The ReLAB-HS consortium is committed to ensuring that that digital accessibility goes beyond access to web material and allows people who need rehabilitation to receive the right care within their homes and communities, in ways that benefit everyone fairly. This Global Accessibility Awareness Day, we’re asking, “How can rehabilitation needs be best addressed and what modalities can be used in different contexts across the globe?”
Digital accessibility is “the ability for a website, mobile app or software to be used by somebody who may have a disability that affects their hearing, vision, motor functions, or cognition…digitally accessible design also applies to people who may have language barriers.” A billion people across the globe have disabilities due to visual, hearing, motor, and cognitive impairment. While efforts have been made to address gaps in digital accessibility, there remains a disproportionately wide gap faced by those living in low- and middle-income countries. The global COVID-19 pandemic has further widened this gap for various vulnerable groups including people with disabilities, youth, the elderly, women, those living in rural and remote areas. This widening gap has health, social, financial, and economic implications for the countries. To add to this group are those who need long-term rehabilitation care and were not able to receive it due to the shift in focus on acute care services due to the pandemic.
Telerehabilitation is a branch of medicine that applies principles of rehabilitation using telecommunication modalities to provide rehabilitation to patients within their homes and communities. This has implications for individuals in need of rehabilitation, their caregivers, and rehabilitation providers as it provides services where the need is and overcomes barriers associated with physical access to rehabilitation services. It provides a model of home care and community-based services that can use different modalities (phone, chat, video) to connect providers and patients and address issues related to availability using local technical solutions and resources. Telerehabilitation delivers a customized plan of care and provides an opportunity for mutual decision-making between providers and patients, emphasizing the need of involving patients in their care. There are a 2.4 billion people worldwide who have a condition that would benefit from rehabilitation. This includes 1.4 billion people who do not have a disability but have rehabilitation needs due to their underlying disease condition. Given the pandemic, telerehabilitation services emphasize care that is inclusive of the physical and mental health needs of individuals. It is crucial to think of ways in which telerehabilitation can be made integral to rehabilitation service delivery models and as widely accessible as possible, especially in low- and middle-income countries.
Learning, Acting and Building for Rehabilitation in Health Systems (ReLAB-HS) seeks to understand and address challenges faced by countries to integrate rehabilitation inclusive of assistive technology into their health systems. A key component of ReLAB-HS is to bring rehabilitation care to where people are, that is, within their home and communities. This is to lessen the burden on limited rehabilitation facilities and ensure continuity of care among those who need rehabilitation. Central to this approach is the implementation of appropriate, contextualized service delivery models for rehabilitation that are sustainable and can be scaled up.
ReLAB-HS, will implement telerehabilitation interventions to integrate rehabilitation services into health systems (specifically at the primary and community levels), training health workers and increasing access to information and practice guidelines, and encouraging effective self-management strategies for people with rehabilitation needs and their caregivers. ReLAB-HS’s telerehabilitation service delivery model will be implemented in Uganda, Ukraine, and Pakistan. It will take a multi-sectoral approach to engage with policy-makers, providers, users, and caregivers for holistic service delivery. In addition, the plan is also to hone in on local public-private partnerships and engage the private sector within the sustainability efforts for rehabilitation care.
Taking a phased person-centered approach, ReLAB-HS will start by engaging with providers and potential users of the application to determine their needs, which we will use to inform the development of the software prototype for the structure of the service delivery application. The prototype will be developed based on General Web Content Accessibility Guidelines and adapted based on local contexts and accessibility needs. The second phase will focus on developing and implementing software functionalities for priority rehabilitation populations to be used by healthcare workers across the care continuum. It will be an iterative process, guided by local rehabilitation needs and contexts, to address service delivery gaps at primary and community levels. Additional functionalities will be added to the application to support patients and their informal caregivers, which may be family members, friends, or other community members.
Digital accessibility will be ensured through functionalities that are mobile-based and allow office access to the application. This approach allows people the opportunity to be actively involved in their rehabilitation care plan and develop local technical capacity to develop models of service delivery that are inclusive of rehabilitation care.
Photo credit: “Mobile Phone Charging Station” by AdamCohn is licensed under CC BY-NC-ND 2.0