{"paper_id":"4d092c1b-7eca-43e9-84f9-e06307ff811f","body_text":"Integration of academic rehabilitation services in primary health care: the first implementation report of an ongoing initiative in Iran | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integration of academic rehabilitation services in primary health care: the first implementation report of an ongoing initiative in Iran Vida Rahimi, Abbas Vosoogh, Alireza Olyaee Manesh, Ahmad Reza Khatoonabadi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7722508/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Access to rehabilitation in low- and middle-income countries (LMICs) is limited, highlighting the need for integration into primary health care (PHC). This study reports the first academic initiative in Iran to embed multidisciplinary rehabilitation—including physiotherapy, occupational therapy, speech therapy, and audiology—within urban PHC, aiming to improve both community health and professional education. Methods This descriptive implementation study, designed as a case study, was initiated in a Tehran district through a memorandum of understanding between the School of Rehabilitation and the Deputy of Public Health of Tehran University of Medical Sciences. The integration plan addressed three domains: ( 1 ) management and policy development through intersectoral coordination and standardized protocols; ( 2 ) education via internship programs and capacity-building workshops; and ( 3 ) rehabilitation services through supervised student-led clinics at a comprehensive health center. Data were documented daily and analyzed with SPSS 26. Results In the management domain, a governance framework was established, including technical committees, policy guidelines, and monitoring mechanisms. In education, 177 students from all rehabilitation fields completed structured internships, curricula were revised to reflect local health priorities, and targeted workshops were delivered to staff, teachers, and the public. In the service domain, 3,753 free rehabilitation services were provided over two years (Sep 2023–2025), with audiology comprising the largest share (1,911), followed by physiotherapy (898), speech therapy (658), and occupational therapy (286). Commonly identified conditions included developmental language disorder (69.3%), ADHD (30.8%), and postural limb disorders (28.3%). Conclusions Integrating rehabilitation into PHC proved feasible and effective across management, education, and service delivery. This model provides a scalable blueprint for LMICs while underscoring the need for long-term evaluation and scale-up. The initiative remains ongoing, with refinements underway for broader implementation. Integrated Rehabilitation Primary Health Care Multidisciplinary Service Health Systems Strengthening Community base rehabilitation (CBR) Figures Figure 1 Figure 2 Figure 3 Figure 4 Backgound Rehabilitation is a key pillar of the health system that aims to optimize function, increase independence, reduce disability, and improve the quality of life of people who are faced with functional, emotional or cognitive limitations due to congenital anomalies, diseases, injuries, and accidents( 1 ). Rehabilitation services include a wide range of specialized interventions; from physiotherapy, occupational therapy, and speech therapy to psychosocial support and life skills training that may be needed for anyone with health problems in movement, vision, hearing, speech, swallowing, or cognition ( 2 ). These services are not only used for rehabilitation after illness or accidents, but also play a preventive role in reducing the severity of disability, disease progression, and independence. On the other hand, rehabilitation interventions are cost-effective, require minimal resources, and can be used as successful models of care ( 3 ). Demographic transition has led to an increase in chronic diseases in adults, which has exceeded the need for rehabilitation services. Meanwhile, the need for rehabilitation services has increased with the increscent in hearing and developmental disorders such as autism, learning disabilities, and disorders due to physical development and growth impairment in children ( 4 ). While the demand for rehabilitation services is increasing worldwide, access to it still faces challenges and the need for rehabilitation services significantly outstrips the supply of services, leaving many people with unmet basic needs for rehabilitation ( 1 ). According to a study published in The Lancet, in 2019, 2.41 billion people worldwide had conditions requiring rehabilitation services, equivalent to almost one-third of the world’s population ( 5 ). In low- and middle-income countries, 50% of people currently do not have access to the rehabilitation services they need. These trends should encourage health policy makers to prioritize rehabilitation services( 6 ). Primary health care (PHC) includes preventive, curative, rehabilitative, and palliative services according to the needs of individuals. Rehabilitation in community health centers can be a window for timely identification and provision of required services to the patients( 7 ). Iranian PHC network ,which is well structured and distributed at rural and urban areas, affiliated to the universities of medical sciences and health services, mainly financed by the government, and most of the services are free of charge. More than 90% of Iranians are covered by social health insurance organizations, including Iran Health Insurance Organization, the