Clinician's Commentary on Clarke et al.1

In the past few decades, interest and opportunities to participate in initiatives positioned at the intersection of global health, rehabilitation, and disability—including community-based re-habilitation—have grown exponentially. Although the implementation of community-based rehabilitation (CBR) varies widely, it is generally described as a multi-sectoral strategy in community development that focuses on people with disabilities and their families, aiming to equalize educational and employment opportunities and increase the social inclusion of participants, as outlined in the 2006 Convention on the Rights of Persons with Disabilities. 2 A stronger grasp of the ethical implications of our individual and collective actions becomes critical as physiotherapists increasingly engage in CBR in Canada and other countries. Accordingly, Clarke and colleagues 1 seek to understand how ethical considerations are reflected in the CBR literature. Their findings are valuable because they encourage more formal consideration of the ethical issues confronting every physiotherapist who considers or engages in CBR projects. Using a critical interpretative approach, Clarke and colleagues reviewed the literature for key ideas about their primary research question: How are ethical considerations reflected in the CBR literature? They defined an ethical consideration as a situation in which values deemed to be important are either in accordance or in conflict with actual practice, policy, or implementation aspects of CBR. Drawing on 51 relevant articles, they structure their findings on the research question into five key topic areas: partnerships among stakeholders, respect for culture and local experience, empowerment, accountability, and fairness in programme design. They then formulate eight questions that reflect the main underlying ethical tensions. 1 Their insights make a useful contribution to the growing evidence base for CBR. To apply these results to practice, we asked three questions: first, Who would benefit from knowing these results? Second, How can these results be integrated into CBR practice? And, third, What do physiotherapists need to consider about the study limitations so that we can advance CBR practice? First, Clarke and colleagues' findings are relevant to CBR stake-holders (including physiotherapists, policy makers, managers, and people with disabilities) as well as to any physiotherapist interested in promoting social justice and equity in health. Experienced global health practitioners will find that at least some of Clarke and colleagues' discussion of the eight concluding questions will resonate with their own experiences and may help both to situate those experiences and to prepare for future work. For physiotherapists considering work in a low-resource setting, this landscape …