Rehabilitation Global Needs

Introduction[edit | edit source]

Rehabilitation is the care needed when a person is experiencing or is likely to experience limitations in everyday functioning due to aging or a health condition, including chronic diseases or disorders, injuries, or trauma[1]. According to the World Health Organization (WHO), rehabilitation is defined as a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions interacting with their environment and is now considered an urgent and growing global issue[2]. The world's population is ageing, and the number of people living with non-communicable diseases is increasing. Also, people with injuries and injury-related consequences are becoming more frequent due to conflict, rapid urbanization, and motorization. The current demographic and health shifts are contributing to a rapid increase in the number of people experiencing impairment or decline in functioning for substantially larger periods of their lives. These changing health and demographic trends are contributing to rapid global increases in the numbers of people experiencing decline in functioning, resulting in enormous unmet rehabilitation needs. Much of these unmet needs are concentrated amongst the poorest and most vulnerable populations in low- and middle-income countries and conflict-affected settings, which are often ill equipped to cope with these increasing needs for rehabilitation services

Rehabilitation is a critical health strategy to optimise everyday functioning and ensure the highest possible standard of health and well-being and can include exercise, balance training, home modification, sensory integration, community activities, mobility aids, prosthetics/orthotics and many other interventions.[3] Rehabilitation interventions optimize function and well-being by addressing impairments, limitations, and restrictions in many areas (mobility, vision, and cognition) while considering personal and environmental factors.[2]  The need for rehabilitation depends on timing, aetiology and severity of the person’s health condition, the prognosis, the way in which illness affects the person’s ability to function in their environment, as well as the individual’s identified personal goals.[2] These services may be required  throughout their lifespan by persons with health conditions. Yet despite its individual and societal benefits in optimising function, rehabilitation has not been prioritised in countries and is under-resourced. [4]

Growing Demand for Rehabilitation Services[edit | edit source]

In the 21st century, rapid population ageing accompanied with a rise in chronic conditions, trauma/injury survival and non-communicable diseases (NCD) in conjunction with increasing global conflict, rapid urbanization and motorization are leading to a rapid shift in health care needs.[5] Hence, rehabilitation needs will further increase in the years to come, which is a considerable challenge for health and social systems.[4]

Reliable data about unmet needs for rehabilitation and assistive technology are scarce, but useful estimates can be drawn from information like the global burden of disease profiles and age statistics. According to the Global Burden of Disease Study in 2019, 2·41 billion individuals, which equates to approximately 1 in 3 people, had conditions that would benefit from rehabilitation, contributing to 310 million years of life lived with disability (YLDs) but estimates of current demand and supply are unclear, especially in LMICs. This has increased by 63% from 1990 to 2019, although age-standardised prevalence and YLDs rates showed modest declines since 1990, indicating that the large increase in cases is due to population growth and more specifically population ageing.[4] Excluding acute and remitting conditions associated with mild disability, 74% of YLD's globally are a result of health conditions for which rehabilitation would be beneficial, while severe levels of disability account for 15% of all YLD's where rehabilitation is a fundamental health intervention in order to optimise function.

Gender Considerations[edit | edit source]

If we consider this in terms of gender, the prevalence of a condition with rehabilitation needs was almost equal in men (1·19 billion) and women (1·22 billion), although women present with more YLDs (163 million) in comparison to men (146 million).

Age Considerations[edit | edit source]

According to the world data published in 2019, life expectancy has continued to increase globally with a 6-year increase seen alone between 2000 and 2019; from 66.8 years in 2000 to 73.4 years in 2019.[6] Generally, people can now expect to live more than twice as long as our ancestors, and this progress is seen in every world region.[7] According to WHO, the number of people over 60 years of age is predicted to double by 2050, with more people living with chronic conditions such as diabetes, cardiovascular disease, stroke, and cancer. [8]

Figure.1 Disease categories of prevalent conditions that would benefit from rehabilitation globally, by three age groups, 2019

As expected, if we consider rehabilitation needs in relation to an ageing population, the age where we see the greatest need both in terms of prevalence and YLDs is in people aged 50-70 years, while we see the lowest need for rehabilitation services in those aged 95 years and older. Musculoskeletal disorders, neurological disorders, sensory impairments, and chronic respiratory diseases were the largest contributors for those aged >65 years, while mental disorders and musculoskeletal disorders accounted for a smaller proportion than in comparison to adults younger than 65 years. [4] Widespread availability of rehabilitation services is essential for health systems to be able to respond effectively to the needs of an ageing population. Evidence suggests that access to primary care services and community-based rehabilitation increases the safety and independence of older people, reduces the risk of falls, and decreases the need for hospital and nursing home admissions. [2] With ageing populations, the need for long-term care is going to increase, especially in low-resource settings where already a large part of the world's ageing population lives, so integration of rehabilitation into long-term care is an essential strategy in long-term care, as one of its main goals is to improve limitations in everyday functioning due to ageing or underlying health conditions.

