Influential factors for access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: a scoping review

To explore factors impacting access to and participation in rehabilitation for people with lower limb amputation (LLA) in East, South, and Southeast Asian developing countries. A scoping review was undertaken following the PRISMA-ScR guidelines. Five electronic databases (PsycINFO (Ovid), Medline (Ovid), CINAHL (EBSCO), AMED, and Proquest Social Sciences) were searched for articles from January 1980 till March 2020. Two authors independently assessed articles for inclusion. Included articles were classified according to the Health Care Delivery System Approach (HCDSA) framework levels. Twenty-four studies from 14 countries were identified. At patient level, age, gender, limited rehabilitation awareness, and economic status; at the rehabilitation level, gaps in referrals, family support, and professional skills; at the environmental level, services availability, and location; and, at government level, service costs, income loss, and lack of supporting policies were identified as important influencing factors. Rehabilitation access and participation factors were identified at multiple levels of the HCDSA. Contextually appropriate and accessible services considering individual characteristics and socio-economic status of individuals with LLA are needed, with timely referral to rehabilitation by trained professionals. Improving rehabilitation services for people with LLA in Asian developing countries requires supportive environments, accessible transport, social and financial security, and increased awareness, underpinned by appropriate policy.Implications for rehabilitationProvision of timely referral to rehabilitation by primary/acute health care settings with involvement of family/peer supports.Improved government support systems to facilitate individual access to and participation in rehabilitation with consideration of contextual socio-demographic and economic factors.Prioritisation of adequately resourced and well-designed rehabilitation centres by health care organisations in accessible locations.Implementation by local government of strategies to support development and implementation of well resourced, accessible, equitable, and contextually responsive rehabilitation services. Provision of timely referral to rehabilitation by primary/acute health care settings with involvement of family/peer supports. Improved government support systems to facilitate individual access to and participation in rehabilitation with consideration of contextual socio-demographic and economic factors. Prioritisation of adequately resourced and well-designed rehabilitation centres by health care organisations in accessible locations. Implementation by local government of strategies to support development and implementation of well resourced, accessible, equitable, and contextually responsive rehabilitation services.

为探究东亚、南亚及东南亚发展中国家下肢截肢（lower limb amputation, LLA）人群获取康复服务及参与康复的影响因素，本研究遵循PRISMA范围综述扩展版（PRISMA-ScR）指南开展范围综述。本研究检索了5个电子数据库：PsycINFO（Ovid平台）、Medline（Ovid平台）、CINAHL（EBSCO平台）、AMED以及Proquest Social Sciences，检索时限为1980年1月至2020年3月。由2名研究者独立对文献进行纳入评估，纳入的文献依据医疗服务递送系统框架（Health Care Delivery System Approach, HCDSA）的层级进行分类。最终纳入来自14个国家的24项研究。研究识别出多维度的重要影响因素：在患者层面，包括年龄、性别、康复认知不足及经济状况；在康复服务层面，包括转诊机制缺失、家庭支持不足及专业技能短板；在环境层面，包括服务可及性不足及地理位置限制；在政府层面，包括服务费用高昂、收入损失及配套政策缺失。下肢截肢人群的康复服务获取与参与影响因素分布于医疗服务递送系统框架的多个层级。需结合下肢截肢人群的个体特征与社会经济状况，提供符合当地情境且可及的康复服务，并由受过专业培训的人员及时开展转诊。改善亚洲发展中国家下肢截肢人群的康复服务，需依托适宜政策，打造支持性环境、完善可及性交通体系、提供社会与金融保障，并提升大众康复认知。康复实践启示：由基层/急诊医疗机构及时开展康复转诊，并联动家庭或同伴支持群体参与其中；完善政府支持体系，结合当地社会人口学与经济特征，助力个体获取并参与康复服务；医疗机构应优先在交通可及的区域设立资源充足、规划完善的康复中心；地方政府应落实相关策略，支持建设并推行资源充足、可及性强、公平可及且贴合当地情境的康复服务。由基层/急诊医疗机构及时开展康复转诊，并联动家庭或同伴支持群体参与其中；完善政府支持体系，结合当地社会人口学与经济特征，助力个体获取并参与康复服务；医疗机构应优先在交通可及的区域设立资源充足、规划完善的康复中心；地方政府应落实相关策略，支持建设并推行资源充足、可及性强、公平可及且贴合当地情境的康复服务。