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Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Program are collaborating to produce four Cochrane overviews of systematic reviews that synthesize the current evidence from health policy and systems research (HPSR) in rehabilitation. They will focus on the four pillars of HPSR identified by the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. The protocol describes why HPSR is currently needed in rehabilitation, provides detailed information on the four EPOC pillars in interaction with rehabilitation and reports the Cochrane methods that will be followed to produce the overviews. 1. Del Furia MJ, Minozzi S, Arienti C, Battel I, Capodaglio P, Côté P, Décary S, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Mudau Q, Ryan R, Sabariego C, Negrini S. Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews. 2. Gimigliano F, Arienti C, Butzback OK, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Iolascon G, Kiekens C, Liguori S, Minozzi S, Mudau Q, Negrini S, Paoletta M, Ryan R, Sabariego C, Moretti A. Financial arrangements for rehabilitation services in health systems: an overview of systematic reviews. 3. Atkinson-Graham M, Mior S, Bakaa N, Konstantinidis T, Wong J, Arienti C, Capodaglio P, Décary S, De Groote W, Del Furia MJ, Duttine A, Frontera WR, Kiekens C, Minozzi S, Gimigliano F, Mudau Q, Negrini S, Ryan R, Sabariego C, Côté P. Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews. 4. Touhami D, Ryan R, Engeda EH, Arienti C, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Minozzi S, Mudau Q, Negrini S, Sabariego C. Implementation strategies for rehabilitation services in health systems: an overview of systematic reviews. The protocol is largely common to all four overviews. The individual parts of each overview can be identified by the sub-titles delivery arrangements, financial arrangements, governance arrangements, and implementation strategies for overviews 1 to 4.

Background: This systematic review analyzes the impact of COVID-19 on dementia patients' functional, cognitive, neuropsychiatric, and health related outcomes. It hypothesizes that dementia patients infected with SARS-CoV-2experience more pronounced deterioration compared to those who are uninfected., Methods: Research from 01/03/2020 to 07/10/2023 was conducted using Medline, Web of Science, and Embase databases, and adhering to PRISMA guidelines and the PICO framework. The study aimed to determine if SARS-CoV-2 infection is associated with worse outcomes in dementia patients. The protocol is registered in PROSPERO (CRD42022352481), and bias was evaluated using the Newcastle-Ottawa Scale., Results: Among 198 studies reviewed, only three met the criteria. Chen et al. (2023) identified higher mortality in SARS-CoV-2-infected dementia patients, while Merla et al. (2023) observed faster cognitive decline in infected individuals with increased hospital admissions. Additionally, Cascini et al. (2022) reported an increased risk of infection and significantly elevated mortality in dementia patients, highlighting comorbidities and antipsychotic medication use as key risk factors., Conclusion: These limited data suggest higher mortality and cognitive decline in dementia patients following COVID-19, underscoring the need for extensive research in this area., Competing Interests: Nothing to report., (© 2024 The Authors. Published by Elsevier B.V.)

Introduction: With an increasing number of people experiencing limitations in functioning during their life course, the need for comprehensive rehabilitation services is high. In 2017, the WHO Rehabilitation 2030 initiative noted that the need for the establishment and expansion of rehabilitation services is paramount in order to obtain well-being for the population and to ensure equal access to quality healthcare for all. The organization of rehabilitation services is however facing challenges especially in low-and middle-income countries with a very small proportion of people who require rehabilitation actually getting them. Various surveys conducted in low-and -middle income countries have revealed existing gaps between the need for rehabilitation services and the actual receipt of these services. This systematic review aimed to determine the barriers and facilitators for increasing accessibility to rehabilitation services in low- and middle-income countries. Recommendations for strengthening rehabilitation service organization are presented based on the available retrieved data., Evidence Acquisition: In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25 th April 2021 (PubMed), 3 rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review., Evidence Synthesis: Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators., Conclusions: Recommendations for improving and expanding rehabilitation service organization include funding, training, education, and sharing of resources.