In those aged 15-64 years, 1600 million have a condition that would benefit from rehabilitation in 2019, with musculoskeletal disorders contributing to approximately two-thirds of this number. [4]

Yet the potential benefits of rehabilitation services are not restricted to the adult and aging populations. There are approximately 150 million children and adolescents who experience disabilities, and injuries for people of all ages are becoming more frequent due to conflict, rapid urbanization and motorization. Children constitute a significant and important portion of users of rehabilitation services. According to WHO, while child mortality rates are declining, not all who survive thrive.[6] Early interventions that optimize developmental outcomes for children with various health conditions and injuries (including congenital, acquired, neurological, orthopaedic, musculoskeletal and cognitive impairments) can positively affect participation rates in education, community activities, and future capacity to work. If we consider children younger than 15 years, sensory impairments, mental disorders, and musculoskeletal disorders accounted for 91% of the 162·3 million prevalent cases of children who have rehabilitation needs. [4]

For further information in relation to age and rehabilitation implications, causal distribution of the need for rehabilitation by age group can be found at: Global Burden of Disease Supplementary Appendix

Regional Considerations[edit | edit source]

The highest needs for rehabilitation services were seen in the Western Pacific Region, with 610 million people, which accounts for 83 million YLDs, followed closely by the Southeast Asia Region at 593 million people and 77 million YLDs. The highest age-standardised prevalence of 34% and YLDs rate of 0·040 per person was in the European Region, while the Western Pacific region had the lowest prevalence of of 26% and the Americas had the lowest YLDs rate of 0·034 per person.[5]

For further information in relation to Region-specific and country-specific results and considerations causal distribution of the need for rehabilitation by WHO Region can be found at: Global Burden of Disease Supplementary Appendix

Condition Considerations[edit | edit source]

Musculoskeletal disorders, with 1·71 billion people globally and 149 million YLDs, accounts for the greatest contribution to prevalence, and are the largest contributor to the need for rehabilitation services among children and accounts for approximately two-thirds of those aged 15-64 years. Low back pain is the main reason for a premature exit out of the workforce and has the highest burden globally, with 568 million people and 64 million YLDs, and is the leading health condition contributing to the need for rehabilitation services in 134 of the 204 countries analysed. [4] Evidence suggests that these numbers will increase in the future, and even more rapidly in low-income and middle-income countries. [9]

Figure. 2 Map of leading health conditions requiring rehabilitation in each country, 2019

Sensory impairment is the second largest disease area in terms of number of people, with 677 million people at 45 million YLDs, which is split between vision loss (329 million people and 21 million YLDs) and hearing loss (403 million people and 24 million YLDs). Children aged under 15 and older adults are the largest contributors within this category, which may be attributed to a growing increase in conditions like myopia among school-aged children, and increases in the number of older adults with age-related conditions (eg, presbyopia, glaucoma, age-related macular degeneration, and age-related hearing loss) due to global population growth and ageing.[4]

Neurological disorders are the third largest disease area at 255 million people with 51 million YLDs, where stroke represents the highest overall need for rehabilitation within this group of diseases with 86 million people and 18 million YLDs.[4]

The incidence of traumatic injury (such as burns), the occurrence of natural disasters (earthquakes/floods), disease outbreaks, and human-induced hazards (conflict, terrorism, or industrial accidents) can also create overwhelming rehabilitation needs due to injury or illness, with YLDs from injuries largest between the ages of 20 and 69 years, which encompasses the working age population, promoting the importance of investing in rehabilitation to gain individual and societal benefits.. They affect existing services and significantly impact the most vulnerable populations and the weakest health systems.[8] Almost 1 billion people globally live with the consequences of fractures, amputations, spinal cord injury, traumatic brain injury, or other traumatic injuries, and rehabilitation is vital for many of these, especially those living with long-term consequences of the injury. [4]

