Fary Khan, Bhasker Amatya, Wouter de Groote, Mayowa Owolabi, Ilyas M. Syed, Abderrazak Hajjoui, Muhammad N. Babur, Tahir M. Sayed, Yvonne Frizzell, Amaramalar S. Naicker, Maryam Fourtassi, Alaeldin Elmalik , Mary P. Galea
Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia. E-mail: fary.khan@mh.org.au
DOI: 10.2340/16501977-2313

Objective: Despite the prevalence of disability in low-and middle-income countries, the clinical skills of the rehabilitation workforce are not well described. We report health professionals’ perspectives on clinical skills in austere settings and identify context-specific gaps in workforce capacity.
Methods: A cross-sectional pilot survey (Pakistan, Morocco, Nigeria, Malaysia) of health professionals’ working in rehabilitation in hospital and community settings. A situational-analysis survey captured assessment of clinical skills required in various rehabilitation settings. Responses were coded in a line-by-line process, and linked to categories in domains of the International Classification of Functioning, Disability and Health (ICF).
Results: Respondents (n = 532) from Pakistan 248, Nigeria 159, Morocco 93 and Malaysia 32 included the following: physiotherapists (52. 8%), nurses (8. 8%), speech (5. 3%) and occupational therapists (8. 5%), rehabilitation physicians (3. 8%), other doctors (5. 5%) and prosthetist/orthotists (1. 5%). The 10 commonly used clinical skills reported were prescription of: physical activity, medications, transfer-techniques, daily-living activities, patient/carer education, diagnosis/screening, behaviour/cognitive interventions, comprehensive patient-care, referrals, assessments and collaboration. There was significant overlap in skills listed irrespective of profession. Most responses linked with ICF categories in activities/participation and personal factors.
Conclusion: The core skills identified reflect general rehabilitation practice and a task-shifting approach, to address shortages of health workers in low-and middle-income countries.

Despite increasing number of persons with disability in developing countries, clinical skills of the rehabilitation workforce working in this field are not well described. In this study we conducted a survey of 532 healthcare professionals in Pakistan, Morocco, Nigeria and Malaysia to obtain their perspectives on clinical skills required in various rehabilitation and community settings, and identify specific gaps. Various commonly used clinical skills and gaps were identified, which reflect general rehabilitation practice and shortages of healthcare workers in many developing countries.

Appendix S1