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com/dre
ISSN 0963-8288 print/ISSN 1464-5165 online

Disabil Rehabil, Early Online: 1–10

! 2013 Informa UK Ltd. DOI: 10.3109/09638288.2013.845257

REVIEW ARTICLE

A scoping review of 10 years of published literature on

community-based rehabilitation
Shaun Cleaver1,2 and Stephanie Nixon1,2,3,4
1
Graduate Department of Rehabilitation Science, 2International Centre for Disability and Rehabilitation, 3Department of Physical Therapy, and
4
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
Disabil Rehabil Downloaded from informahealthcare.com by Columbia University on 08/18/14

Abstract Keywords
Purpose: To identify the characteristics of peer-reviewed literature on community-based Community-based rehabilitation,
rehabilitation (CBR) in low- and middle-income countries published in English from 2003 to empowerment, human rights, low- and
2012. Methods: This scoping review involved a systematic search of electronic databases using middle-income countries
specific keyword/subject heading combinations. Journal articles were included if they were
published in English, used ‘‘CBR’’ as related to rehabilitation with persons with disabilities and History
not limited to high-income countries (HICs). Data were charted according to both pre-
determined and emergent categories. A subset of articles was charted by two reviewers to Received 14 May 2013
ensure reliability of variables. Results: A total of 114 articles were included. Fifty-two articles Revised 28 August 2013
presented empirical research and 49 were published in one of two journals. The articles Accepted 12 September 2013
For personal use only.

represented CBR activity in 26 specific countries, although only two of these were in Europe Published online 23 October 2013
and only one was in the Americas. Authors were predominantly affiliated at universities and in
HICs. Conclusions: This scoping review identified and characterized a large pool of literature on
CBR, facilitating its incorporation into research and practice. Future research should examine
the engagement of persons with disabilities in creating CBR literature, and analysis of literature
in languages other than English.

ä Implications for Rehabilitation

 Community-based rehabilitation (CBR) has been promoted as a rehabilitation strategy of
choice in low- and middle-income countries (LMICs), but it has been critiqued for lack of an
evidence base.
 A large number (114) of peer-reviewed articles were published on CBR between 2003 and
2012.
 Just under half of these articles (45%) presented empirical research, indicating that the
evidence base for CBR is growing but will benefit from continued, rigorous inquiry.
 Furthermore, researchers from LMICs appear to be largely under-represented in published
CBR research, flagging the need to support LMIC partners to share their CBR research in
peer-reviewed journals.

