Management of Undergraduate Community-Based Rehabilitation Programmes in the Philippines: A Cross-Sectional Survey

Pocholo B Trinidad, Litty M Shibu, Napoleon R Caballero, Ebrahim Rajab

Abstract


Purpose: The survey aimed to identify common strengths and weaknesses regarding the characteristics, management and implementation of Community-Based Rehabilitation (CBR) training in the undergraduate curriculum of Schools of Physical Therapy in the Philippines, and make recommendations for improvement.

Method: A survey was conducted with the academic heads of CBR departments in 10 Physical Therapy schools. The institutions were selected through cluster sampling according to regional location. Nine of these were private institutions. Data was collected through a 24-item self-assessment survey distributed to the heads of the participating colleges /departments.

Results: A number of strengths and weaknesses were identified. The strengths were:  all schools had a 1 to 2-month clinical CBR course integrated into their undergraduate curriculum; CBR courses were supported by a course syllabus, learning outcomes, student assessment and clinical training manual; 80% of institutions had implementing policies and guidelines governing management of the CBR programme(s); at least one physiotherapist was involved in the management of the CBR programme(s); and, CBR activities were delivered in coordination with key stakeholders management, with emphasis on delivery of physical therapy services, disability prevention, health education, participation of persons with disabilities and community awareness. The weaknesses were: no head/programme coordinator for 30% of CBR programmes; 40% did not have clinical coordinators as designated management positions in the CBR programme; only 50% of academic staff received formal CBR training, of which 80% was provided through CBR summits and professional interaction with other physical therapists; and, only 50% of schools adopted a multidisciplinary approach to service delivery which was focused on the Health domain of the CBR Matrix.

Conclusion:  The CBR component of the undergraduate physical therapy curriculum in the Philippines can be improved. A shift in the teaching to transdisciplinary care and inter-professional learning is recommended. Regular review of the CBR indicators should be done by the schools, including the key stakeholders.  Challenges for CBR implementation were recruitment of community volunteers as CBR workers, availability of indigenous resources and finances to support CBR activities, and family participation in the rehabilitation of a relative with a disability. Each school should determine whether current human resources and training are adequate. Schools must be encouraged to jointly identify common problems in CBR education and share solutions. 


Keywords


Asia-Pacific region; persons with disabilities; global health; implementation

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References


Balasubramanian MM, Dhanesh KG, Amarnath A (2012). Functional independence and quality of life for persons with locomotor disabilities in institutional based rehabilitation and community based rehabilitation - A comparative study. Disability, CBR & Inclusive Development; 23(3): 150-155. https://doi.org/10.5463/dcid.v23i3.147

Bowers B, Kuipers P, Dorsett P (2015). A 10-year literature review of the impact of community based rehabilitation. Disability, CBR & Inclusive Development; 26(2): 104-119. https://doi.org/10.5463/dcid.v26i2.425

Bury T (2005). Primary health care and community based rehabilitation: implications for physical therapy. Asia Pacific Disability Rehabilitation Journal; 16(2): 29-61.

Carrington L (2007). Changing concepts of CBR 2 - Implications for physical therapists [online]. Retrieved from https://www.wcpt.org/sites/wcpt.org/files/files/KN-Changing_Concepts_of_CBR2.pdf [Accessed on 7 Jun 2019]

Cayetano RDA, Elkins J (2016). Community-based rehabilitation services in low and middle-income countries in the Asia-Pacific Region: successes and challenges in the implementation of the CBR Matrix. Disability, CBR & Inclusive Development; 27(2): 112-127. https://doi.org/10.5463/dcid.v27i2.542

Commission on Higher Education (2006). CHED Memorandum Order No. 24. Series of 2006. Policies standards and guidelines for physical therapy and occupational therapy education. Philippines, [online]. Available at: https://ched.gov.ph/2006-ched-memorandum-orders/ [Accessed on 7 Jun 2019]

Commission on Higher Education (2017). CHED Memorandum Order No. 55. Series of 2017. Policies, standards and guidelines for the Bachelor of Physical Therapy education. Philippines, [online]. Available at: https://ched.gov.ph/2017-ched-memorandum-orders/ [Accessed on 7 Jun 2019]

Como E, Batdulam T (2012). The role of community health workers in the Mongolian CBR programme. Disability, CBR & Inclusive Development; 23(1): 14-33. https://doi.org/10.5463/dcid.v23i1.96

Cornielje H, Velema JP, Finkenflugel H (2008). Community based rehabilitation programmes: monitoring and evaluation in order to measure results. Leprosy Review; 79(1): 36-49.