Social Security Organization, and the Armed Forces Health Insurance Organization ( 8 ). Therefore, it can be a suitable platform for making rehabilitation services available. The integration of rehabilitation services into PHC has been considered as an effective solution to respond to this widespread need. The aim of this integration is to facilitate equitable access, reduce individual and health system costs, improve the quality of services, and intervene early to prevent progressive disabilities. Experience from different countries has also shown that rehabilitation is most effective when it is initiated in the early stages of the disease and at the community level ( 9 ). Unfortunately, in the Iranian health system (IHS), rehabilitation services are largely provided at the secondary and tertiary levels and have a small share in the PHC network. This lack of integration has led to lost opportunities, increased long-term costs, and reduced quality of life for many people in need ( 10 ). In 2009, McColl et al. presented a review of models for integrating rehabilitation and primary health care. The team of researchers discussed six different models for delivering primary health care and rehabilitation services in an integrated approach: clinic, development, self-management, community-based rehabilitation, collaborative care, and patient management. Rehabilitation providers interested in working at primary care may benefit from considering these models ( 11 ). To achieve proper and systematic integration of rehabilitation in health centers and full implementation of community-based rehabilitation in countries, especially in low- and middle-income countries, and to ensure that well trained future health professionals are ready to participate in interdisciplinary work, it is also necessary the integration occurs in the education of students in these fields. An experience reported in 2010 by Dabaloz et al. in Canada, with the creation of a model of interdisciplinary academic rehabilitation clinics in health centers for collaborative learning for physiotherapy students in a clinical setting ( 12 ). Therefore, it seems that integration should be carried out at the university education levels of rehabilitation disciplines in the form of integrating rehabilitation internships alongside service provision. In this regard, the first official experience of integrating academic rehabilitation services into the PHC network has begun in one of the selected areas of Tehran capital city. This approach was taken in response to the Rehabilitation 2030 initiative and \"Call to Action\" in Iran and attempted to respond to some of the priority areas expressed by WHO in this program( 13 ). This article aims to introduce and analyze this experience, examine its implementation process, challenges, opportunities, and initial results, and attempt to provide solutions for the sustainable development of this novel model at the national and global levels. Methods This is descriptive implementation study using a case study approach which reviewed 2 years implementation of a pioneer initiative began on September 16, 2022, that is still ongoing. The information gathered by desk review of the existing documents, interviews to the stakeholders and the secondary data sheets. Content analysis of the qualitative data were done by research team and SPSS 26 used for descriptive analysis of the quantitative data. Organizational agreement The School of Rehabilitation (SoR) and the Deputy of Public Health (DoPH) at Tehran University of Medical Sciences (TUMS) signed a Memorandum of Understanding (MoU) in October 2022. Under this agreement, the SoR has been providing academic services, including counseling and screening for disorders, with the goal of enhancing rehabilitation services within the framework of the Integrated Comprehensive Universal Healthcare Network (ICUHC). Additionally, the MoU aims to expand student internships in urban UCHC centers, fostering the integration of rehabilitation into healthcare through both service delivery and medical education.The MoU considered proposed policy solutions regarding each World Health Organization (WHO) six building blocks framework ( 9 ). Accordingly, four target groups were designed for this project: 1) Managers, experts, and health service providers,2) Students in rehabilitation fields, 3) service users to UCHC, and 4) the defined population of UCHC. In accordance with the target group, 3 areas were defined in this project: 1- Management area and project development and definition 2- Educational area 3- Therapeutic area Management area and project definition In the management domain, the implementation process began with the formation of an inter-sectoral technical committee (TC), established on the basis of the MoU aligned with national health plans ie: Non-Communicable Diseases (NCDs, elderly health, Ear health, and etc. Official representatives from the SoR and the DoPH were nominated. Key instructions of the MoU were identified by TC. (Table 1 ) An introductory meeting was held to orient all stakeholders, followed by subgroup meetings to map shared capacities and define expectations. A detailed meeting schedule was developed for both executive and monitoring subcommittees. Knowledge management was ensured through systematic documentation and reporting of all sessions. Regular executive committee meetings served to raise awareness, provide structured training, and discuss the integration of rehabilitation into the academic primary health