Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 20

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C. Gutenbrunner et al.
Box 2. Short descriptions of rehabilitation professions
and their main roles in the rehabilitation team (15)
• Physicians: diagnosing the underlying pathology and
impairments, medical assessment and treatment, setting-
up treatment and rehabilitation plan, prescription of
pharmacological and non-pharmacological treatments and
assessment of response to these.
• Rehabilitation nurses: addressing and monitoring day-to-day
care needs. Expertise in the management of tissue viability
and continence problems. Providing emotional support to
patients and their families.
• Physiotherapists: detailed assessment of posture and
movement problems, administering physical treatments,
including exercise, to restore movement and alleviate
pain, etc.
• Occupational therapists: assessing the impact of physical or
cognitive problems on activities of daily living, return to work,
education and/or leisure activities, etc. Providing expertise on
strategies that can be used by the patient and his/her family
and environmental adaptations to facilitate independence.
• Speech and language therapists: assessing and treating
communication and swallowing disorders.
• Clinical psychologists: detailed assessment of cognitive,
perceptual and emotional/behavioural problems. Development
of strategies to manage these with the patient, his/her family
and with other health professionals.
• Social workers: promoting participation, community re-
integration and social support.
• Prosthetists, orthotists and rehabilitation engineers:
expertise in the provision of technologies ranging from splints
and artificial limbs to environmental controls to address
functional limitations; for example, following limb loss, loss
of independent mobility, loss of ability to communicate.
• Dieticians: assessing and promoting adequate nutrition.
WHO list of health professionals has some weak-
nesses from the perspective of rehabilitation (14).
The list does not reflect the professions identified
by Neumann et al. (15) (Box 2). The definition of
rehabilitation professionals from the WRD does
not reflect the differentiation we believe is neces-
sary for provision of a high-quality rehabilitation
service. There is no internationally accepted des-
cription of, and curriculum for, community-based
rehabilitation workers. Thus, a pragmatic approach
was chosen based on a common understanding of
training and professional roles of the most relevant
rehabilitation professions.
With regard to benchmarking, no international-
ly accepted standards existed for the quantity and
quality of rehabilitation services in health systems.
From systematic research it can be recommended
that health-related rehabilitation services should
be integrated into the health system and financed
like other (general) health services as part of the
goal of universal health coverage. Thus, at present,
NHDRPs cannot make quantitative recommenda-
tions for service implementation. Estimating how
many services are needed to meet the needs must
be part of the implementation process.
www.medicaljournals.se/jrm
In order to achieve consensus among stake-
holders of health and rehabilitation systems, the
implementation tool of a stakeholder dialogue
was used. This is a tool for reaching consensus
for decision-making regarding policies (16, 17).
For the development of an NHDRP, the stake-
holder dialogue was used to discuss the recom-
mendations proposed by the RAT. Each recom-
mendation was presented and briefly discussed. If
there was broad agreement (>75% of participants)
the recommendation was accepted. If the level of
acceptance was lower a more detailed discussion
was applied, the recommendation voted on again,
and the result documented for the final report. In
theory, recommendations with less than 25% of the
vote were excluded from the final report; however,
until now this has not happened, probably due
to the fact that the RATs had single discussions
with all stakeholders beforehand. Finally, all par-
ticipants in the stakeholder workshop assigned a
priority level to each recommendation. The mean
priorities were set out in the final report.
For reporting purposes the decision was made
about the best structure for the recommendations.
The following options were considered:
• use some general recommendations and all
specific recommendations on rehabilitation from
the WRD (a total of 20 categories of recom-
mendations); or
• use the recommendations from the GDAP,
objective 2 strengthening rehabilitation (52
categories of recommendations).
For pragmatic reasons it was decided to use fewer
categories (see Table II). All of the most important
areas of service implementation are covered in the
list. Additional categories were provided at the
end after final agreement with the RAT; in 1 case
the report was transformed in light of the WHO 6
health systems building blocks (18) and “synch-
ronized” with other health system implementation
activities at the country level.
APPLICATION, TESTING AND
RECOMMENDATIONS
Application and testing
The plan for developing an NHDRP described
here, based on the ISPRM-WHO collaboration
plan, was used in Egypt (in 2015; (6)) and in the
Ukraine (in 2016; (7)). Another application was
conducted in collaboration with Handicap Inter-
national (HI) for the DPRK (8). Summarizing