Ernstzen DV, Statham SB, Hanekom SD (2014). Learning experiences of physiotherapy students during primary healthcare clinical placements. African Journal of Health Professions Education; 6(2): 211-216. https://doi.org/10.7196/AJHPE.530

Futter MJ (2003). Developing a curriculum module to prepare students for community-based physiotherapy rehabilitation in South Africa. Physiotherapy; 89(1): 13-24. https://doi.org/10.1016/S0031-9406(05)60665-7

Gotlib J, Bialoszewski D, Sierdzinski J, Jarosz MJ, Majcher P, Barczyk K, Prokopowicz K (2010). A comparison of the perceptions and aspirations of third-year physiotherapy students trained in three educational settings in Poland. Physiotherapy; 96(1): 30-37. https://doi.org/10.1016/j.physio.2009.08.005. PMid:20113760

Jansen-van Vuuren JM, Aldersey HM (2019). Training needs of community-based rehabilitation workers for the effective implementation of CBR programmes. Disability, CBR & Inclusive Development; 29(3): 5-31. https://doi.org/10.5463/dcid.v29i3.742

Kandyomunda B, Dube S, Kangere M, Gebretensay MT (2002). The role of local NGOs in promoting participation in CBR. New York: Cornell University ILR School.

Karthikeyan P, Ramalingam K (2014). Physiotherapy training to enhance community-based rehabilitation services in Papua New Guinea: an educational perspective. Disability, CBR & Inclusive Development; 25(1): 82-94. https://doi.org/10.5463/dcid.v25i1.259

Kelland K, Hoe E, McGuire MJ, Yu J, Andreoli A, Nixon SA(2014). Excelling in the role of advocate: a qualitative study exploring advocacy as an essential physiotherapy competency. Physiotherapy Canada; 66(1): 74-80. https://doi.org/10.3138/ptc.2013-05

PMid:24719513 PMCid:PMC3941126

Kusuwo P, Myezwa H, Pilusa S, M'kumbuzi V (2017). A systematic review to identify system-related elements that can be used to evaluate community-based rehabilitation (CBR) programmes. European Journal of Physiotherapy; 19(sup1): 41-46. https://doi.org/10.1080/21679169.2017.1381323

Lee HS, Chang JS, Kwon YH, Choi Y-J (2011). Awareness of community-based rehabilitation with a focus on public health centres. Journal of Physical Therapy Science; 23(6): 909-913. https://doi.org/10.1589/jpts.23.909

Lopez JM, Lewis JA, Boldy DP (2000). Evaluation of a Philippine community based rehabilitation programme. Asia Pacific Journal of Public Health; 12(2): 85-89. https://doi.org/10.1177/101053950001200206. PMid:11836924

Madden V, O'Sullivan P, Fisher J, Malambule B (2013). "Our training left us unprepared"- two physiotherapists' reflections after working with women with low back pain in a rural Zulu community in South Africa. Journal of Community and Health Sciences; 8(2): 9-20.

Magallona MLM (2005). Manual for CBR workers and caregivers. 1st edition. Philippines: C & E Publishing, Inc.:7-8.

Magallona MLM, Datangel JP-B (2012). The community cased rehabilitation programme of the University of the Philippines Manila, College of Allied Medical Professions. Disability, CBR & Inclusive Development; 22(3): 39-61. https://doi.org/10.5463/dcid.v22i3.110

Magallona ML, Wirz S (1994). Transdisciplinary approach: Is the day of the multi-therapist with us already? Human Communication; 3(4): 12-13.

Mauro V, Biggeri M, Deepak S, Trani JF (2014). The effectiveness of community-based rehabilitation programmes: an impact evaluation of a quasi-randomised trial. Journal of Epidemiology and Community Health; 68(11): 1102-1108. https://doi.org/10.1136/jech-2013-203728. PMid:25194053

McGlade B, Mendoza V (2009). Philippine CBR manual: An inclusive development strategy. Manila, Philippines: CBM South East Asia & Pacific Regional Office (SEAPRO).

Mostert-Wentzel K, Frantz J, Van Rooijen AJ (2013). Status of undergraduate community-based and public health physiotherapy education in South Africa. South African Journal of Physiotherapy; 69(1): 26-35. https://doi.org/10.4102/sajp.v69i1.369

Narin S, Ünver B, Narin AN (2018). Physiotherapy students' expectations and career choice in Turkey. Journal of Exercise Therapy and Rehabilitation; 5(1):38-45.

Norris M, Allotey P (2008). Culture and physiotherapy. Diversity in Health and Social Care; 5: 151-159.

Nualnetr N (2009). Physical therapy roles in community-based rehabilitation: A case study in rural areas of north eastern Thailand. Asia Pacific Disability Rehabilitation Journal; 20(1): 73-81.

Nualnetr N, Sakhornkhan A (2012). Improving accessibility to medical services for persons with disabilities in Thailand. Disability, CBR & Inclusive Development; 23(1): 34-49. https://doi.org/10.5463/dcid.v23i1.86

Ojwang VP, Hartley S (2002). Community based rehabilitation training in Uganda: An overview. In: CBR, a Participatory Strategy in Africa. Hartley S (ed). London: University College London.