Objectives: The aim is to identify and compare the content of screening tools and needs assessments used to select rehabilitation beneficiaries and to describe the context of their use., Design: Scoping review., Data Sources: We systematically searched five indexed databases for studies published from 1 January 2010 to 3 February 2023., Eligibility Criteria: We searched for papers published in English only. Papers describe a screening tool or needs assessment aiming to prospectively select potential beneficiaries of rehabilitation services based on a cut-off score or classification system., Data Extraction and Synthesis: We charted the evidence according to the characteristics of the paper, rehabilitation needs screening context, screening tool and content of the screening tool. A descriptive synthesis is provided for screening methodology, settings, target populations, rehabilitation need types and phases of care. The WHO International Classification of Functioning, Disability and Health is used to categorise screening items., Results: We identified 24 tools that use a range of screening methodologies, but mostly questionnaires that are used by health workers. Most tools have been proposed for the identification of a rehabilitation beneficiary among people with selected health conditions assessing the need to access a specific rehabilitation intervention, programme or occupational group. The majority of tools screen for current functioning limitations, and this is often the only screening component. When mapping screening items with the WHO International Classification of Functioning, Disability and Health (ICF), almost all ICF chapters for body functions and activities and participation have been included across screening tools, with the following most frequently included ICF categories: emotional functions (b152), acquiring, keeping and terminating a job (d845), sensation of pain (b280) and carrying out daily routine (d230)., Conclusions: Rehabilitation need screening tools commonly include the screening for current functioning limitations among people with selected health conditions. A screening tool that is applicable across health conditions and settings is not available., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Research on health policy, systems, and services (HPSSR) has seen significant growth in recent decades and received increasing attention in the field of rehabilitation. This growth is driven by the imperative to effectively address real-life challenges in complex healthcare settings. A recent resolution on 'Strengthening rehabilitation in health systems' adopted by the World Health Assembly emphasizes the need to support societal health goals related to rehabilitation, particularly to promote high-quality rehabilitation research, including HPSSR. This conceptual paper, discussed with the participants in the 5 th Cochrane Rehabilitation Methodological Meeting held in Milan on September 2023, outlines study designs at diverse levels at which HPSSR studies can be conducted: the macro, meso, and micro levels. It categorizes research questions into four types: those framed from the perspective of policies, healthcare delivery organizations or systems, defined patient or provider populations, and important data sources or research methods. Illustrative examples of appropriate methodologies are provided for each type of research question, demonstrating the potential of HPSSR in shaping policies, improving healthcare delivery, and addressing patient and provider perspectives. The paper concludes by discussing the applicability, usefulness, and implementation of HPSSR findings, and the importance of knowledge translation strategies, drawing insights from implementation science. The goal is to facilitate the integration of research findings into everyday clinical practice to bridge the gap between research and practice in rehabilitation.

Background: The World Health Organization Disability Assessment Schedule 2.0 12-item survey (WHODAS-12) is a questionnaire developed by the WHO to measure functioning across health conditions, cultures, and settings. WHODAS-12 consists of a subset of the 36 items of WHODAS-2.0 36-item questionnaire. Little is known about the minimal important difference (MID) of WHODAS-12 in persons with chronic low back pain (LBP), which would be useful to determine whether rehabilitation improves functioning to an extent that is meaningful for people experiencing the condition. Our objective was to estimate an anchor-based MID for WHODAS-12 questionnaire in persons with chronic LBP., Methods: We analyzed data from two cohort studies (identified in our previous systematic review) conducted in Europe that measured functioning using the WHODAS-36 in adults with chronic LBP. Eligible participants were adults with chronic LBP with scores on another measure as an anchor to indicate participants with small but important changes in functioning over time [Short-form-36 Physical Functioning (SF36-PF) or Oswestry Disability Index (ODI)] at baseline and follow-up (study 1: 3-months post-treatment; study 2: 1-month post-discharge from hospital). WHODAS-12 scores were constructed as sums of the 12 items (scored 0-4), with possible scores ranging from 0 to 48. We calculated the mean WHODAS-12 score in participants who achieved a small but meaningful improvement on SF36-PF or ODI at follow-up. A meaningful improvement was an MID of 4-16 on ODI or 5-16 on SF36-PF., Results: Of 70 eligible participants in study 1 (mean age = 54.1 years, SD = 14.7; 69% female), 18 achieved a small meaningful improvement based on SF-36 PF. Corresponding mean WHODAS-12 change score was - 3.22/48 (95% CI -4.79 to -1.64). Of 89 eligible participants in study 2 (mean age = 65.5 years, SD = 11.5; 61% female), 50 achieved a small meaningful improvement based on ODI. Corresponding mean WHODAS-12 change score was - 5.99/48 (95% CI - 7.20 to -4.79)., Conclusions: Using an anchor-based approach, the MID of WHODAS-12 is estimated at -3.22 (95% CI -4.79 to -1.64) or -5.99 (95% CI - 7.20 to -4.79) in adults with chronic LBP. These MID values inform the utility of WHODAS-12 in measuring functioning to determine whether rehabilitation or other health services achieve a minimal difference that is meaningful to patients with chronic LBP., (© 2023. The Author(s).)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer GS declared a past co-authorship with the author CK to the handling editor. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Cochrane Rehabilitation developed a series of actions to provide the global rehabilitation community with the best available evidence to respond to the COVID-19 pandemic. These initiatives constituted the REH-COVER (Rehabilitation COVID-19 evidence-based response) action. In March 2020, the first initiative started in agreement with the European Journal of Physical and Rehabilitation Medicine (EJPRM): the rapid systematic review of all papers relevant to COVID-19 rehabilitation to inform rehabilitation health professionals rapidly. Currently, we are facing the long-term consequences of COVID-19, initially called "long Covid" and now named post COVID-19 condition (PCC), which led to the request by the WHO Rehabilitation Programme for evidence synthesis to support the development of specific recommendations. Cochrane Rehabilitation provided the best available evidence from the REH-COVER rapid living systematic review results, a systematic scoping review on the models of care and a summary of "evidence relevant to" the rehabilitation for adults with PCC. Based on this evidence, expert groups developed the 16 recommendations for the rehabilitation of adults with PCC recently published in Chapter 24 of the WHO "Clinical management of COVID-19 living guideline." This paper aims to introduce the Special Section of EJPRM reporting the work performed by Cochrane Rehabilitation to produce a summary of the existing "evidence relevant to" the rehabilitation of adults with PCC. The paper reports the methodology (overview of systematic reviews with mapping) and introduces the concept of "evidence relevant to" rehabilitation.

