Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); International; Health Services Research
Objective : To evaluate the effectiveness of a community-based rehabilitation program (CBR) on the function of people living with chronic musculoskeletal diseases.
Design : Prospective, comparative before-and after observational study with quantitative and qualitative evaluation components.Track:
Setting : Community setting in the Mayan Municipality of Chankom, Southeast Mexico.
Participants (or Animals, Specimens, Cadavers) : Adults with a diagnosis of osteoarthritis, rheumatoid arthritis, fibromyalgia or chronic back pain diagnosed by a Physiatrist or a Rheumatologist following the ACR criteria during a census based on the WHO-COPCORD methodology proposed on the entire adult population of the Municipality (1).
Interventions : A CBR designed in collaboration with community representatives was implemented and included: 1) Specialized, transdisciplinary services (i.e. Rehabilitation and Rheumatology), 2) Community exercise therapy and thermotherapy, 3) Medications' distribution, 4) Laboratory services' facilitation, 5) health system navigation through community liaisons, and 6) community capacity building.
Main Outcome Measure(s) : Quantitative: a culturally translation and adaptation of the Health Assessment Questionnaire Disability Index (HAQ-DI) (2) was applied to both the participants that received the intervention (n=130) and to a control group (n=84). Qualitative outcomes: one-on-one in-depth interviews were applied to 25 participants in the intervention and 25 participants in the control groups by anthropologists before and after 9 months aiming to understand participants' experiences of change regarding disability.
Results : 214 participants completed both evaluations. Wilcoxon's sign tests revealed significant positive changes (i.e. p<0.01) after the intervention's implementation on the HAQ-DI dimensions of dressing, eating, walking, bathing, reaching, usual activities and pain only for the intervention group. Narratives on disability experiences showed a positive impact of the intervention in allowing performance of meaningful activites without pain, which was perceived as being cured: "I am happy, I am cured, I don't have a disability anymore" (woman, 60 yo with rheumatoid arthritis).
Conclusions : A multi-dimensional CBR program designed in collaboration with community representatives is effective to improve the function of people living with chronic musculoskeletal diseases in the Mayan Municipality of Chankom Yucatan.
Adalberto Loyola Sanchez– Assistant Professor, University of Alberta, Edmonton, Alberta
Ingris Pelaez-Ballestas– Medical Researcher, Rheumatology Unit, Hospital General de México, Mexico City, Distrito Federal
Ana Gabriela Cruz-Martín– Doctoral student, Universidad Nacional Autonoma de Mexico, Mérida, Yucatan