Towards strengthening rehabilitation within health systems: a scoping review of rehabilitation-specific quality indicators.

Abstract

To identify, categorize, and appraise rehabilitation-specific quality indicators (QIs) with generic applicability for evaluating interprofessional rehabilitation care. Peer-reviewed literature was searched through PubMed and Web of Science. Grey literature was retrieved through Google Scholar, websites on professional quality standards and national QI repositories, reference tracking and expert consultation. Two reviewers independently screened 4,423 records following predefined eligibility criteria. Seventy-nine sources explicitly reporting QIs for rehabilitation were included (52 from peer-reviewed literature and 27 from grey literature). Two reviewers independently extracted data on 1,070 QIs, including indicator characteristics and development processes. Methodological quality was appraised by three reviewers using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. All extracted QIs were assessed on their generic applicability and measurability. After duplicate removal, 23 indicator sets were retained with 177 QIs. Only five indicator sets demonstrated a strong methodological foundation based on domain 1-3 ≥50% of the AIRE instrument. These five sets included 77 QIs of which 46 were identified as rehabilitation-specific and mapped to the WHO quality domains, predominantly people-centred (n = 19) and effective (n = 16), followed by integrated (n = 6), with minimal representation of safe (n = 2), timely (n = 2) and efficient (n = 1). According to the Donabedian framework, the majority of rehabilitation-specific QIs were process indicators (n = 42), while only four were outcome indicators. This review provides the first overview of rehabilitation-specific QIs with generic applicability and a strong methodological foundation. These findings can inform the selection and implementation of meaningful indicators to enhance the quality of interprofessional rehabilitation care. As such, these rehabilitation-specific QIs can serve as a starting point for quality improvement initiatives, including audit and feedback and benchmarking.