Long-term effectiveness of rehabilitation services delivery for wenchuan earthquake survivors with impairments over a 4-year period : a prospective cohort study

Abstract

Objective To examine long-term effectiveness of rehabilitation services on physical function, pain severity and post-traumatic stress disorder (PTSD) in earthquake survivors over a 4-year period. Design Prospective cohort study with early and late intervention and geographical control group. Setting Three counties of Sichuan Province, China. Participants 591 survivors of the 2008 Wenchuan earthquake were followed-up over a 4-year period ranging from 2008 to 2012. Interventions In Mianzhu county, a comprehensive hospital-based and community-based rehabilitation programme was implemented in September 2008; in Anxian county, the same programme was implemented 1 year later; in Shifang county, the programme was not implemented and survivors from this county served as a control group. Outcomes Physical function was measured using Modified Barthel Index (MBI), pain severity with Visual Analogue Scale and PTSD with the PTSD Checklist-Civilian Version. All outcomes were assessed at three time points (baseline from 2008 to 2009, 2010 and 2012) and analysed with mixed effects regression. Results 400 patients completed all assessments. In all groups, physical function and pain severity improved over time. MBI improvement per month as compared with control was greater in the late rehabilitation (b=1.69, 95% CI 1.20 to 2.19) than the early rehabilitation group (b=0.96, 95% CI 0.68 to 1.24). This rehabilitation effect was however marginally decreasing over time. Superior improvement as compared with control with regard to pain was only found in the early rehabilitation group (b=-0.05, 95% CI -0.09 to -0.02). PTSD symptoms decreased over time, but the observed differences could not be specifically linked to the rehabilitation intervention. Conclusion Physical rehabilitation of earthquake survivors appears to be effective in improving physical function and, if delivered early, pain. Effects on mental health are less clear and need further examination using more consistent and frequent assessments of relevant outcomes and determinants.