Introduction Finkenflugel et al. [3]. The authors focused exclusively on LMICs

because of the prominence of CBR as an approach to rehabili-
The World Health Organization and other UN-affiliated bodies
tation in those countries and because they understood CBR in
have promoted community-based rehabilitation (CBR) since at
high-income countries (HICs) to be a different entity given the
least 1979 [1], particularly as a strategy to make rehabilitation
stronger health systems and institutional support [3]. In the
available to persons with disabilities in low- and middle-income
review, the authors identified 128 publications and found that the
countries (LMICs). Some proponents have even declared that
rate of publication increased over time during the 25-year range
CBR ‘‘is the only credible basis for a programme of ‘rehabili-
(1978–2002). Finkenflugel et al. then organized the included
tation for all’’’ [2]. Despite these extensive endorsements, the
publications according to ‘‘type of article’’ and ‘‘key aspect’’ and
CBR field has been critiqued for having insufficient scientific
used these variables to argue that (1) CBR literature was
research to inform its practice [3–5].
dominated by ‘‘descriptive’’ and ‘‘theoretical’’ types of papers
A key effort to investigate the scientific basis of CBR was an
and (2) the key aspects of ‘‘implementation’’ and ‘‘stakeholders’’
extensive review of literature on CBR in LMICs conducted by
were over-represented compared to other concerns [3]. Building
upon this analysis, the authors concluded that ‘‘the evidence base
Address for correspondence: Shaun Cleaver, Graduate Department of for CBR is fragmented and incoherent’’ [3].
Rehabilitation Science, University of Toronto, 500 University Avenue, Despite the review’s strong conclusion, Finkenflugel et al.
Toronto, Ontario, M5G 1V7 Canada. E-mail: shaun.cleaver@utoronto.ca conducted the exercise without defining the term ‘‘evidence
 2 S. Cleaver & S. Nixon
base’’, or explaining how one would determine the adequacy of an
evidence base [3]. The authors lamented the preponderance of
‘‘theory papers’’ among the included articles and called for these
to be complemented by more ‘‘in-depth case reports, descriptive
studies or intervention studies’’ [3]. Nonetheless, in the absence
of describing what a unified and coherent evidence base would be,
the conclusion that the evidence base for CBR is ‘‘fragmented and
incoherent’’ [3] is not justified.
An additional limitation, also identified by Finkenflugel et al.
[3], was the exclusion of articles in journals not indexed in
Medline, Social Science Citation Index or PubMed, which may
have removed a number of relevant articles. In particular, the
authors note the omission of the Asia Pacific Disability
Rehabilitation Journal, which they claim had developed into a
good quality source of literature on rehabilitation in LMICs [3].
Ten years have elapsed since the end-range of the review by
Finkenflugel et al. [3]; and during this time, there have been
important international developments in CBR. These develop-
ments include the update of an important joint position paper [6],
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the development of the CBR matrix [7] and the drafting of
guidelines for CBR [8]. Significantly, CBR has evolved in
recognition of the Convention on the Rights of Persons with
Disabilities [9], including a declaration that CBR should be
grounded in human rights principles [10]. One of these principles
is ‘‘empowerment, including self-advocacy’’ [10], whereby
empowerment implies the involvement of persons with disabilities
in all matters of their concern [11]. According to this principle,
the persons with disabilities whom CBR programs are intended to
benefit should be involved in all aspects of their development,
including CBR research.
For personal use only.
Given these developments in CBR, there is need for a review
of literature on CBR published since the period covered by
Finkenflugel et al. [3]. As such, the purpose of this review is to
identify the characteristics of peer-reviewed literature on CBR in
LMICs published from 2003 to 2012. In particular, the review
investigates the degree to which research has kept pace with the
conceptual shift in CBR toward empowerment of, participation in
and ownership by the people most affected: namely, persons with
disabilities and their allies in LMICs.
Methods
This review uses the scoping review methodology outlined
by Arksey and O’Malley [12] and further developed by Levac
et al. [13].
Identifying relevant articles
This scoping review identified peer-reviewed journal articles
on CBR in LMICs published between 2003 and 2012. The review
focused on peer-reviewed literature (as opposed to grey literature)
in order to systematically apply the search strategies that have been
developed for identifying journal articles and because the results
of Finkenflugel et al. suggested that a large number of publications
would be identified [3]. Five major electronic databases of
literature (Medline, Embase, CINAHL, AMED and PsycInfo)
were searched from January 2003 to December 2012 using the
following combination of subject headings and/or keywords
(expressed in Boolean logic): CBR OR (disability AND rehabili-
tation AND community). The actual terms varied depending on
database. Upon the recommendation of a scientific librarian,
PubMed was also reviewed for 2011 and 2012 since this database
includes ‘‘in-process citations’’ [14], capturing more recently
published literature than the other databases where there is a lag
time between publication and indexing. In addition, two disability
and rehabilitation-specific electronic databases (Source: http://
www.asksource.info/ and CIRRIE: http://www.cirrie.buffalo.edu/)
Disabil Rehabil, Early Online: 1–10
were searched using the term ‘‘community-based rehabilitation’’.
The full search strategy was reviewed by a scientific librarian to
ensure appropriateness.
Article selection
The inclusion and exclusion criteria for this scoping review are
presented in Table 1. These criteria were chosen in order to
clearly delimit a bounded pool of substantive CBR literature
through criteria that could be defined and reliably applied. Only
articles published in English were included due to the language
skills of reviewers and the probability that this search would be
biased towards English language publications: in conducting a
literature search using similar databases, Arksey and O’Malley
noted a ‘‘a Western and particularly US bias’’ [12]. Such a bias
will privilege English language literature and underrepresent
publications from other languages, leading to biased conclusions
about the volume and percentage of literature on CBR in other
languages. To avoid perpetuating this bias through analyses and
conclusions that purport to represent a multitude of languages, but
do so ineffectually, this scoping review opted instead to adopt an
internally valid [15] strategy of only including articles written in
English. Papers without abstracts or structured summaries were
excluded in order to differentiate ‘‘letters to the editor’’ or short
editorials from substantial articles. These criteria were applied in
a sequential and methodical fashion such that initial steps
prioritized the efficient removal of more easily excluded publi-
cations and each subsequent step involved more detailed
arbitration.
In the first sequential step, the titles and abstracts (where
