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

Alarcos Cieza, Kate Causey, Kaloyan Kamenov, Sarah Wulf Hanson, Somnath Chatterji, Theo Vos, Alarcos Cieza, Kate Causey, Kaloyan Kamenov, Sarah Wulf Hanson, Somnath Chatterji, Theo Vos

Abstract

Background: Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritised in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury.

Methods: 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 bespoke aggregations of sequelae that were selected as amenable to rehabilitation. All analyses were done at the country level and then aggregated to seven regions: World Bank high-income countries and the six WHO regions (ie, Africa, the Americas, Southeast Asia, Europe, Eastern Mediterranean, and Western Pacific).

Findings: Globally, in 2019, 2·41 billion (95% uncertainty interval 2·34-2·50) individuals had conditions that would benefit from rehabilitation, contributing to 310 million [235-392] YLDs. This number had increased by 63% from 1990 to 2019. Regionally, the Western Pacific had the highest need of rehabilitation services (610 million people [588-636] and 83 million YLDs [62-106]). The disease area that contributed most to prevalence was musculoskeletal disorders (1·71 billion people [1·68-1·80]), with low back pain being the most prevalent condition in 134 of the 204 countries analysed.

Interpretation: To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need.

Funding: Bill & Melinda Gates Foundation.

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article published under the CC BY-NC-ND 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Figures

Figure 1
Figure 1
Global number of prevalent cases with conditions that would benefit from rehabilitation and the corresponding years of life lived with disability by age and sex with 95% uncertainty intervals, 1990 and 2019
Figure 2
Figure 2
Disease categories of prevalent conditions that would benefit from rehabilitation globally, by three age groups, 2019
Figure 3
Figure 3
Age-standardised prevalence rate of conditions that would benefit from rehabilitation and corresponding age-standardised YLDs rate for each major rehabilitation category, globally and by WHO region, 2019 For both prevalence and YLDs, the total height of the bars is higher than the age-standardised rates, corresponding to total need for rehabilitation. Each coloured section represents the age-standardised prevalence of individuals with at least one condition in this rehabilitation category or the corresponding age-standardised YLD rate. When we aggregated to all rehabilitation, we accounted for individuals with conditions in more than one category. YLDs=years of life lived with disability.
Figure 4
Figure 4
Map of leading health conditions requiring rehabilitation in each country, 2019 Each country's colour corresponds to the health condition with the highest number of individuals requiring rehabilitation. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. Marshall Isl=Marshall Islands. Solomon Isl=Solomon Islands. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

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