The impact of rehabilitative services in the lives of adults and children with disabilities, in low-income and middle-income countries: an assessment of the quality of the evidence

Purpose: To describe the methodological quality of the studies that assess the impact of rehabilitative services in the lives of adults and children with disabilities, in low-and middle-income countries. Method: A literature search was conducted using the electronic databases: EMBASE, MEDLINE, Global Health and Web of Knowledge to identify eligible studies. Twenty-four studies were identified and reviewed against a set of quality criteria. Results: Out of the 24 studies, nine were randomised controlled trials (RCT), five were non-randomised trials and 10 were case series studies. The majority of studies (n) including RCTs focused on participants with mental illness. Impact assessments of Community Based Rehabilitation programmes were conducted as observational studies only. Reports of sample size calculations and sampling methodologies were inadequate. Regression analysis accounting for confounding factors was rarely conducted. Conclusions: There have been few studies assessing the impact of rehabilitative services using research designs that allow attribution of changes in client-centred outcomes to interventions. Although it is not always feasible to conduct RCTs for rehabilitative interventions in these settings, all studies should be conducted and reported to a high methodological quality.