Andréa D. Furlan, Emma Irvin, Claire Munhall, Mario Giraldo-Prieto, Laura Fullerton, Robert McMaster, Shivang Danak, Alicia Costante, Kristen Pitzul, Rohit P. Bhide, Stanislav Marchenko, Quenby Mahood, Judy A. David, John F. Flannery, Mark Bayley
Toronto Rehabilitation Institute- UHN, 550 University Avenue, Room 7-141-1, Toronto ON, M5G 2A2, Canada. E-mail: afurlan@iwh.on.ca
DOI: 10.2340/16501977-2325

Objective: To compare models of rehabilitation services for people with mental and/or physical disability in order to determine optimal models for therapy and interventions in low- to middle-income countries.
Data sources: CINAHL, EMBASE, MEDLINE, CENTRAL, PsycINFO, Business Source Premier, HINARI, CEBHA and PubMed.
Study selection: Systematic reviews, randomized control trials and observational studies comparing >2 models of rehabilitation care in any language.
Date extraction: Standardized forms were used. Methodological quality was assessed using AMSTAR and quality of evidence was assessed using GRADE.
Data synthesis: Twenty-four systematic reviews which included 578 studies and 202,307 participants were selected. In addition, four primary studies were included to complement the gaps in the systematic reviews. The studies were all done at various countries. Moderate- to high-quality evidence supports the following models of rehabilitation services: psychological intervention in primary care settings for people with major depression, admission into an inpatient, multidisciplinary, specialized rehabilitation unit for those with recent onset of a severe disabling condition; outpatient rehabilitation with multidisciplinary care in the community, hospital or home is recommended for less severe conditions; However, a model of rehabilitation service that includes early discharge is not recommended for elderly patients with severe stroke, chronic obstructive pulmonary disease, hip fracture and total joints.
Conclusion: Models of rehabilitation care in inpatient, multidisciplinary and specialized rehabilitation units are recommended for the treatment of severe conditions with recent onset, as they reduce mortality and the need for institutionalized care, especially among elderly patients, stroke patients, or those with chronic back pain. Results are expected to be generalizable for brain/spinal cord injury and complex fractures.

We reviewed the published scientific literature to identify the best rehabilitation models for the World Health Organization guideline of Rehabilitation in Health Systems, which was released in 2017. Rehabilitation can be delivered in various different settings, for people with major depression it is better to receive psychological interventions in primary care; for people with a severe disabling condition, it is better to be admitted to an inpatient, multidisciplinary or specialized rehabilitation unit; for people with less disabling conditions, they can receive rehabilitation in outpatient settings with a multidisciplinare team. Elderly people with severe stroke and other diseases should not be discharged early from hospital. These results are especially important for low- and middle-income countries to know which rehabilitation model is better so they can invest their human and financial resources appropriately.

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