Allen Heinemann

Axen, Iben

Azim, Muhammad Ehab

Battistella, Linamara

Birkan

Borg, Kristia

Campos, Ines

Carla Sabariego

Carlotte Kiekens

Castro, Rodrigo

Chaler, Joaquim

Chan, Leighton

Christine Rolland

Claire D Johnson

DeGroote, Wouter

Devesa, Ignacio

Douglas P Gross

Evcik, Deniz

Farooq Azam Rathore

Ferriero, Giorgio

Francisco, Gerard E

Frank Kandziora

French, Simon

Frontera, Walter R.

Ghaffar, Abdul

Jae-Young Lim

Louise Gustafsson

Manoj

Matthieu Guemann

Peggy Nelson

Randolph J Nudo

Sivan Furqan Ahmed Siddiq Sonel Tur

Stam, Henk J

Stefano Respizzi

Steven A Gard

Stewart, Aimee

Tamara Ownsworth

Thorsten Meyer

Wilco Peul

English

Archivio istituzionale della ricerca - Università dell'Insubria

EditorialImportance of health policy and systems research forstrengthening rehabilitation in health systems:A callto action to accelerate progressWalter R. Frontera1, Wouter DeGroote2, Abdul Ghaffar3 and the Health Policy and Systems Research forRehabilitation GroupDuring the last few decades, the field of rehabilitation hasexperienced substantial development, growth, and acceptance.Rehabilitation addresses the impact of a health condition ona person’s everyday life by optimizing their functioning andreducing their experience of disability. Rehabilitation expands thefocus of health beyond preventative and curative care to ensurepeople with a health condition can remain as independent aspossible and participate in education, work, and meaningful liferoles.1 A definition of rehabilitation for research purposes hasbeen recently published.2 Scientific and clinical research havegenerated a body of knowledge that strongly supports the use ofmany rehabilitation interventions with positive outcomes invarious populations and health conditions.We also have now a better understanding of the growingglobal need, demand, and recognition of rehabilitation aroundthe world. For example, it has been estimated that 2.41 billionpeople in the world could benefit from rehabilitation services.This means that at least 1 in every 3 persons in the world needsrehabilitation at some point during the course of their diseaseor injury.3 This figure has most likely increased because of theCOVID-19 pandemic. The need for rehabilitation increased by63% between 1990 and 2017 because of the aging population,the increasing prevalence of noncommunicable health condi-tions, and the shifting epidemiological profile in most countries.3Finally, according to the 2022 global report on health equity forpersons with disabilities, approximately.1.3 billion people or 16% of the world’s population hasmoderate to severe levels of disability associated with theunderlying health conditions and impairments.4 Now more thanever before, it is crucial that rehabilitation is available andaccessible to populations globally according to their needs. Theimportant contribution of rehabilitation to the functioning,including social and occupational participation and well-beingof populations worldwide, can no longer be denied or delayed.Rehabilitation is critical for the attainment of the United NationsSustainable Development Goal 3, Ensure healthy lives andpromote well-being for all at all ages.5Notwithstanding the foregoing arguments, there continues tobe a high unmet need for rehabilitation globally, with some low-and middle-income countries reporting unmet needs up to 50% ofthose who could benefit from rehabilitation. Rehabilitationservices are not accessible to many people around the world.6Many of those in need do not have access because of the failure, atleast partially, to effectively plan for rehabilitation services. Manynations and health systems have not implemented policy measuresthat recognize rehabilitation as an essential component ofuniversal health coverage.7,8 Health policy, planning, and decisionmaking for rehabilitation often require more local evidence toadequately plan, finance, implement,and monitor quality re-habilitation services including infrastructure and workforce tomake services accessible