(I’m re-posting this from an article in the APTA Weekly)

A global study of disease burden finds a glaring need for rehab in primary care.ReviewDate: Tuesday, January 5, 2021

In this review: “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”
The Lancet

The Message
A review of data from a study on the global impact of diseases and injuries estimates that, worldwide, at least one in three people had a condition that would have benefitted from some form of rehabilitation in 2019, a prevalence rate that has increased estimates of years of life lived with disability — YLDs — by an estimated 63% from 2009 to 2019, to 310 million. Musculoskeletal disorders led the way, with low back pain being the most frequent MSK condition reported. Authors of the study believe that their findings make a compelling case for a worldwide effort to make rehabilitation a standard part of primary care.

The Study

Researchers based their findings on data from the Global Burden of Disease Study from 2019, an analysis of incidence and prevalence of 354 diseases and nearly 3,500 related disabling consequences of those diseases in 204 countries around the world. The study includes demographic information as well as YLDs for the various diseases and related conditions, and breaks down data by individual countries and world regions.

For the study published in The Lancet, authors focused on 20 conditions with the highest number of associated YLDs, and an additional five conditions “for which rehabilitation is a key intervention as part of an overall management plan.” The list included not only musculoskeletal disorders but also conditions such as cardiovascular disease, neoplasms, mental disorders, stroke, cerebral palsy, and impairments to vision or hearing. The researchers then analyzed their findings according to geographic region and compared results with the broader GBD study.


  • In 2019, researchers estimate, 2.41 billion people “had conditions that would benefit at some point during the course of the disease from rehabilitation services.” That incidence resulted in an estimated 310 million YLDs — a dramatic 63% increase from 1990, when an estimated 1.48 billion people were found to have had conditions that would have benefitted from rehab.
  • The prevalence of the conditions was nearly equal between men and women, with women reporting higher YLDs.
  • Musculoskeletal disorders were the most prevalent conditions globally, with low back pain leading the way in that category. Researchers estimate that 568 million people experienced LBP, resulting in 64 million YLDs. In fact, LBP was reported as the leading condition in need of rehab services in 134 of the 204 countries analyzed.
  • Sensory impairment (vision or hearing loss) was the second most-prevalent condition, but at 677 million people, it trailed MSK disorders significantly. The third largest condition group was neurological disorders (255 million), with stroke representing the highest rehab need in that category (86 million people and 18 million YLDs).
  • Regionally, the Western Pacific region reported the highest need, with an estimated 610 million people who could’ve benefitted from rehabilitation services. Southeast Asia was second (593 million), followed by World Bank high-income countries (530 million), Europe (373 million), the Americas (310 million), Africa (214 million), and the Eastern Mediterranean (182 million).

Why It Matters

“Rehabilitation has often been construed to be a very specialized and expensive service for the few, but our findings challenge this view,” authors write, adding that the need for rehabilitation was probably underestimated in their study, and is likely to rise even more rapidly in the aftermath of the COVID-19 pandemic and lingering disabilities experienced by survivors of the disease. The absence of sufficient rehabilitation services not only limits the lives of those in need, but comes at a significant societal cost, as increasing numbers of people are forced to leave employment due to disability, authors argue.

The Need for Change

Authors don’t mince words when it comes to how to address the looming problem.

“The only possible way to scale up rehabilitation to reach all those in need is through its integration into the health system and, specifically, for rehabilitation services to be strengthened at the primary care level,” authors write. “Our findings, combined with the changing global demographic and health trends, place new and major demands on health and social systems, increasing the need for strong primary care.”

Achieving this goal isn’t just about mustering sufficient political and economic will, authors write, but must also require “the traditional workforce in primary care settings” to have a better understanding of rehabilitation and rehab needs. In addition, rehabilitation specialists — physical therapists, occupational therapists, and speech-language pathologists — need to be accepted members of the primary care team.

All told, they write, the inclusion of rehabilitation in primary care will require a broad shift in thinking.

“To … make rehabilitation a political priority, rehabilitation stakeholders need to unite behind the common concept of functioning,” authors assert. “Optimizing functioning is the ultimate objective of rehabilitation, regardless of who the beneficiary is, who delivers it, or the context in which rehabilitation is delivered.”

Keep in Mind…

Authors of the study acknowledge several limitations, most of which are related to the limitations of the GBD study from which they drew their data. Among those factors: a reliance on estimates over primary data, and the standardization of disability weights that may not fully account for cultural and other differences. The study’s authors also point out that evidence supporting the effectiveness of rehabilitation interventions for certain health conditions is at times “scarce and low in quality.”