Estimates of the need for rehabilitation

ENLACE REHABILITATION NEED WORKFORCE ASSISTIVE TECHNOLOGY COUNTRY PROFILE TECHNICAL NOTES ABOUT

Rehabilitation is a set of interventions needed when a person is experiencing limitations in everyday physical, mental, and social functioning due to aging or a health condition, including chronic diseases or disorders, injuries, or trauma. Rehabilitation includes services such as physiotherapy, occupational therapy, speech and language therapy, physiatry, psychology, prosthetics and orthotics, and others. Rehabilitation is an essential service for Universal Health and might be needed by anyone with a health condition who experiences difficulties in mobility, vision, or cognition, among others. Estimates of the need for rehabilitation are essential for policy and program development.

This visualization presents the need for rehabilitation services in countries of the Americas. It allows users to explore the prevalence and years of life lived with disability (YLDs) of 25 disease causes, impairments, and aggregations of sequelae that would be amenable to rehabilitation at some point in the course of the disease by age, sex, and country from 1990 to 2019.

In 2019, across the Americas, 366 million people (188 million women and 178 million men) had health conditions that would benefit from rehabilitation at some point during the course of their disease contributing to 46 million YLDs.

The number of people who may benefit from rehabilitation has increased by 58% from 231 million in 1990. The increase was higher in women (61%) than in men (56%).

The age-standardized prevalence and YLD rates showed modest declines since 1990, indicating that the large increase in cases is due to population growth and population aging.

The age-standardized prevalence rate (per 100,000 population) varied from 35.9 thousand cases in the United States of America to 26.8 thousand cases in Bolivia. Across all ages, the crude prevalence rate (per 100,000 population) ranged from 45.5 thousand cases in the United States of America to 23.5 thousand cases in Bolivia.

The countries with the highest prevalence of people with conditions amenable to rehabilitation are: The United States of America, Haiti, Uruguay, Argentina, Chile, Guatemala, El Salvador, and Canada.

The countries with the lowest prevalence of people with conditions amenable to rehabilitation are: Dominica, Peru, United States Virgin Islands, Bahamas, Ecuador, Trinidad and Tobago, Barbados, and Bolivia (Plurinational State of). It should be noted, however, that even in these countries, prevalence is still high with at least 1 in 4 people having a potential need for rehabilitation in all countries.

The likelihood of having a rehabilitation need increases exponentially with age. Musculoskeletal disorders (such as back and neck pain, fractures, and arthritis) and sensory impairments (such as vision or hearing loss) are the two most frequent groups of conditions by age.

Across the Americas in 2019, the five most common individual conditions amenable to rehabilitation were low back pain, osteoarthritis, fractures, hearing loss, and other injuries.

Regionwide in 2019, the top five leading individual conditions amenable to rehabilitation contributing to YLD rate were: Low back pain, osteoarthritis, fractures, neck pain, and hearing loss.

Data source

In this topic, data from the global estimates of the need for rehabilitation, jointly produced by WHO and the Institute for Health Metrics and Evaluation (IHME), were used. The data sources and methods for measuring the need for rehabilitation were documented in the paper “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019” published in the medical journal The Lancet. The paper provides the first-ever global, regional, and national figures on the number of people in need of rehabilitation. Full detail of the methodology to calculate the rehabilitation need is described there. A summary is shown below:

To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, or aggregations of sequelae that were selected as amenable to rehabilitation.

The GBD 2019 study estimated incidence, prevalence, and YLDs by age, sex, year, and location for 354 diseases and injuries, and 3484 sequelae (ie, the disabling consequences of these diseases and injuries). Prevalence accounts for the number of people (new and old cases) with a disease or health condition. YLDs are a measure of the burden of non-fatal disease and injury measured in number of years and were calculated by multiplying the prevalence of each sequela by the estimated level of health loss in the form of a disability weight.

For the selection of health conditions amenable to rehabilitation: 1. the 20 conditions with the highest number of associated YLDs were identified. 2. conditions for which rehabilitation is not essential and is usually indicated as a secondary intervention (eg, dietary iron deficiency or oral disorders) were excluded. 3. a group of experts in the field of rehabilitation was convened by WHO to discuss the current list and add any health conditions for which rehabilitation is a key intervention as part of an overall management plan. 25 health conditions were selected for the analysis.

Twenty-five health conditions were selected for the analysis and were grouped and presented into seven aggregate disease and injury categories, following the GBD standard categorization of diseases.

List of conditions amenable to rehabilitation

Aggregate disease and injury category	Individual conditions
Musculoskeletal disorders	Low back pain Neck pain Fractures Other injuries Osteoarthritis Amputation Rheumatoid arthritis
Neurological disorders	Cerebral palsy Stroke Traumatic brain injury Alzheimer's disease and dementia Spinal cord injury Parkinson's disease Multiple sclerosis Motor neuron disease Guillain-Barré syndrome
Sensory impairments	Hearing loss Vision loss
Mental disorders	Developmental intellectual disability Schizophrenia Autism spectrum disorders
Chronic respiratory diseases	Chronic respiratory diseases
Cardiovascular diseases	Heart failure Acute myocardial infarction
Neoplasms	Neoplasms

Outcome measures

Prevalence and years lived with disabilities (YLDs) were estimated for all conditions, the seven aggregate categories, and individual conditions amenable to rehabilitation. Both measures we calculated by age, sex, location, and year from 1990 to 2019.

Estimates of each outcome measure were corrected for comorbidity using simulation methods and assumed a multiplicative model for coexisting health states.

Full details of the methodology are available in the paper “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019”

DATA CLASSIFICATION

In the map and horizontal bar chart, the data is presented in five classes created using the quantile classification method. Each class contains 20% of countries, which is easy to interpret. The quintile intervals are labeled sequentially from Quintile 1, also called the bottom quintile which includes the lowest fifth (0 to 20%) of data points to Quintile 5 (or top quintile), which includes the top fifth (80% to 100%) of data points.

Cieza A. Rehabilitation the health strategy of the 21st century, really? Arch Phys Med Rehabil 2019; 100: 2212–14. DOI: https://doi.org/10.1016/j.apmr.2019.05.019

Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021 Dec 19;396(10267):2006-2017. doi: 10.1016/S0140-6736(20)32340-0

Suggested citation:

Regional and national estimates of the need for rehabilitation in the Region of the Americas, 1990-2019. ENLACE data portal. Pan American Health Organization. 2022. [Internet] https://www.paho.org/en/enlace/estimates-need-rehabilitation.