Patel S, Alavi Y, Lindfield R, Kuper H. (2013). The impact of rehabilitative services in the lives of adults and children with disabilities, in low-income and middle-income countries: An assessment of the quality of the evidence. Disability and Rehabilitation; 35(9): 703-712. https://doi.org/10.3109/09638288.2012.705949. PMid:22897156

Periquet AO (2009). Community-based rehabilitation in the Philippines. International Disability Studies; 11(2): 95-96. https://doi.org/10.3109/03790798909166400. PMid:2534311

Pettignano R, Bliss L, McLaren S, Caley S (2017). Interprofessional medical-legal education of medical students. Academic Medicine; 92(9): 1254-8. https://doi.org/10.1097/ACM.0000000000001581. PMid:28177959

Raj VSV, Thomas M (2015). Effectiveness of training community-based rehabilitation workers on multiple disabilities: A pilot study. International Journal of Health & Allied Sciences; 4(4): 259-262. https://doi.org/10.4103/2278-344X.167654

Ramklass SS (2009). An investigation into the alignment of a South African physiotherapy curriculum and the expectations of the healthcare system. Physiotherapy; 95(3): 216-223. https://doi.org/10.1016/j.physio.2009.02.004. PMid:19635342

Rhoda AJ, Waggie F, Filies G, Frantz J (2016). Using operative models (ICF and CBR) within an interprofessional context to address community needs. African Journal of Health Professions Education; 8(2): 214-6. https://doi.org/10.7196/AJHPE.2016.v8i2.850

Robertson J, Emerson E, Hatton C, Yasamy MT (2012). Efficacy of community-based rehabilitation for children with or at significant risk of intellectual disabilities in low- and middle-income countries: a review. Journal of Applied Research in Intellectual Disabilities; 25(2): 143-154. https://doi.org/10.1111/j.1468-3148.2011.00679.x. PMid:22473966

Rule S (2013). Training CBR personnel in South Africa to contribute to the empowerment of persons with disabilities. Disability, CBR & Inclusive Development; 24(2): 6-21. https://doi.org/10.5463/dcid.v24i2.180

Shamrock J (2009). Evaluation of a pilot community based rehabilitation training programme in East Timor. Asia Pacific Disability Rehabilitation Journal; 20(2): 17-31.

Thomas M, Thomas MJ (2003). Manual for CBR planners. First edition. Bangalore, India. Asia Pacific Disability and Rehabilitation Journal Group Publication.

Twible R, Henley E (2000). Preparing occupational therapists and physiotherapists for community based rehabilitation. Asia Pacific Disability Rehabilitation Journal; 1: 113-129.

United Nations Economic and Social Commission for Asia and the Pacific - UNESCAP (2016). Disability at a glance 2015: strengthening employment prospects for persons with disabilities in Asia and the Pacific, UN, New York, [online]. https://doi.org/10.18356/904748a8-en

Van Hees S, Cornielje H, Wagle P, Veldman E (2014). Disability inclusion in primary health care in Nepal: an explorative study of perceived barriers to access governmental health services. Disability, CBR & Inclusive Development; 25(4): 99-118. https://doi.org/10.5463/dcid.v25i4.373

Wasti SP, Simkhada P, Randall J, Freeman JV, Van Teijlingen E (2012). Barriers to and facilitators of antiretroviral therapy adherence in Nepal: a qualitative study. Journal of Health, Population, and Nutrition; 30(4): 410-419. https://doi.org/10.3329/jhpn.v30i4.13294. PMid:23304907 PMCid:PMC3763612

Weiss MG, Ramakrishna J, Somma D (2006). Health-related stigma: rethinking concepts and interventions. Psychology Health and Medicine; 11(3): 277-287. https://doi.org/10.1080/13548500600595053. PMid:17130065

World Confederation for Physical Therapy (2016). WCPT keynotes. Community based rehabilitation. Changing concepts of CBR 1 - The WHO review [online]. Available from https://www.wcpt.org/node/29614 [Accessed on 7 Jun 2019].

World Health Organisation (2001). International classification of functioning, disability and health (ICF). Geneva, Switzerland, [online]. Retrieved from https://www.who.int/classifications/icf/icf_more/en/ [Accessed on 26 Apr 2020]

World Health Organisation (2010). Community-based rehabilitation guidelines. Geneva, Switzerland, [online]. Available at https://www.who.int/disabilities/cbr/guidelines/en/ [Accessed on 7 Jun 2019]

World Health Organisation (2019). Western Pacific regional framework on rehabilitation. Manila, Philippines, [online]. Retrieved from https://iris.wpro.who.int/handle/10665.1/14344 [Accessed on 7 Jun 2019].

Ziebart C, MacDermid JC (2019). Reflective practice in physical therapy: A scoping review. Physical Therapy; 99(8): 1056-1068. https://doi.org/10.1093/ptj/pzz049. PMid:30921467




DOI: https://doi.org/10.5463/dcid.v31i1.849



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