Rural rehabilitation disparities and strengthening strategies: Umbrella review

BackgroundRural residents with disabilities often experience healthcare disparities versus urban counterparts.ObjectiveTo meta-synthesize the rural rehabilitation disparities, including access barriers, and the strategies for improving rehabilitation access for rural underserved populations.MethodsUmbrella review of the contemporary (2015-2024), English-language reviews focused on rural rehabilitation service-delivery gaps or strategies for adults or children with disabilities, with no country restrictions. Six scientific databases (Medline/PubMed, Scopus, CINAHL, Cochrane Library, PDQ-Evidence, REHABdata) were searched, supplemented by snowballing. Two independent reviewers performed full-text assessments and quality appraisals of the systematic reviews on intervention effects, using the Measurement Tool to Assess Systematic Reviews-2.ResultsOf the 530 records identified, 366 were unique references and 16 reviews were finally included, including 8 systematic reviews, two of them with meta-analyses. The 16 reviews included collectively synthesized information from 484 studies. Rural rehabilitation-access disparities were identified. For instance, those derived from supply shortages in low-density markets, workforce recruiting and retention issues, long travel requirements and costs, waiting times or low intervention intensity, and generalist versus specialist skills of the therapist workforce. Rural rehabilitation strengthening strategies were also identified. These include telehealth service options - benefits and challenges; outreach, home and community-centered approaches; navigator programs; and finally, task-sharing with (remote) specialist support.ConclusionsThis umbrella review provides a meta-synthesis of the issues affecting equitable access to rehabilitation by rural populations and of the strengthening strategies to address those disparities. Alone or combined, these strategies might be tailored to and with local communities and interested parties for effective co-implementation.