available) of all identified publications were transferred into a
Microsoft Excel spreadsheet and scanned using the ‘‘find’’
function to identify articles in which the words ‘‘CBR’’ or
‘‘community-based rehabilitation’’ or ‘‘community based rehabili-
tation’’ were used. The references identified were then independ-
ently screened by two reviewers and retained for full-text review
if they (1) were journal articles, (2) were published in English,
(3) used ‘‘CBR’’ as related to rehabilitation with/for persons with
disabilities and (4) were not apparently limited to HICs.
Disagreements between reviewers were resolved through consen-
sus and used as a platform of discussion to refine the inclusion
and exclusion criteria. Finally, the full-text of all retained publi-
cations was reviewed in detail during the data charting phase to
determine their final inclusion into the scoping review. During this
stage, a clearer definition of what constituted a paper ‘‘about
CBR’’ was developed (refer to Table 1, footnote a).
Table 1. Inclusion and exclusion criteria for publications.
Inclusion Exclusion
The publication is about commu- The publication’s scope is limited
nity-based rehabilitation (CBR) to a given or an identified
and uses that precise term in the collection of high-income
title or abstracta countriesb
The publication is a peer-reviewed The publication has no abstract or
journal article summary
The article is written in English
The material was published during
the years 2003–2012 (inclusive)
a
Publications were considered to be ‘‘about CBR’’ when the meaning was
not detached from the rehabilitation of/with people with disabilities
(i.e. for criminal or substance abuse rehabilitation), when the appear-
ance of the term in the title or abstract was not merely through
connection with a CBR facility to conduct an unrelated study and when
reviewers agreed that there was sufficient focus on CBR in the article.
b
The income status of countries was determined according to the July
2012 World Bank list of economies [27].
 DOI: 10.3109/09638288.2013.845257
Figure 1. Flow of citations through the 8531 publications retrieved through
publication identification process. database search (after duplicates removed)
Titles and abstracts scanned
for presence of “CBR” term
367 publications with term
Titles and abstracts
screened for
inclusion/exclusion
criteria
149 publications retained
Full text reviewed for
inclusion/exclusion criteria
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114 publications included
in scoping study
CBR = Community based rehabilitation; HICs = High-income countries; PWDs = Persons with disabilities
Charting the data
Data charting was an iterative process [13] guided by the use of a
data charting form [12] created for this review. A list of
descriptors was developed prior to the data charting process,
and these were refined on an ongoing basis during the review.
For personal use only.
The ‘‘empirical research’’ variable emerged through the data
charting process and was based upon the reviewer’s assessment of
the following characteristics: the presentation of research
methods, the use of primary data such as direct observation or
measurement and the mention of approval from a research ethics
board. A subset of the included articles (n ¼ 17) was charted by
two reviewers [13] in order to ensure that variables could be
coded reliably and in turn refine the data charting.
Collating, summarizing and reporting results
The data charting form was reviewed to summarize the main
results and identify other results of interest to the purpose of this
review. These results were then reported and their meaning
related to the review’s purpose [13].
Results
Over 13 000 publications were identified through the electronic
databases, although only 8531 remained after duplicate articles
were removed. The flow of citations through the identification
process is outlined in Figure 1. One-hundred forty-nine articles
were full-text reviewed. Of these, 35 were excluded, mostly
because they were not ‘‘about CBR’’ due to insufficient CBR
content. In these cases, the abstract contained the term ‘‘CBR’’ (or
close derivative), but the article text contained only a few mentions
of CBR that were generally detached from the article’s main points.
One article was excluded at the full-text review stage because it
described an intervention strategy that was initially developed
through CBR principles [16,17] but was ultimately distanced from
CBR and renamed ‘‘community care’’ [18]. Another article
focused on CBR in the ‘‘cosmopolitan setting’’ [19], which the
author conceptualized as the combination of HICs (except for some
rural parts of these countries) and privileged urban contexts
of LMICs, and thus was too detached from the purpose of this
review. With these two publications added to the 131 excluded at
Scoping review of CBR literature 3
8164 publications without term
218 publications excluded:
16 not about CBR for/with
PWDs
51 not journal articles
20 in language other than Other
English languages:
131 exclusive focus on HICs 3 Chinese
1 Dutch
1 French
1 Hungarian
35 articles excluded during full- 1 Norwegian
text review: 2 Polish
23 not about CBR for/with 4 Slovak
PWDs 5 Spanish
10 no abstract or structured 2 Turkish
summary in article
2 exclusive focus on HICs
the screening step, a total of 133 publications were excluded due
to an exclusive focus on CBR in HICs. Ultimately, 114 articles
were included in this scoping review. Articles are presented
according to their basic characteristics in Table 2.
Publication over time
Quantification of the publications by year demonstrates that a
range of 9–17 articles per year were published in English on
CBR in LMICs in peer-reviewed journals between 2003 and 2012.
The annual distribution is presented in Figure 2.
Empirical research
Of the 114 included articles, 52 (46%) presented empirical
research. Classification according to this variable was difficult to
ascertain in cases where unpublished secondary data were
reviewed using a sound methodology [20] and where detailed
and insightful narrative accounts were presented without refer-
ence to research methods [21,22]. In all of these cases, the articles
were ultimately determined to not be empirical research.
The articles presenting empirical research covered a broad
spectrum of epistemologies (e.g. critical, ethnographic, phenom-
enological, participatory and/or action), methodologies (e.g.
quantitative, qualitative and mixed), designs (e.g. clinical trial,
cohort, cross-sectional and case study) and data collection
strategies (e.g. interviews, focus groups, surveys and clinical
records). The non-empirical articles were primarily commentaries
and review papers. The review papers covered a range of
systematicity and rigour. Systematic reviews or SWOT analyses
[23] of specific topics related to CBR were at one end of this range;
at the other were discussions substantiated by published literature.
Journals containing included articles
A substantial proportion of the included articles (49 of
114 ¼ 43%) were published in two journals: the Asia Pacific
Disability Rehabilitation Journal,1 (n ¼ 32) and Disability and
Rehabilitation (n ¼ 17). An additional nine journals published
1
The Asia Pacific Disability Rehabilitation Journal changed its name to
become Disability, CBR and Inclusive Development in 2011.
 4 S. Cleaver & S. Nixon Disabil Rehabil, Early Online: 1–10

