1. The Impact of physical rehabilitation on the lives of persons with physical impairments in Myanmar
Karl Blanchet – Associate Professor, HHCC
Islay Mactaggart – Research Fellow, ICED
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2. Outline Study Background Methods Results Improving health worldwide

3. Study Background Project duration: Jan 2015 – Dec 2016
Commissioned by the International Committee of the Red Cross
Conducted in Collaboration with the University of Public Health, Yangon, Myanmar
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4. Physical Impairment & Rehabilitation
Up to 16% of the global population experience disability, of which physical impairment is a major component
Evidence suggests that persons with disabilities are generally:
Less likely to be working1
More likely to be unwell2
More likely to live in poverty3
1 Trani & Loeb (2012); Mizunoya & Mitra (2015); ICED (2017)
2 Kuper et al. (2014); Mactaggart et al. (2015); Eide et al. (2015); ICED (2017)
3 Mitra et al. (2013); Banks & Keogh (2016);
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5. Physical Impairment & Rehabilitation
Physical rehabilitation is a key component of rehabilitation and inclusion
Can optimise functioning
Can support economic & social independence
Can support participation
Can increase quality of life
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6. Physical Impairment & Rehabilitation
Conflict and post-conflict settings increase risk of physical impairment and potential need for physical rehabilitation1
Very little evidence on the impact of physical rehabilitation exists
1 Dos Santos-Zingale & McColl (2006), Rischewski et al. (2008), WHO (2011)
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7. Disability in Myanmar 51.4 million population
1.8% GDP spending on health
Census estimates:
4.6% prevalence of disability
1.9% prevalence of physical impairment
Common Causes of physical impairment:
Unintentional injury (road accidents, falls, machinery)
land mine injury
secondary amputation due to peripheral vascular disease (PVD)
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8. Rehabilitation in Myanmar
30 Physical Medicine Departments in General Hospitals
69 Physiotherapist-led departments
Multiple Community Based Rehabilitation Initiatives
Limited prosthetic and orthotic services
Substantial reliance on NGOs
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9. Rehabilitation in Myanmar
ICRC has supported over 6000 people to receive artificial limbs in Myanmar since 2013
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10. Study Aim & Objectives
Study Aim: To assess the impact of physical rehabilitation on the physical functioning, economic status and quality of life of persons with physical impairments in Myanmar.
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11. Study Aim & Objectives
Study Aim: To assess the impact of physical rehabilitation on the physical functioning, economic status and quality of life of persons with physical impairments in Myanmar.
Study Objectives:
To measure changes in physical functioning, quality of life and economic status amongst persons with physical impairments before and one year after receiving physical rehabilitation for the first time
To compare these indicators to persons without physical impairments
To understand the changes persons with disabilities experienced after their accident and after rehabilitation
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12. Methods A quantitative observational impact case-control study
2) A qualitative investigation of the impact of physical impairment and rehabilitation in Myanmar
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13. Quantitative Study
100 persons with physical impairments (cases) recruited prior to accessing physical rehabilitation (prostheses or orthoses) for the first time
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14. Quantitative Study
100 persons with physical impairments (cases) recruited prior to accessing physical rehabilitation (prostheses or orthoses) for the first time
100 community controls recruited (same age, sex, community as each case)
Data collected at:
Baseline (pre intervention)
6 months post intervention
12 months post intervention
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15. Quantitative Study
100 persons with physical impairments (cases) recruited prior to accessing physical rehabilitation (prostheses or orthoses) for the first time
100 community controls recruited (same age, sex, community as each case)
Data collected by:
Trained mid-level rehab professionals at NRH and HORC
Recruitment
Physical assessment of recruited clients
Assessment of quality of assistive devices
6 full time recruited research assistants
Interviews and physical functioning assessment
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16. Quantitative Study
100 persons with physical impairments (cases) recruited prior to accessing physical rehabilitation (prostheses or orthoses) for the first time
Eligibility criteria
Cases
Controls
Aged 18+
Had never before been fitted with a prosthesis or orthotic assistive device
According to a trained physiotherapist, need to be fitted with either a prosthesis or orthotic device
Was able to communicate with the data collectors either independently or via a translator
Did not plan to migrate outside of Myanmar within the following 12 months
Did not have a physical impairment
Was the same sex as the Case
Between 5 years younger and 5 years older than the Case
From the same village as the Case
Did not plan to migrate outside of Myanmar within the preceding 12 months
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17. Data Collection Core Domain Tool Info Physical Functioning
Physical Performance Test
9 items of daily living
Two Minute Walk Test
Distance walked in 2 minutes
Quality of Life
WHOQOL-BREF
26 QOL items
Stylised Activity List (LSMS)
10 activities (productive, leisure, inactivity and assistance)
Socio-Economic Status
Average Monthly Household Income
Relative Wealth Index
Principle components analysis of asset ownership
Personal Consumption Expenditure
85 household expenditure items (food, education, health, household, personal and rent)
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18. Results - Participants
108 cases and 104 controls recruited at baseline
18 – 39 (43%)
40 – 59 (44%)
60+ (14%)
Age
Working Status
<0.01
<0.01
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19. Results - Participants
Amongst cases at baseline:
98% amputees
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20. Results – Physical Functioning
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21. Results – Physical Functioning
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22. No significant change amongst cases between baseline and follow up
Results – Quality of Life
P<0.001 for all domains
No significant change amongst cases between baseline and follow up
P=0.3
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23. Results – Time Use Hours Improving health worldwide www.lshtm.ac.uk
<0.001
<0.001
<0.001
Hours
<0.001
<0.001
<0.001
<0.05
<0.05
<0.001
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24. Results – Socioeconomic status
Cases significant decrease expenditure and increase income compared to baseline – now similar to controls
No significant differences in PCE or PCY
Y gap <0.05
Income 34.0
Income 41.4
Income 41.4
Income 41.5
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25. Discussion
Majority of reported causes preventable – need for policies to minimise risk of trauma and of amputation from acquired health conditions
At baseline, cases had lower physical functioning and quality of life; spent less time working and much higher expenditure on healthcare than controls leading to a higher income gap
Physical functioning improved significantly for cases at follow up, with most gains made by 6 months post-intervention
Cases at follow up spent significantly more time working than at baseline, spent less on expenditure and therefore no longer experienced a bigger income gap compared to controls
No change in overall quality of life at follow up across all sub-domains except social relationships
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26. Discussion
Rehabilitation support in Myanmar has substantial positive benefits for persons with physical impairments
Physical functioning
Ability to work
Financial security
More nuanced approaches to measuring impact on QOL may be needed
Need better understanding of longer term support needs
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27. Visit http://disabilitycentre.lshtm.ac.uk/ to download
More in Report!
Further quantitative analyses
Qualitative Study
Service Delivery – quality of care and assistive device functionality across study period
Visit to download
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