to those in need.9The field of health policy and systems research (HPSR) seeks tounderstand and improve how societies organize themselves inachieving collective health goals and how different actors interact inthe policy and implementation processes to contribute to policyoutcomes.10,11 By nature, it is interdisciplinary, a blend of medicineand health sciences, economics, sociology, anthropology, politicalscience, law sciences, public health, and epidemiology that togetherdraw a comprehensive picture of how health systems respond andadapt to health policies, and how health policies can shape—and beshaped by—health systems and the broader determinants of health.The importance of HPSR for rehabilitation has been recentlyhighlightedwith robust data that needs to be considered andused byhealth policy and systems community and leadership.12 Health1American Journal of Physical Medicine and Rehabilitation2Rehabilitation Programme, World Health Organization3World Health Organization Alliance for Health Policy and Systems ResearchCorresponding author:Walter R. Frontera, Department of Physical Medicine, Rehabilitation, and SportsMedicine School of Medicine, University of Puerto Rico, GPOBox 365067, San Juan,PR.This editorial is being published almost simultaneously in all journals listed to reach asmany readers as possible.Acta Fisiatrica; Advances in Rehabilitation Science and Practice; American Journal ofPhysical Medicine and Rehabilitation; Annals of Geriatric Medicine and Research;Archives of Physical Medicine and Rehabilitation; Australian Occupational TherapyJournal; Brain and Spine; Chiropractic and Manual Therapies; Die Rehabilitation;European Journal of Physical and Rehabilitation Medicine; European RehabilitationJournal; Foundation University Journal of Rehabilitation Sciences; Frontiers inRehabilitation Sciences; Journal of Manipulative and Physiological Therapeutics;Journal of Occupational Rehabilitation; Journal of Pakistan Medical Association;Journal of Prosthetics and Orthotics; Journal of Rehabilitation Medicine; Journal ofSpeech, Language, and Hearing Research; Medicina Riabilitativa; Neuropsycholog-ical Rehabilitation; Neurorehabilitation and Neural Repair; Portuguese Journal ofPhysical and RehabilitationMedicine; Rehabilitación; Revista Colombiana deMedicinaFı́sica y Rehabilitación; Revista Mexicana de Medicina Fı́sica y Rehabilitación; RevueSanté Publique; South African Journal of Physiotherapy; The Journal of theInternational Society of Physical and Rehabilitation Medicine; Turkish Journal ofPhysical Medicine and Rehabilitation.Copyright © 2023 The Authors. Published by Wolters Kluwer incorporated on behalfof The International Society for Prosthetics and Orthotics. This is an open accessarticle distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible todownload and share the work provided it is properly cited. The work cannot bechanged in any way or used commercially without permission from the journal.DOI: 10.1097/PXR.00000000000003342 Volume 48·Number 1·2024 Prosthetics and Orthotics Internationalpolicy and systems research for rehabilitation generates the evidenceneeded by policy makers to make appropriate decisions and todevelop action plans to enhance the capacity of the health system toserve the population in need of rehabilitation services. For example,the evidence generated by HPSR helps (1) establish priorities forrehabilitation service delivery, (2) evaluate outcomes of variousrehabilitation interventions in relation to the levels of care in thehealth system, (3) identify specific benefits to society justifying thosedecisions, and (4) strengthen health systems to increase access,quality, and provision of health services for rehabilitation.13Supported by the recent resolution on “Strengthening rehabilitationin health systems” that has been endorsed by the World HealthAssembly for the first time in the history of the World HealthOrganization,14 it is time to leverageHPSR to support societal healthgoals as they apply to rehabilitation.In 2022, the