Table 2. Characteristics of included articles.

Country (or area) Empirical

Authors (year) Journals of focus research
Adeoye et al. (2012) [28] Disability & Rehabilitation Uganda Yes
Binken et al. (2009) [29] South African Journal of Occupational Therapy South Africa Yes
Borker et al. (2012) [30] Annals of Tropical Medicine and Public Health India Yes
Boyce and Cote (2009) [31] Asia Pacific Disability Rehabilitation Journal Tanzania Yes
Brinkmann (2004) [32] Asia Pacific Disability Rehabilitation Journal Undefined No
Burggraaf and Bourke-Taylor (2008) [33] New Zealand Journal of Occupational Therapy Solomon Islands No
Bury (2005) [34] Asia Pacific Disability Rehabilitation Journal Undefined No
Byford et al. (2003) [35] Papua New Guinea Medical Journal Papua New Guinea Yes
Campbell (2011) [36] Disability & Rehabilitation Sub-Saharan Africa No
Chappell and Johannsmeier (2009) [37] Disability & Rehabilitation South Africa Yes
Chatterjee et al. (2003) [16] British Journal of Psychiatry India Yes
Chatterjee et al. (2009) [17] British Journal of Psychiatry India Yes
Cheausuwantavee (2005) [38] Asia Pacific Disability Rehabilitation Journal Thailand Yes
Cheausuwantavee (2007) [39] Asia Pacific Disability Rehabilitation Journal Undefined No
Chung et al. (2011) [40] Disability & Rehabilitation China Yes
Chung et al. (2011) [41] Disability & Rehabilitation China No
Cornielje (2009) [42] Asia Pacific Disability Rehabilitation Journal Undefined No
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Cornielje et al. (2008) [43] Leprosy Review Undefined No

Dai et al. (2006) [44] Biomedical & Environmental Sciences China Yes
Dalal (2006) [45] Psychology Health & Medicine India No
D’Antonio and Nagarajan (2003) [46] Folia Phoniatrica et Logopedica India No
Dawad and Jobson (2011) [47] Disability & Rehabilitation South Africa Yes
Deepak (2003) [48] Indian Journal of Leprosy Undefined No
Deepak et al. (2011) [49] Disability, CBR & Inclusive Development Various Yes
Dunleavy (2007) [50] Disability & Rehabilitation Cambodia No
Ebenso et al. (2010) [51] Leprosy Review Nigeria No
Edmonds (2005) [52] Disability & Society Bosnia Yes
Finkenflugel (2005) [53] Asia Pacific Disability Rehabilitation Journal Southern Africa No
Finkenflugel (2006) [54] Asia Pacific Disability Rehabilitation Journal Undefined No
For personal use only.

