Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews

BACKGROUND: Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview focuses on governance arrangements, defined in the EPOC taxonomy as the rules or processes that affect the way in which powers are exercised, particularly regarding authority, accountability, openness, participation, and coherence. OBJECTIVES: This overview aimed to synthesize the current evidence on governance arrangements in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews, incorporating evidence on governance arrangements, delivery arrangements, financial arrangements, and implementation strategies, have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. METHODS: We searched the Epistemonokos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non-Cochrane systematic reviews of randomized controlled trials (RCTs) and selected non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to governance arrangements as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR-2 to critically appraise the quality of the reviews. Reviews with ratings of high-to-moderate confidence are reported separately from low-confidence reviews. MAIN RESULTS: We found no Cochrane or non-Cochrane systematic reviews of RCTs or NRSIs pertaining to rehabilitation and relevant to the EPOC pillar of governance arrangements. As a result, we are unable to offer a broad synthesis of the existing evidence or to signpost relevant reviews on health policy and systems interventions related to this pillar for end-users. We did describe relevant research gaps and priorities for future primary HPSR in the rehabilitation field. AUTHORS' CONCLUSIONS: We found no evidence to address our research objectives of understanding the broad effects of governance arrangements for rehabilitation or identifying evidence that could help end-users, including decision-makers and policymakers, to address potential related health policy questions. Authors of future Cochrane overviews of reviews in HPSR focusing on governance and rehabilitation may wish to consider including systematic reviews with a broader range of observational designs, as well as qualitative and mixed-methods research designs. FUNDING: This Cochrane review was funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. REGISTRATION: The protocol was first published in the European Journal of Physical and Rehabilitation Medicine online on 27 January 2025. The manuscript was received on 11 November 2024 and was accepted on 26 November 2024. PROTOCOL: DOI 10.23736/S1973-9087.24.08833-6.