Tuesday, 15 December 2015

SPHPM analysis of medical rehabilitation interventions in survivors from natural disasters

SPHPM’s Associate Professor Farees Khan has co-authored an article with researchers from the Royal Melbourne Hospital, the Harvard School of Public Health and the International Society of Physical and Rehabilitation Medicine in Geneva, reviewing the efficacy of medical rehabilitation interventions in survivors from natural disasters.

Disaster refers to an incident that causes great disruption or damage to a community, impairing its ability to function effectively and resulting in a myriad of losses, including material, economic, human, and environmental. This means that the community cannot rely on its own resources to maintain itself.

There are categories of disasters as classified by the authors, including natural, complex humanitarian emergencies (such as effects of war) and technologic (nuclear incidents). Natural disasters cause numerous consequences, not just limited to the loss of human life. Individuals can face permanent disability due to debilitating injuries, such as brain trauma, amputations, spinal cord damage and psychological injury. Figures have indicated that annually, more than 100,000 individuals have perished due to natural disasters.

The immediate priority following natural disasters is to save as many lives as possible. Recent statistics demonstrate that there is a great increase in the number of injuries from natural disasters relative to mortality, which highlights that there is a need for both medical and nonmedical rehabilitation when considering natural disaster management and coordination.

The term medical rehabilitation refers to measures which are designed to aid individuals who are experiencing, or are at risk of experiencing disability; assisting them to maintain prime sensory, intellectual, physical and psychological functioning. Recent evidence does highlight that patients who are treated in areas with rehabilitation services following natural disasters have a shorter hospital stay, less medical complications and improved clinical outcomes when compared against patients who had no access to rehabilitation physicians.

The intention of this review was to assess the efficacy, cost-efficiency and safety of various medical rehabilitation interventions in patients who are survivors of natural disasters. While there is a growing amount of empirical data on medical rehabilitation following disasters, there is a lack of studies which utilise a systematic analysis approach to the numerous rehabilitation services specifically in natural disaster environments.

The authors utilised a thorough analytical approach to review all existing literature, both peer-reviewed articles and grey literature, utilising a number of databases (including MEDLINE, PsychInfo and Embase) to search for peer-reviewed articles. The range was limited to literature published between 2000 and September 2014.

To minimise publication bias, unpublished literature was sourced if available. Furthermore, health care institutions, non-government organisations and experts were also consulted for studies and data. Two independent reviewers undertook the study selection process by choosing studies that also included functional restoration and participation. A narrative analysis was conducted to synthesise all obtained data.

This review identified a total of 10 studies (both randomised controlled trials and observational studies) that analysed a number of interventions on treating natural disaster survivors. The employed interventions were diverse, with some focusing on a community educational program approach with others utilising a multidisciplinary model.

Due to methodological limitations, the quality assessment score for these studies was low. Results indicated efficacy of inpatient rehabilitation services, in terms of reducing disability and bettering the quality of life. However, there was no data on the costs associated with these services, thereby limiting the overall picture.

The authors conclude that medical rehabilitation should be better incorporated into both response planning and natural disaster management in preparation for future incidents. Significantly, they note the dire need for increased access to rehabilitation and further investment into both education and sustainable infrastructure. Future studies undertaking a broader methodological approach should be conducted to further build the evidence base on such interventions, while also considering cost-effectiveness.

You can read the paper here.

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