Finkenflugel and Rule (2008) [55] Leprosy Review Undefined No

Finkenflugel et al. (2005) [3] International Journal of Rehabilitation Research Undefined No
Finkenflugel et al. (2008) [56] Disability & Rehabilitation Undefined No
Goel (2007) [57] Internet Journal of Health Undefined No
Gulati et al. (2011) [58] Occupational Therapy International India Yes
Hartley et al. (2005) [59] Child: Care, Health & Development Uganda Yes
Hartley et al. (2009) [60] Disability & Rehabilitation Kenya Yes
Hassin (2010) [20] International Journal of Therapy & Rehabilitation Iraq No
Jackson (2003) [61] South African Journal of Occupational Therapy Central Africa No
Johnson Raj and Prema Latha (2004) [62] Asia Pacific Disability Rehabilitation Journal India Yes
Judd (2003) [63] Neuropsychological Rehabilitation Undefined No
Karthikeyan and Ramalingam (2012) [64] Disability & Rehabilitation Papua New Guinea No
Khasnabis and Motsch (2008) [65] Leprosy Review Undefined No
Kuipers and Harknett (2008) [66] Asia Pacific Disability Rehabilitation Journal Undefined No
Kuipers and Hartley (2006) [67] International Journal of Rehabilitation Research Undefined No
Kuipers et al. (2003) [68] Asia Pacific Disability Rehabilitation Journal Thailand No
Kuipers et al. (2008) [69] BMC International Health and Human Rights Undefined No
Kuyini et al. (2011) [70] Journal of Social Work in Disability & Rehabilitation Ghana Yes
Lang (2011) [71] Disability & Rehabilitation Undefined No
Lightfoot (2004) [72] International Social Work Undefined No
Lutala et al. (2010) [73] South African Family Practice DR Congo Yes
MacLachlan et al. (2012) [74] Tropical Medicine and International Health Undefined No
Mallick et al. (2010) [75] Eastern Mediterranean Health Journal Pakistan Yes
Mannan and Turnbull (2007) [76] Asia Pacific Disability Rehabilitation Journal Various No
Mannan et al. (2012) [77] Human Resources for Health Undefined No
Masika and Lutala (2011) [78] African Journal of Primary DR Congo Yes
Health Care & Family Medicine
McConkey and Mariga (2011) [79] Journal of Research in Special Educational Needs Tanzania Yes
Mijnarends et al. (2011) [80] Disability, CBR & Inclusive Development Vietnam Yes
Miles (2003) [81] Asia Pacific Disability Rehabilitation Journal Undefined No
M’Kumbuzi (2003) [82] South African Journal of Physiotherapy South Africa Yes
Monk and Wee (2008) [83] Asia Pacific Disability Rehabilitation Journal Kenya Yes
Mubarak (2005) [84] AeJAMH (Australian e-Journal for Malaysia Yes
the Advancement of Mental Health)
Muhit et al. (2007) [85] British Journal of Ophthalmology Bangladesh Yes
Mukherjee and Samanta (2005) [86] Disability & Rehabilitation India Yes
Myezwa and M’kumbuzi (2003) [87] Asia Pacific Disability Rehabilitation Journal Zimbabwe No
Narayan and Reddy (2008) [88] Asia Pacific Disability Rehabilitation Journal India Yes
Nualnetr (2009) [89] Asia Pacific Disability Rehabilitation Journal Thailand Yes
Odebiyi et al. (2008) [90] West African Journal of Medicine Nigeria Yes

(continued )
 DOI: 10.3109/09638288.2013.845257 Scoping review of CBR literature 5
Table 2. Continued

Country (or area) Empirical

Authors (year) Journals of focus research
Olaogun et al. (2010) [91] African Journal of Physiotherapy Undefined No
and Rehabilitation Sciences
Oliver and de Almeida (2005) [92] WFOT Bulletin Brazil No
Pande and Dalal (2004) [21] Asia Pacific Disability Rehabilitation Journal India No
Patel, S. et al. (2012) [93] Disability & Rehabilitation Undefined No
Patel, V. et al. (2007) [94] Lancet Undefined No
Penny et al. (2007) [95] Disability & Rehabilitation Uganda Yes
Pollard and Sakellariou (2007) [96] British Journal of Occupational Therapy Undefined No
Pollard and Sakellariou (2008) [97] Disability & Rehabilitation Undefined No
Pollard and Sakellariou (2009) [98] Asia Pacific Disability Rehabilitation Journal Undefined No
Prathanee and Chowchuen (2010) [99] Journal of the Medical Association of Thailand Thailand No
Prathanee et al. (2006) [100] Journal of the Medical Association of Thailand Thailand Yes
Prathanee et al. (2010) [101] Journal of the Medical Association of Thailand Thailand Yes
Prathanee et al. (2011) [102] Journal of the Medical Association of Thailand Laos Yes
Rabaia and Gillham (2010) [22] Intervention Occupied Palestinian Territories No
Raja et al. (2008) [103] International Journal of Rehabilitation Research South Asia No
Rangaswamy and Sujit (2012) [104] International Review of Psychiatry Undefined No
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Rensen et al. (2011) [105] Disability & Rehabilitation India Yes

Rhoda and Hendry (2003) [106] South African Journal of Physiotherapy South Africa Yes
Robertson et al. (2012) [107] Journal of Applied Research in Intellectual Disabilities Undefined No
Rule (2008) [108] South African Journal of Occupational Therapy South Africa Yes
Sakellariou and Pollard (2006) [109] British Journal of Occupational Therapy Undefined No
Salamati et al. (2009) [110] Pakistan Journal of Medical Sciences Iran Yes
Scovil et al. (2012) [111] Spinal Cord Nepal Yes
Shamrock (2009) [112] Asia Pacific Disability Rehabilitation Journal Timor Leste Yes
Sharma (2004) [113] Disability & Rehabilitation Undefined No
Sharma (2005) [114] Asia Pacific Disability Rehabilitation Journal Undefined No
Sharma (2006) [115] Asia Pacific Disability Rehabilitation Journal Undefined No
Sharma (2007) [116] Asia Pacific Disability Rehabilitation Journal Undefined No
For personal use only.

