Dear Colleagues,

As the year 2020 entered its final month, a groundbreaking, must-read article was published in The Lancet that necessitates ARN's attention and action. ARN is the only national and international specialty association for rehabilitation nurses in the world positioned to respond to the call for action posed in this article.

The Global Need for Rehabilitation
In December, Cieza and colleagues (2020) published the first worldwide baseline estimate of the need for rehabilitation services based on age, gender, disorders, and conditions. Their findings should be reviewed by every state health agency, rehabilitation organization, and rehabilitation healthcare system to confirm the greater need for access to rehabilitation services around the world. High-level findings are reported to entice you to read the entire article.

Utilizing data from the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, Cieza and colleagues calculated the prevalence and years of life lived with disability (YLDs) of 25 diseases, impairments, and specific populations who could benefit from rehabilitation. The data analyzed were from 204 countries, aggregated into World Health Organization (WHO) regions. The 25 diseases requiring rehabilitation were grouped in seven categories: musculoskeletal, neurological, cardiovascular, respiratory and chronic obstructive pulmonary disease (COPD), neoplasms, mental, and sensory. The authors compared 1990 data with 2019 data, as well as prevalence and YLD of the population that is aging and living longer.

From their analysis, they reported that "at least 1 in every 3 people in the world needs rehabilitation at some point during the course of their disease or injury" (Cieza et al., 2020, p. 8). Their findings confirm that the global need for rehabilitation is great and will only continue to increase. Around the world, the need for rehabilitation services is prevalent, confirming that rehabilitation is a public health need across the life span. Life expectancy is increasing and people are living longer with disorders and disabilities, as you will read from these key findings.

Key Findings (Cieza et al., 2020)

• Globally, in 2019, 2.4 billion (95% uncertainty interval 2.34–2.50) individuals had conditions that could benefit from rehabilitation, contributing to 310 million (235–392) YLDs. The number increased by 63% from 1990 to 2019.
• The number of YLDs associated with all health conditions has increased substantially, with a 69% increase seen since 1990, which means in 2019, people were living longer with disability.
• In 2019, more than 1,600 million adults aged 15–64 years had a condition that would benefit from rehabilitation.
• The disease area that contributed most to prevalence was musculoskeletal disorders, with low back pain being the most prevalent condition in 134 of the 204 countries analyzed.
• Musculoskeletal conditions are among the largest contributors to the need for rehabilitation services among children and account for two-thirds of all prevalent cases in adults.
• The second largest disease area was sensory impairments, split between vision and hearing loss.
• The third largest group was neurological disorders, which had the longest years living with disability, wherein stroke represented the highest need for rehabilitation.
• Injuries contribute largely to the overall need for rehabilitation. Almost 1 billion people live with the consequences of fractures, amputations, spinal cord injury, traumatic brain injury, or other injuries.

Focus on Function

As the authors report in this first-time comprehensive baseline information on the need for rehabilitation services, rehabilitation has not been prioritized and is under-resourced and not fully integrated into all healthcare services. They recommend that to gain traction and promote acceptance of the spread of rehabilitation, all stakeholders should unite around the common concept of "function." They assert that optimizing function is the ultimate objective and is essential to a patient's well-being, a recommendation ARN affirms.

I learned from reading this article that Functioning is WHO's third health indicator, along with morbidity and mortality. In an aging world, we know that more people are living longer due to advances in preventive strategies and medical interventions. They are living and functioning with diminishing capacity and abilities. Thus, the depth and breadth of rehabilitation needs reported in this study deserve urgent attention from political leaders and presents a unique opportunity for advocacy—a need that ARN proudly fulfills. In addition, as rehabilitation nurses, we are dedicated to sustaining, restoring, and maximizing function for all persons across all ages. Although not everyone needs physical, occupational, and/or speech therapy, everyone needs nursing during their lifetime, and that includes rehabilitation nursing, whether because of changes in function due to aging, chronic disease, disabling conditions, or injury. When select rehabilitation services are discontinued, rehabilitation nursing continues through the life span and care continuum. These assertions position rehabilitation nurses in a vital role in the access of rehabilitation services.

Scale Up Your Voice

Opportunities exist to further leverage our influence. We must all be bold with our voice and advocacy—rehabilitation is an essential healthcare service that enables people to live well with chronic disease or disability while maximizing function and preventing complications.

Rehabilitation nurses are well-positioned to integrate rehabilitation principles and practices into all areas of practice, which includes primary health care. Currently, it is not a standard of practice to screen for function or changes that impair function. This can be changed by advocating for the development of new screenings that focus on changes in function that have affected an individual's abilities in daily life since their last healthcare visit.

A positive screen creates the opportunity for assessment and access to rehabilitation, which in essence "is a set of interventions needed when a person is experiencing limitations in everyday physical, mental, and social functioning due to ageing or a health condition, including chronic diseases or disorders, injuries, or trauma" (Cieza et al., 2020, p. 1).

The implications for such a simple change in practice within health care could increase access to rehabilitation nursing and services.

The researchers also addressed the emerging long-term consequences that people affected by COVID-19 are living with, increasing the demand for rehabilitation globally. As reported in their online presentation of this research, available here, WHO is receiving growing reports about substantial cases of organ damage—lung, brain, and heart—even from those thought to have had mild cases. Rehabilitation can help, and rehabilitation services should be tailored for COVID-19 patients. ARN now must start developing rehabilitation nursing clinical practice assessment and care planning protocols for this specialty population.

I look forward to your thoughts and invite you to share this article and webinar widely—the manuscript is available as open access, which means you can widely distribute it, and the webinar presentation is excellent!

Thank you for your voice and your influence on policy, practice, and, most importantly, persons' access to rehabilitation services through rehabilitation nursing.

Patricia A. Quigley, PhD ARNP CRRN FAAN FAANP FARN

President, Association of Rehabilitation Nurses

References
Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2020). 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. Published online. https://doi.org/10.1016/S0140-6736(20)32340-0