Abstract
Background In low-resource settings, access to basic rehabilitation could be supplemented by community-level
interventions provided by community health workers, health volunteers, or family caregivers. Yet, it is unclear whether
basic physical rehabilitation interventions delivered to adults by non-professional alternative resources in the community,
under task-shifting or task-sharing approaches, are effective as those delivered by skilled rehabilitation professionals.
We aim to synthesize evidence on the effectiveness of community-level rehabilitation interventions delivered
by non-professional community-level workers or informal caregivers to improve health outcomes for persons with
physical impairments or disabilities.
Methods We performed a systematic review with a PROSPERO registration. Eight databases were searched for
(PubMed, CINAHL, Global Health, PDQ Evidence, Scopus, ProQuest, CENTRAL, and Web of Science), supplemented by
snowballing and key-informant recommendations, with no time restrictions, applied. Controlled and non-controlled
experiments were included if reporting the effects of interventions on mobility, activities of daily living (ADLs), quality
of life, or social participation outcomes. Two independent investigators performed the eligibility decisions, data
extraction, risk of bias, and assessed the quality of the evidence using the GRADE approach.
Results Ten studies (five randomized controlled trials [RCTs]) involving 2149 participants were included. Most common
targeted stroke survivors (n = 8); family caregivers were most frequently used to deliver the intervention (n = 4);
and the intervention was usually provided in homes (n = 7), with training initiated in the hospital (n = 4). Of the four
RCTs delivered by family caregivers, one demonstrated a statistically significant improvement in mobility (effect
size: 0.3; confidence interval [CI] 121.81–122.19; [p = 0.04]) and another one in ADLs (effect size: 0.4; CI 25.92–35.08;
[p = 0.03]). Of the five non-RCT studies by community health workers or volunteers, one demonstrated a statistically