Sharma (2007) [117] Asia Pacific Disability Rehabilitation Journal Undefined No

Sharma and Deepak (2003) [118] Asia Pacific Disability Rehabilitation Journal Various Yes
Shaw (2004) [119] Papua New Guinea Medical Journal Papua New Guinea Yes
Sinclair (2004) [120] WFOT Bulletin Undefined No
Sinclair et al. (2006) [121] WFOT Bulletin Undefined Yes
Srivastava and Baipai (2005) [122] WFOT Bulletin India No
Stanley and Shwetha (2006) [123] International Journal of Psychosocial Rehabilitation India Yes
Thomas (2011) [124] Psychology and Developing Societies Undefined No
Thomas and Thomas (2004) [125] Asia Pacific Disability Rehabilitation Journal Undefined No
Velema and Cornielje (2010) [126] Asia Pacific Disability Rehabilitation Journal Undefined No
Velema et al. (2008) [25] Leprosy Review Various No
Vijayakumar et al. (2003) [127] Indian Journal of Ophthalmology India Yes
Warf et al. (2011) [128] Journal of Neurosurgery: Pediatrics Uganda Yes
Wee (2004) [129] Asia Pacific Disability Rehabilitation Journal Undefined No
Wee (2010) [130] Asia Pacific Disability Rehabilitation Journal Kenya Yes
Wickenden (2012) [131] International Journal of Speech-language Pathology Undefined No
Yeung et al. (2011) [132] Physiotherapy Canada Bosnia Yes
Yu et al. (2009) [133] Clinical Rehabilitation China Yes
Zhang (2007) [134] Asia Pacific Disability Rehabilitation Journal China Yes

Figure 2. Number of included articles per

year.
 6 S. Cleaver & S. Nixon Disabil Rehabil, Early Online: 1–10

between two and five articles each to account for 24% of all those Table 3. Most published authors of CBR literature 2003–2012.
included. The balance of included articles (n ¼ 38, 33%) were
published in journals that only had one article included in this Name First authored Co-authored Total publications
scoping review. Sharma, M. 6 0 6
Finkenflugel, H. 5 1 6
Countries or geographic areas of focus Hartley, S. 2 4 6
Pollard, N. 3 2 5
Forty-two of 114 articles (37%) were about CBR in LMICs Sakellariou, D. 1 4 5
without focusing on any one country or region. An additional four Kuipers, P. 4 0 4
articles (4%) focused on multiple countries that could not be Prathanee, B. 4 0 4
classified as being from one region. The remaining articles Cornielje, H. 2 2 4
(n ¼ 68, 60%) focused on specific countries or regions. All but Velema, J. P. 2 2 4
Wee, J. 2 2 4
three were focused on the following WHO regions: Africa
(n ¼ 24), Eastern Mediterranean (n ¼ 4), South-East Asia (n ¼ 24)
and Western Pacific (n ¼ 13). Two articles focused on Europe Table 4. Affiliations of first authors (n ¼ 113)a.
(both on Bosnia) and one on a location in the Americas. Among
the included articles, there is a focus on 26 different countries, Institutional Country
primarily India (n ¼ 14), South Africa (n ¼ 6), Thailand (n ¼ 6)
and China (n ¼ 5). University 66 UK 18
NGO 14 India 13
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Hospital 13 Australia 11
Authors Health professional association 4 Netherlands 11
The number of authors publishing the included articles ranged Research institute 2 USA 11
International (UN-affiliated) 2 Canada 7
between 1 and 10; with 69 articles (61%) articles having either organization
one or two authors. Almost all articles had five authors or fewer Government 1 South Africa 7
(n ¼ 110, 96%). No single author stood out as having pub- Other 2 Thailand 7
lished much more than others, although there was a group of Not listed 9 Hong Kong 4
10 authors with four or more publications each during this period Chinab 3
(see Table 3). The institutional affiliations of the first authors are Ireland 3
DR Congo 2
presented in Table 4, along with the countries in which their
Germany 2
affiliations were based. Seventy-nine of 104 (76%) declared first
For personal use only.