World Health Organization Rehabilitation Pro-gram established the World Rehabilitation Alliance (WRA)15 tostrengthen networks and partnerships that advocate for theintegration of rehabilitation into health systems. The WRA isa World Health Organization–hosted global network of stake-holders whose mission and mandate are to support the implemen-tation of the Rehabilitation 2030 Initiative16 through advocacyactivities. The WRA focuses on promoting rehabilitation as anessential health service that is integral to Universal HealthCoverage and to the realization of the United Nations SustainableDevelopment Goal 3. The work of the WRA is divided into thefollowing 5 workstreams: workforce, primary care, emergencies,external relations, and research. The research workstream isdedicated to the generation and routine use of HPSR evidence forplanning and integrating rehabilitation into health systems. Thespecific objectives of this workstream are to advocate for (1) thedemand and utilization ofHPSR evidence for rehabilitation, (2) thewidespread generation of high-quality HPSR evidence for re-habilitation, and (3) the publication, dissemination, and imple-mentation of HPSR evidence for rehabilitation.In this context, the coauthors of this editorial on behalf of theirrespective academic journals express their full support for theWRA mission in general and for the specific objectives of theresearch workstream. In concrete terms, we commit that ourjournals, as much as possible, will implement 1 or more of thefollowing actions: (1) invite researchers in the field of HPSR forrehabilitation to submit their manuscripts to our Journals for peerreview and possible publication, (2) create a special journal section,series, or designation dedicated to HPSR for rehabilitation, (3)appoint editorial board members with expertise in HPSR forrehabilitation, and (4) disseminate research articles among fundingagencies and policymakers. These actions by our academicjournals will help the WRA achieve its goal of strengtheningrehabilitation services for all.FundingThe authors disclosed that they received no financial support forthe research, authorship, and/or publication of this article.Declaration of conflicting interestThe authors disclosed no potential conflicts of interest with respectto the research, authorship, and/ or publication of this article.AcknowledgmentsThe Health Policy and Systems Research for Rehabilitation Group(Editors-in-Chief of collaborating journals listed in alphabeticalorder): Iben Axen, DC, PhD (Chiropractic andManual Therapies),Muhammad EhabAzim, DPT,MS-NMPT (Foundation UniversityJournal of Rehabilitation Sciences), Linamara Battistella, MD,PhD (Acta Fisiatrica), Kristian Borg, MD, PhD (Journal ofRehabilitation Medicine), Ines Campos, MD, MSc (PortugueseJournal of Physical and RehabilitationMedicine), Rodrigo Castro,MD (Revista Colombiana de Medicina Fı́sica y Rehabilitación),Joaquim Chaler, MD, PhD (Rehabilitación), Leighton Chan, MD,MPH (Archives of Physical Medicine and Rehabilitation), IgnacioDevesa, MD (Revista Mexicana de Medicina Fı́sica y Rehabil-itación), Deniz Evcik, MD (Turkish Journal of Physical Medicineand Rehabilitation), Giorgio Ferriero, MD, PhD (EuropeanJournal of Physical and Rehabilitation Medicine), Gerard E.Francisco, MD (The Journal of the International Society ofPhysical and Rehabilitation Medicine), Simon French, PhD(Chiropractic and Manual Therapies), Steven A. Gard, PhD(Journal of Prosthetics and Orthotics), Douglas P. Gross, PhD,BScPT (Journal of Occupational Rehabilitation), Matthieu Gue-mann, PT, PhD (European Rehabilitation Journal), LouiseGustafsson, PhD (Australian Occupational Therapy Journal),Allen Heinemann, PhD (Archives of Physical Medicine andRehabilitation), Claire D. Johnson, DC, PhD (Journal of Manip-ulative and Physiological Therapeutics), Frank Kandziora, MD,PhD (Brain and Spine), Carlotte Kiekens, MD (Frontiers inRehabilitation Sciences), Jae-Young Lim, MD, PhD (Annals ofGeriatric Medicine and Research), Thorsten Meyer, PhD (DieRehabilitation), Peggy