Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series

Purpose: The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation. Method: A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation. Results: The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement. Conclusions: Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program.Implications for rehabilitation A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities. For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement. For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.