Italy 2
author institutional affiliations are universities or hospitals, also Papua New Guinea 2
noting that the websites of most hospitals indicated affiliation Brazil 1
with a university. Seventy-one of 113 declared first author Ghana 1
affiliations (63%) are in HICs for this scoping review of CBR Greece 1
literature pertaining to LMICs. Thirty-three of the 64 articles Iran 1
Nepal 1
(52%) that focus on one country were written by an author with an Nigeria 1
affiliation in that country. Occupied Palestinian 1
territory
Discussion Pakistan 1
Rwanda 1
This is the first review to methodically identify literature on CBR Switzerland 1
from 2003 to 2012, categorize its status as empirical research and
a
explore the positionalities of its authors. This publication focuses In one article, the first author’s affiliation is not reported.
b
on the time period following the seminal review of literature ‘‘China’’ refers exclusively to the ‘‘Peoples’ Republic of China’’,
excluding Hong Kong.
on CBR from 1978 to 2002 conducted by Finkenflugel et al. [3]
in order to provide a more recent and comprehensive view of
the field.
analysis to relate the number of publications to population size,
This scoping review examined the characteristics of
we note that the populous countries of India and China had more
114 articles published on CBR in LMICs over a 10-year period.
articles devoted to them. It was surprising that there was only one
Although a sizeable amount (33%) were published in journals that
included article that focused on LMICs in the WHO region of the
had only one article about CBR in this 10-year period, many of
Americas and only two focused in Europe (which includes the
the articles (n ¼ 49, 43%) were clustered in two journals. This
former Soviet republics). These areas include a notable number
finding is striking given that the methods for this scoping review
LMICs (particularly middle-income countries) and could have
did not include a hand search of well-known journals, which is a
been under-represented either due to less CBR activity in these
strategy that may have amplified the clustered distribution of
regions or to fewer scientific publications stemming from the
articles among journals. This finding confirms the value of a
initiatives that exist. What is more likely, however, is that in
comprehensive search strategy in order to identify a more
restricting this review to English language publications, literature
complete picture of the literature on CBR. Conversely, the
from some parts of the world remained outside of the field of
finding also confirms that CBR stakeholders may expediently stay
analysis. CBR literature from South and Central American
abreast of nearly half the literature in the field by following only
audiences could be preferentially published for Spanish or
two journals.
Portuguese-speaking audiences, and that of the former Soviet
Union preferentially published in Russian. Among the 20 articles
National and geographic distribution
written in languages besides English, five of these were in
The presence of articles on CBR in 26 specific countries over a Spanish (none in Portuguese or Russian, but four in Slovakian),
10-year period is encouraging because it demonstrates involve- and it is likely that some of these would be excluded if they were
ment in CBR in many LMICs. Although there was no detailed full-text reviewed. This number of articles is too small to account
 DOI: 10.3109/09638288.2013.845257
for such large and populous areas of the world. Repeating the
literature search with explicit consideration for the trends and
tools of literature on CBR in other languages (i.e. language-
appropriate databases and search terms) will permit more
confident claims regarding the presence of literature from areas
under-represented in this scoping review.
Who speaks for CBR?
The explicit identification of human rights principles as a
grounding for CBR [8] reinforces the notion that CBR, an entity
that exists to address the needs of persons with disabilities, should
be developed through the active involvement of persons with
disabilities. When referring to CBR in LMICs, these principles
apply more specifically to persons with disabilities in those
countries. Although the data from this scoping review do not
address the disability status of authors, the finding that nearly
two-thirds of the first authors of articles on CBR in LMICs were
affiliated at institutions in HICs conflicts with the principle of
Disabil Rehabil Downloaded from informahealthcare.com by Columbia University on 08/18/14
empowerment and self-advocacy. Admittedly, there may be more
nuance to this finding, such as situations where authors from HICs
partner with colleagues from LMICs to conduct research projects
but accept the majority of the responsibility to draft the resulting
articles. Another possibility that would not be revealed by these
data is that of authors who are native to LMICs working at
institutions in HICs. Even if this possibility proves to be true, it
raises the question of whether individuals from the diaspora of
LMICs should be the most numerous voices for CBR, instead
of having this role played by individuals still residing and working
in LMICs. More encouraging, however, is the finding that over
For personal use only.
half of all papers that were focused on a given country had a first
author whose primary institutional affiliation was in that country,
a finding that supports the notion that people from LMICs are
playing a more prominent role in bringing literature on CBR in
their country into the international domain.
The finding that over three-quarters of included articles had a
first author affiliated with a university or a (primarily university-
affiliated) hospital has similar implications to the distribution of
the countries of the authors: it suggests that those individuals
writing about CBR may be a different group of people than those
closely involved with CBR implementation in the field. This
finding is, in and of itself, insufficient to say who speaks for CBR
