Rehabilitation Access for Patients with Rare and Complex Neurological Diseases in Georgia: A Mixed-Methods Study
DOI:
https://doi.org/10.33700/jhrs.5.2.260Keywords:
rehabilitation access, unmet rehabilitation need, telerehabilitation, health services research, financial barriers, rare and complex neurological diseases, Georgia, mixed-methods studyAbstract
Introduction: This study assessed access to rehabilitation services among patients with rare and complex neurological diseases in Georgia and identified key financial, geographic, organisational, and technological barriers.
Methods: A sequential explanatory mixed-methods design was used. The quantitative phase included a cross-sectional survey of 150 adults with rare and complex neurological diseases who had used or needed rehabilitation services. The qualitative phase included semi-structured interviews with 10 patients and 10 experts. Quantitative data were analysed using descriptive statistics, bivariate analyses, and logistic regression; qualitative data were analysed thematically and integrated during interpretation.
Results: Only 34.7% of respondents were receiving rehabilitation at the time of the survey, although 74.7% had used rehabilitation services at least once. Overall, 85.3% reported out-of-pocket payments, and 63.3% could not afford recommended rehabilitation. More than half (58.7%) had discontinued rehabilitation, mainly because of cost, distance, or transport difficulties. Participants living outside Tbilisi reported greater travel difficulties, more service interruptions, and higher unmet rehabilitation need. In the adjusted analysis, lack of local rehabilitation services, absence of funding, residence outside Tbilisi, high out-of-pocket financial burden, and transport barriers were associated with unmet rehabilitation need. Telerehabilitation use was low, but willingness to use it was high. Qualitative findings highlighted financial burden, geographic inequality, discontinuity of care, workforce shortages, and policy gaps.
Conclusions: Survey participants faced substantial barriers to continuous multidisciplinary rehabilitation. Long-term financing, regional service development, strengthening of the multidisciplinary rehabilitation workforce, and hybrid telerehabilitation models should be considered to improve access.
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Data Availability Statement
The data supporting the findings of this study are not publicly available due to privacy and confidentiality considerations related to patient and interview data. De-identified data may be made available from the corresponding author upon reasonable request and with appropriate ethical approval.
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