Objective: To systematically map the current evidence about the characteristics of health systems, providers and patients to design rehabilitation care for post coronavirus disease 2019 (COVID-19) condition., Methods: We conducted a scoping review by searching the databases: MEDLINE®, Embase®, Web of Science, Cochrane COVID-19 Registry and Cochrane Central Register of Controlled Trials, from inception to 22 April 2022. The search strategy included terms related to (i) post COVID-19 condition and other currently known terminologies; (ii) care models and pathways; and (iii) rehabilitation. We applied no language or study design restrictions. Two pairs of researchers independently screened title, abstracts and full-text articles and extracted data. We charted the evidence according to five topics: (i) care model components and functions; (ii) safe delivery of rehabilitation; (iii) referral principles; (iv) service delivery settings; and (v) health-care professionals., Findings: We screened 13 753 titles and abstracts, read 154 full-text articles, and included 37 articles. The current evidence is conceptual and expert based. Care model components included multidisciplinary teams, continuity or coordination of care, people-centred care and shared decision-making between clinicians and patients. Care model functions included standardized symptoms assessment, telehealth and virtual care and follow-up system. Rehabilitation services were integrated at all levels of a health system from primary care to tertiary hospital-based care. Health-care workers delivering services within a multidisciplinary team included mostly physiotherapists, occupational therapists and psychologists., Conclusion: Key policy messages include implementing a multilevel and multiprofessional model; leveraging country health systems' strengths and learning from other conditions; financing rehabilitation research providing standardized outcomes; and guidance to increase patient safety., ((c) 2022 The authors; licensee World Health Organization.)

Competing Interests: Competing interests: None declared.

Objective: Despite the prevalence of disability in low-and middle-income countries, the clinical skills of the rehabilitation workforce are not well described. We report health professionals' perspectives on clinical skills in austere settings and identify context-specific gaps in workforce capacity., Methods: A cross-sectional pilot survey (Pakistan, Morocco, Nigeria, Malaysia) of health professionals' working in rehabilitation in hospital and community settings. A situational-analysis survey captured assessment of clinical skills required in various rehabilitation settings. Responses were coded in a line-by-line process, and linked to categories in domains of the International Classification of Functioning, Disability and Health (ICF)., Results: Respondents (n = 532) from Pakistan 248, Nigeria 159, Morocco 93 and Malaysia 32 included the following: physiotherapists (52.8%), nurses (8.8%), speech (5.3%) and occupational therapists (8.5%), rehabilitation physicians (3.8%), other doctors (5.5%) and prosthetist/orthotists (1.5%). The 10 commonly used clinical skills reported were prescription of: physical activity, medications, transfer-techniques, daily-living activities, patient/carer education, diagnosis/screening, behaviour/cognitive interventions, comprehensive patient-care, referrals, assessments and collaboration. There was significant overlap in skills listed irrespective of profession. Most responses linked with ICF categories in activities/participation and personal factors., Conclusion: The core skills identified reflect general rehabilitation practice and a task-shifting approach, to address shortages of health workers in low-and middle-income countries.