[24], and this analysis will stop short of declaring who should.
Nonetheless, the discovery that the first authorship of articles on
CBR in LMICs belongs primarily to a particular segment of CBR
stakeholders (i.e. those affiliated with academic institutions in
HICs) is cause for further investigation to uncover the dynamics
behind this phenomenon.
CBR literature and CBR research
A key contribution of this scoping review was the categorization
of articles as ‘‘empirical research’’ or not. This categorization
serves an initial purpose of describing the empiricism of the
literature on CBR in LMICs (less than half of all published
articles are empirical research). This paper will not arbitrate
whether this percentage, or the volume of empirical papers (52 in
10 years), is adequate. Nor will it comment upon the appropri-
ateness of the types and quality of published CBR research: the
assessment of research quality is considered to be outside the
function of a scoping review [12], and the assessment of type
requires consistent categorization with a model to guide what
types of research ought to be conducted. Unlike the under
conceptualized claim that the ‘‘evidence base for CBR showed
little coherency’’ [3], this review has focused upon a rigorous
literature search and reliable article characterization. The many
types of reviews and research papers among the included studies
Scoping review of CBR literature 7
give rise to the need for a subsequent study that rigorously
investigates the content of this body of research and its
contributions to practice and/or policy change.
Limitations
This review focused on English language literature to privilege
internal validity in design, but systematically excluded a portion
of the literature on CBR in the process. Since this scoping review
was designed to identify the presence of a bounded pool of
literature, the application of reliable inclusion and exclusion
criteria was essential. However, certain criteria may more
appropriately be conceptualized on a spectrum than as discrete
dichotomous entities, particularly the inclusion criterion that an
article must be ‘‘about CBR’’. Beyond the articles in which all
elements of the paper were concerned with CBR, there were many
others in which the concern was more superficial, including some
where CBR was mentioned once in the abstract but not in the
article. Through a process of ranking and ordering articles with
varying amounts of CBR content, a threshold was established
such that articles were only included when the authors used the
term CBR in the article text at least twice in ways of interest to
CBR stakeholders.
The ‘‘empirical research’’ variable was also less dichotomous
than foreseen. A threshold was determined, which increases the
validity of the ‘‘empirical research’’ variable, and strengthens its
utility as a basis for further analysis. Nonetheless, we note that a
line was drawn, and this line could be supported or reconsidered
depending upon the aims of future analyses.
Implications
This scoping review has identified and characterized a large pool
of CBR literature, which is now accessible to stakeholders,
including those implementing programs or conducting CBR
research. This review has also uncovered issues that demand
additional analysis.
The first of these is the identification and synthesis of
literature on CBR in languages besides English. Search strategies
focused on other languages are possible but require explicit
consideration of language-appropriate search terms and data-
bases, such as the review conducted by Velema et al. where the
authors described a specific search for Spanish and Portuguese
literature [25].
Second, research is needed that explores and engages the
inclusion and active involvement of persons with disabilities in
LMICs in the production of literature on CBR. In particular, this
scoping review could be extended by using the optional stage six
of the Arksey and O’Malley framework [12] to inform a
consultation exercise conducted together with persons with
disabilities from LMICs.
Additional analysis should also investigate how well the
literature on CBR responds to the knowledge demands of those
involved in implementing CBR. Analyses should go beyond
declarations that research on CBR is insufficient [3–5,26]. Future
analyses should instead systematically compare research produc-
tion and dissemination (potentially including a structured search
for grey literature), summarized through reliable categories within
a well-articulated model, describing topics that should be
investigated and the types of research that would be considered
appropriate to address those topics.
Conclusion
This scoping review establishes and describes an identifiable
and bounded pool of peer-reviewed journal literature on
CBR in LMICs using a clearly identified methodology [12].
 8 S. Cleaver & S. Nixon
In so doing, the study found that English-language literature on
CBR is nearly evenly split between empirical research and non-
empirical articles, that the literature is clustered in two journals
yet present in many others, that there is literature on CBR from
numerous countries yet some parts of the world are not
represented and that authors of articles likely reflect institutional
affiliations that are different from many CBR stakeholders.
Acknowledgements
We are extremely grateful to Upasana Banerjee and Mehreen
Fatima for having contributed as a second screener and full-text
reviewer, respectively. We extend thanks to scientific librarian
Carla Hagstrom for having reviewed the search terms used for this
review. Finally, we thank Helene Polatajko, Rachel Thibeault,
Debra Cameron and Kelly O’Brien for their constructive sugges-
tions on an earlier version of this article.
Disabil Rehabil Downloaded from informahealthcare.com by Columbia University on 08/18/14
Declarations of interest
Shaun Cleaver is funded by a Canadian Institutes of Health
Research (CIHR) Fellowship and a W. Garfield Weston
Fellowship. Stephanie Nixon is supported by a CIHR New
Investigator Award.
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