EFFECTS OF COMMUNITY –BASED REHABILITATION ON QUALITY OF LIFE AND SELF-ESTEEM OF PERSONS WITH MOBILITY-RELATED PHYSICAL DISABILITIES AND THEIR FAMILY MEMBERS IN NIGERIA

Abstract

Community-Based Rehabilitation (CBR) is a programme of care by which Persons with Mobility Disabilities (PwMDs) may access comprehensive rehabilitation services. The CBR intervention can improve the quality of life and psychosocial wellbeing of PwMDs. Despite the fact that CBR has been practised in some parts of Nigeria for nearly two decades, there is scarcity of information on objective assessment of its effect on PwMDs and their family members. The impact of CBR on Quality of Life (QoL) and Self-Esteem (SE) of PwMDs and their family members was investigated in this study. This ex post facto study involved 1302 consenting PwMDs receiving CBR (CBR group) and 2604 family members (CBR families). They were recruited using a four-stage sampling technique as follows: random selection of eight actively running CBR programmes from four randomly selected geo-political zones in Nigeria and purposive selection of PwMDs (CBR group) and consecutive sampling of family members (CBR family). Control groups were purposively selected individuals -1302 PwMDs not receiving CBR i.e non -CBR group and 2604 family members i.e non-CBR families. They were from eight communities close to but had never received CBR. Outcomes assessed were Self-Esteem (SE) and Quality of Life(QoL) of CBR group using Rosenberg Self-Esteem Scale and WHOQoL-Bref respectively. WHOQoL-Bref assessed in four domains viz: Physical Health (PH), Psychological Health (PsyH), Social Relationships (SR) and Environmental Health (EH). The QoL of CBR and non CBR families (FQoL) was assessed using the Beach Centre Family Quality of Life Instrument (BCFQoL) which assessed in five domains viz: Parenting (P), Family Interaction (FI), Emotional Well-Being (EWB), Physical and Material Well-being (PMW), and Disabilityrelated Support (DrS). Mann-Whitney U-test and Spearman’s rank order correlation were used to analyse the data at p = 0.05. Participants in the CBR group (35.3± 12.1 years) were older than the non-CBR group (32.7 ±11.0 years) but mean ages of CBR families (40.7±12.7 years) and non-CBR families (40.4±11.7 years) were comparable. The CBR group had higher scores in PH (55.4±16.0 vs 29.0± 11.5), PsyH (54.2±19.70 vs 33.80± 12.5), SR (53.6±18.7 vs 41.4±15.4), EH (45.4±16.7 vs 33.7± 11.8) and subsequently higher overall QoL score (3.6±1.1) on the WHOQoL-Bref than the non-CBR group (1.7±0.8). They also had higher SE score (17.4±3.6) than the non- CBR group (14.2±2.2). The CBR families scored significantly higher than non-CBR families in P(3.5±0.8 vs 2.4± 0.7), FI (3.6±0.9 vs 2.4± 0.7), PMW (3.1±1.0 vs 2.8± 0.8) and DrS (3.4±1.0 vs 3.3± 11.5) but not in EWB (3.4±1.54 vs 3.2±0.9) on the BCFQoL. The CBR group scores on PsyH (54.2±19.7) and SR (53.6±18.7) positively correlated with the CBR families’ FI (ƿ=0.06 and 0.06), P (ƿ=0.07 and 0.07) and total FQoL (ƿ=0.06 and 0.07). Significant positive correlations were observed between SE scores (17.4±3.6)of CBR group and PH (ƿ=0.36), PsyH (ƿ=0.31), SR (ƿ=0.21), and EH (ƿ=0.17), of WHOQoL, P=0.001 in all cases. Community-based rehabilitation had a positive effect on self-esteem and quality of life of persons with mobility disabilities and their family members.