The World Health Assembly 2023 resolution calls all stakeholders to prioritize health policy and systems research in rehabilitation

Article type
Authors
Cordani C1, De Groote W2, Décary S3, Del Furia M4, Feys P5, Frontera W6, Jette A7, Kiekens C8, Negrini S1, Oral A9, Resnik L10, Røe C11, Sabariego C12
1Department of Biomedical, Surgical and Dental Sciences, University “La Statale” , Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
2Rehabilitation Program, Department for Noncommunicable Diseases, Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
3Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l’Estrie-CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
4Department of Biomedical, Surgical and Dental Sciences, University “La Statale” , Milan, Italy; Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
5Faculty of Rehabilitation Sciences, University of Hasselt, REVAL Rehabilitation Research Center, Diepenbeek, Belgium
6Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
7Boston University's Sargent College of Health & Rehabilitation Sciences, Boston, MA, USA
8IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
9Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
10Department of Health Services, Policy and Practice, Brown University and Research Career Scientist VA Medical Center, Providence, RI, USA
11Department of Physical Medicine and Rehabilitation, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
12Swiss Paraplegic Research, Nottwil, Faculty of Health Sciences and Medicine and Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
Abstract
Background
The recent World Health Assembly resolution "Strengthening rehabilitation in health systems" aims to scale up and integrate rehabilitation into health systems as part of universal health coverage (UHC), urging member states to promote high-quality rehabilitation research, including health policy and systems research (HPSR). Therefore, the World Rehabilitation Alliance created a “research workstream” to advocate for the demand and utilization; the widespread generation; and the publication, dissemination, and implementation of (high-quality) HPSR evidence for rehabilitation. In collaboration with the World Health Organization (WHO), Cochrane Rehabilitation is developing a project on HPSR evidence synthesis in rehabilitation to effectively address real-life challenges in complex healthcare settings.

Objectives
To introduce a framework for categorizing research questions in health policy, systems, and services research in rehabilitation and explore and propose appropriate study designs

Methods
Drawing from existing reports, categorizations of HPSR articles, and discussions by expert groups, a comprehensive framework outlining different types of HPSR questions relevant to rehabilitation is proposed. Each type is accompanied by illustrative examples and corresponding study designs drawn from contemporary rehabilitation literature. Furthermore, applicability, usefulness, and implementation aspects are discussed.

Results
Four types of HPSR questions were distinguished: 1) policy-focused questions, 2) questions centered on healthcare delivery organizations or systems, 3) questions from defined patient or provider perspectives, and 4) inquiries about critical data sources or research methodologies. Appropriate methodologies are provided for each type of research question, eg, controlled interrupted time series analysis, regression discontinuity design, mixed-methods case study, and validation study.

Conclusions
HPSR presents a dynamic field poised to address pressing issues in rehabilitation service delivery and policy formulation. Elucidating research questions and study designs apply to macro, meso, and micro levels, demonstrating the potential of HPSR in shaping policies, improving healthcare delivery, and addressing patient and provider perspectives.

Relevance and importance to patients
This framework provides a roadmap for generating evidence that directly informs policymaking, healthcare delivery, and patient outcomes in rehabilitation. Addressing key research questions and methodologies facilitates the integration of research findings into clinical practice, ultimately enhancing the quality and effectiveness of rehabilitation services for patients and providers alike.