in India – A SWOT Analysis of the Context for Implementation

Persons with Disabilities (PWD) experience unmet needs related to health, rehabilitation, education, livelihood, social participation, and empowerment, particularly those living in a resource-poor context such as in the Indian context. The same applies to Children with Disabilities (CWD) as well. Given the pandemic restrictions imposed by the government of India, the provision of therapeutic rehabilitation services for PWDs and CWDs has come to a deadlock. Therefore, the PWDs and the parents of CWDs are substantially impacted by the double contextual burden of demand and access to rehabilitation services in India. However, there has been some light at the end of this dark tunnel provided by the existing telecommunication strategies. Both parents/caregivers and rehabilitation service providers started to find a way out of this situation on their own in India by optimizing their skills and resources for telerehabilitation. However, adopting this strategy requires evidence. Hence a critical Strengths Weaknesses Opportunities and Threats (SWOT) analysis of the telerehabilitation strategy for empowering PWDs and CWDs in an Indian context is warranted and is of immense public health importance. A narrative review was conducted.Telerehabilitation has several strengths, weaknesses, opportunities, and threats. Telecommunication resources, Access to Rehabilitation services, Parent’s and consumer acceptance, Service efficiency, and data documentation could be considered as strengths; Skills, Competencies, Opportunity cost, Resource intensiveness, Evidence for Effectiveness, Comprehensibility could be considered as weaknesses; Therapy innovations, Evidence generation, System strengthening and Capacity Building could be considered as opportunities; Patient Safety, Ethical Integrity, Data security, and Professional practice insecurity could be considered as potential Threats to Telerehabilitation. Telerehabilitation has considerable scope for providing meaningful therapeutic experience and hastens the process of rehabilitation of CWDs in the current context. The SWOT and its implications must be kept in mind to ensure that CWDs receive the best quality continuum of care in the present context with utmost ethical and evidence-based considerations. This could bridge the gaps in access to rehabilitation services with sustainable solutions than patchy temporary solutions that are not sustainable

Exploring the research priorities for occupational therapy in India: A descriptive review

Background: Occupational therapists are considered an important workforce for the rehabilitation of persons with disabilities globally. However, in India, the profession is just beginning to gain recognition within the national and state-level systems for health care. One of the reasons for this could be the paucity of specific research related to the development of occupational therapy (OT) and its benefits to the health systems. Therefore, it is of immense public health importance to explore the priorities and gaps in OT research in India. A vast majority of the OT research in India is promoted and disseminated through the All-India Occupational Therapists Association (AIOTA) and its annual national conference (ANC). Objectives: The objective of this study is to descriptively review the conference abstracts of the AIOTA ANC published in the Indian Journal of OT (IJOT), an official publication of the AIOTA, from 2017 to 2021. Study Design: The study design was a descriptive, nonsystematic review. Methods: Review of the abstracts selected for the AIOTA ANC published in the IJOT from 2017 to 2021. A data extraction form was developed and used to synthesize data related to the clinical and demographic characteristics of OT research in India. Results: The search yielded 218 abstracts. State-level trends indicated that close to 85% of the research submissions were from four states and no submissions from the northeastern states until 2020. Nearly 60% of the abstracts were clinical research with OT interventions. About 40% of these research abstracts were related to pediatrics, followed by neurology (17%), musculoskeletal (15%), mental health (10%), and ergonomics and assistive technology (8%). There were 1%–2% of research abstracts submitted related to coronavirus disease-2019 (COVID-19) and geriatrics. About 85% of the research abstracts were related to impairment (39%), activity limitation (26%), and social participation (22%). Conclusion: This review highlights the need for diversifying the research in OT in India. This is particularly important in relation to expanding from selected states to pan-India research and development, especially in the northeastern states. Furthermore, the focus of OT research must move beyond impairments and approach disability from the biopsychosocial perspective. It is also very important to diversify the research in OT to areas that are of public health importance such as COVID-19, geriatrics, noncommunicable diseases, and rehabilitation in health systems. Priority setting for research in OT in India is an important implication of this review