Nelson, PhD (Journal of Speech, Language,and Hearing Research), Randolph J. Nudo, PhD (Neurorehabili-tation and Neural Repair), Tamara Ownsworth, PhD (ExecutiveEditor - Neuropsychological Rehabilitation), Wilco Peul, MD,PhD (Brain and Spine), Farooq Azam Rathore, MD, MSc (SectionEditor—Journal of Pakistan Medical Association), StefanoRespizzi, MD (Medicina Riabilitativa), Christine Rolland, PhD(Revue Santé Publique), Carla Sabariego, PhD (Frontiers inRehabilitation Sciences), Furqan Ahmed Siddiqi, DPT, PhD(Foundation University Journal of Rehabilitation Sciences),ManojSivan, MD (Advances in Rehabilitation Science and Practice),Birkan Sonel Tur, MD (Turkish Journal of Physical Medicine andRehabilitation), Henk J. Stam, MD, PhD (Journal of Rehabilita-tion Medicine), Aimee Stewart, PhD (South African Journal ofPhysiotherapy) (HPSRRG).References1. World Health Organization. Health Topics, Rehabilitation; 2023. Avail-able at: https://www.who.int/health-topics/rehabilitation. Accessed May19, 2023.2. Negrini S, Selb M, Kiekens C, et al. Rehabilitation definition for researchpurposes: a global stakeholders’ initiative by cochrane rehabilitation. AmJ Phys Med Rehabil 2022;101:e100–e107.3. Cieza A, Causey K, Kamenov K, et al. Global estimates of the need forrehabilitation based on the Global Burden of Disease study 2019: a sys-tematic analysis for the Global Burden of Disease Study 2019.Lancet 2021;396:2006–2017.4. World Health.Organization. Global Report on Health Equity for Personswith Disabilities; 2022. Available at: https://www.who.int/publications/i/item/9789240063600. Accessed May 28, 2023.Frontera et al. www.POIjournal.org 35. United Nations (UN). Sustainable Development Goals. Available at:https://sdgs.un.org/goals. Accessed April 26, 2023.6. Kamenov K, Mills JA, Chatterji S, et al. Needs and unmet needs for re-habilitation services: a scoping review.Disabil Rehabil 2019;41:1227–1237.7. The Lancet. Prioritising disability in universal health coverage. Lancet2019;394:187.8. Negrini S, Kiekens C, Heinemann AW, et al. Prioritising people with dis-abilities implies furthering rehabilitation. Lancet 2020;395:111.9. World Health Organization.Rehabilitation in Health Systems: AGuide forAction; 2019. Available at: https://apps.who.int/iris/bitstream/handle/10665/325607/9789241515986-eng.pdf. Accessed April 25, 2023.10. World Health Organization. Health Policy and Systems Research; 2012.Available at: https://ahpsr.who.int/what-we-do/what-is-health-policy-and-systems-research-(hpsr). Accessed June 8, 2023.11. Alliance for Health Policy and Systems Research. What Is Health Policy andSystemsResearch?Available at: https://ahpsr.who.int. AccessedMay 25, 2023.12. Cieza A, Mikkelsen B and Ghaffar A. Advancing rehabilitation throughhealth policy and systems research. Bull World Health Organ 2022;100:655–655A.13. Cieza A, Kwamie A, Magaqa Q, et al. Framing rehabilitation throughhealth policy and systems research: priorities for strengthening re-habilitation. Health Res Pol Syst 2022;20:101.14. WorldHealthOrganization.Resolution on StrengtheningRehabilitation inHealth Systems; 2023. Available at: https://www.who.int/news/item/27-05-2023-landmark-resolution-on-strengthening-rehabilitation-in-health-systems. Accessed June 8, 2023.15. World Health Organization. World Rehabilitation Alliance; 2022.Available at: https://www.who.int/initiatives/world-rehabilitation-alli-ance. Accessed June 7, 2023.16. WorldHealthOrganization.Rehabilitation 2030; 2017. Available at: https://www.who.int/initiatives/rehabilitation-2030. Accessed June 8, 2023.4 Volume 48·Number 1·2024 Prosthetics and Orthotics International

Importance of health policy and systems research for strengthening rehabilitation in health systems: a call to action to accelerate progress

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Importance of health policy and systems research for strengthening rehabilitation in health systems: a call to action to accelerate progress

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