Evaluation of medical rehabilitation in community based rehabilitation

Almost all governments and non-governmental organisations in developing cou ntries use a community-based rehabilitation (CBR) approach to work with dis abled people. Although disabled people's organisations reject the categoris ation of disability in individual terms, 'medical rehabilitation' is still regarded as an important but time limited process within rehabilitation. Th e paper lists measures and methods used in a comprehensive evaluation, and presents a practical method to examine the quality of medical rehabilitatio n. The method was developed and applied in an evaluation of service needs a nd service provision for disabled people in low-income communities, for the Ministry of Welfare, Government of India. The method described is a tracer approach. It assesses quality in three aspects of medical rehabilitation: (i) Technical quality, based on application of minimum technical standards for each impairment. (ii) Interpersonal quality, by observation of service sessions and intervie ws with service users. (iii) Management (structural) quality, by comparing the rehabilitation goal s of service users and service providers. The method differs from most others in that it is process oriented, as oppo sed to output oriented. The method meets the challenges of providing low-co st assessment of a difficult outcome measure (the quality of medical rehabi litation), within a complex process (CBR). It is anticipated that the trace r method will be useful to the objective evaluation of disability services throughout the developing world. (C) 2001 Elsevier Science Ltd. All rights reserved.