Non-communicable diseases (NCDs), also known as chronic diseases, may differ significantly from acute conditions and require a different approach to the disease's complexity and frequent requirements for continuing care. Since chronic diseases are long-lasting, conditions can have a compounding and sustained effect on the social, physical, psychological and economic levels of the individual and broader society. Chronic diseases cost billions of dollars in direct healthcare costs and also in productivity losses. [10] Poverty is also very closely associated with NCDs. Lack of access to health care and screening for conditions and also lack of disease-prevention efforts put people in low-income countries at higher risk of mortality from non-communicable disease.[11][12] Non-communicable disease threatens progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing premature deaths from NCDs by one-third by 2030.[11]

Conclusion[edit | edit source]

As we have shown, evidence suggests that rehabilitation is needed by 2·41 billion people globally, who present with a wide variety of health conditions and rehabilitation needs that cross the lifespan. These changing health and demographic trends are contributing to rapid global increases in the number of people experiencing decline in functioning, resulting in enormous unmet rehabilitation needs. Much of these unmet needs are concentrated amongst the poorest and most vulnerable populations in low- and middle-income countries and conflict-affected settings, which are often ill-equipped to cope with these increasing needs for rehabilitation services.[1]

There is also emerging evidence that many of the people affected by the COVID-19 pandemic also have long-term consequences regardless of their initial disease severity or length of hospitalisation, thus increasing the demand for rehabilitation services globally even further since the global burden of disease study in 2019. It is evident that to meet these rehabilitation needs requires integration of rehabilitation services into health systems and, specifically, for rehabilitation services to be strengthened at the primary care level, where people will benefit from rehabilitation close to home. A strong primary care system, where the diagnosis of most health conditions, identification of problems in functioning, referral to specialised service delivery platforms, and adherence to treatment plans are available is key to overcoming some of the gaps in the provision of rehabilitation services, especially in many low-income and middle-income countries. Promoting these functions of primary care will ensure that a life-course and integrated perspective on care is achieved, thus improving the functioning and quality of life of the population. [4]

Rehabilitation is a key strategy for universal health coverage in the 21st century, with evidence suggesting that the common view of rehabilitation being an optional service that is only needed by a minority of the population is untrue. The findings of the Global Burden of Disease Study 2019 indicate an urgent need to scale up rehabilitation, particularly at primary health care level, to ensure services reach those who need them most. With a global ageing population who live longer as a result of advances in preventive strategies and medical interventions, but often with more disability, rehabilitation and access to rehabilitation services need urgent attention globally. [4]

Resources[edit | edit source]

Health Metrics and Evaluation (IHME) Rehabilitation Needs Estimator

References [edit | edit source]

  1. 1.0 1.1 Cieza, Alarcos. "Rehabilitation the health strategy of the 21st century, really?." Archives of physical medicine and rehabilitation 100.11 (2019): 2212-2214.
  2. 2.0 2.1 2.2 2.3 Mills JA, Marks E, Reynolds T, Cieza A. Rehabilitation: essential along the continuum of care
  3. Key Facts: Rehabilitation. World Health Organization, Geneva. 2020. {Accessed October 11, 2020}
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. 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. 2020 Dec 19;396(10267):2006-17.
  5. 5.0 5.1 World Health Organization, The World Bank. World report on disability. Geneva: World Health Organization; 2011.
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  7. Roser M, Ortiz-Ospina E, Ritchie H. Life expectancy. Our World in Data. 2013 May 23.
  8. 8.0 8.1 World Health Organisation. Rehabilitation. Available from: (accessed on 12 Jan 2021)
  9. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ. What low back pain is and why we need to pay attention. The Lancet. 2018 Jun 9;391(10137):2356-67.
  10. MacIntosh E, Rajakulendran N, Khayat Z, Wise A. Transforming health: Shifting from reactive to proactive and predictive care. Toronto: MaRS Discovery District. Accessed: Jul. 15, 2018.
  11. 11.0 11.1 World Health Organisation. Noncommunicable Diseases. Available from: (accessed 21 Jan 2021)
  12. Patrick Smith A Vicious Circle: Poverty and Noncommunicable Diseases
  13. World Health Organisation (WHO). Release of the Global Estimates of the Need for Rehabilitation. Available from:[last accessed 26/06/21]