care. The process culminated in the formulation and operationalization of an action plan integrating rehabilitation within the ongoing UCHC programs. Table 1 Management Domain Action Plan Action Activities Responsible Party deliverables Agreed priorities Strengthen inter-sectoral coordination to implement national agreements (NCDs, Elderly Health, Mental Health). - Deputy of Public Health - Appoint Representatives Assign representatives from the SoR and DoPH DoPH + SoR Official correspondence and meeting minutes. Form Technical Committee Draft initial terms of the agreement. DoPH Technical Committee (Deputy Head, NCD Unit, South Tehran Health Center) + The Technical/Executive Committee of the SoR (SoR Representative - Dean of the SoR, Vice President for Administration and Finance of the SoR, Vice President for Education of the SoR) Draft agreement clauses. First Orientation Meeting Conduct meeting at the DoPH. DoPH’s Technical Assistant + Rehabilitation Faculty Representative (Rehabilitation Faculty’s Treatment Manager) Meeting minutes and action plan. Subgroup Meeting Define shared capacities and expectations. NCD Unit + South Tehran Health Center + SoR scientific groups Meeting minutes and shared expectations list. Develop Meeting Calendar Prepare a schedule for technical/executive and quarterly monitoring meetings. NCD Unit + SoR representative Approved meeting calendar. Knowledge Management & Reporting Document meetings and prepare reports. NCD Unit + SoR representative Archived meeting minutes and periodic reports. Execute Technical Committee Operationalize rehabilitation services (training, screening, primary treatment and referrals). DoPH Technical Groups (Mental Health, NCDs, Family Health) + The Technical/Executive Committee of the SoR (SoR Representative, All Educational Department of Rehabilitation) Service protocols, performance reports. Monitoring & Evaluation Track key performance indicators (meeting frequency, report quality). DoPH + SoR Checklists and monitoring reports. End Outcome: Functional inter-sectoral coordination framework and quarterly reports. - Final report and approved strategic plan. SoR: School of Rehabilitation; DoPH: Deputy of Public Health; NCD: Non-Communicable Diseases, Education Area The operational plan developed in the field of education is shown in Table 2 . Since this internships program was the first experience to cover all areas of rehabilitation in an integrated manner and was closed in the form of a two-year program, in the first step it was necessary to review the educational curricula in the SoR and how to establish the health center as an integrated educational field. It was done by participation of the Health Education and Promotion Group (HEP) of the DoPH. Table 2 Education Domain Action Plan Table Action Activities Responsible Party Deliverables Academic Field Training Review internship course plans and implement student internships in the field. HEP Group / Health Network Management Group + SoR Educational Groups (Physiotherapy, Audiology, Speech Therapy, Occupational Therapy) Official correspondence and meeting Times. Health Promotion Training for Service Providers Design educational packages and flowcharts for training healthcare staff and the target population. SoR + Health Vice Chancellery 6 pamphlets, 3 flowcharts, and media committee approval documents. Awareness-Raising Training Conduct training sessions to enhance service providers' awareness in agreed-upon areas. SoR + Health Vice Chancellery Two webinars or workshops (scheduled for June 2023 and February 2024). Systematic Health Education Deliver targeted education to vulnerable groups (pregnant women, children, elderly) and the general public. SoR + Southern Tehran Health Center Three webinars (May 2023, November 2023, May 2024) and satisfaction surveys. Curriculum Development Integrate preventive rehabilitation strategies into primary healthcare services. Technical Health Groups + SoR Educational Groups Approved strategic plan and training modules. SoR: School of Rehabilitation; HEP : Health Education and Promotion Group Rehabilitation Services Area To address the need for delivering rehabilitation services to target populations, the implementation of a structured operational plan became imperative. The initial phase involved the systematic development of this plan through collaborative efforts between the TC of the SoR and multidisciplinary teams from the DoPH. These joint meetings aimed to align the plan with national development frameworks, institutional mandates, and the specific requirements outlined in upstream policy documents. Key components of the operational strategy, as detailed in Table 3 , included resource mobilization for procuring specialized rehabilitation equipment, coordination with stakeholders at UCHC, and the cooperation to the social workers, psychologists, and psychiatrists affiliated with the community mental health center (comprehensive social and mental health services, entitled “SERAJ Program”( 14 )). The plan further emphasized establishing interdepartmental referral protocols within primary health centers, extending to the secondary and tertiary care facilities affiliated to TUMS through consultations to the designated Early Childhood Growth and Development Center at Ziaeian teaching hospital. MoU was formalized with the regional education department to facilitate student access to rehabilitation services, while partnerships with non-governmental organizations (NGOs) and comprehensive healthcare centers (CHC) were leveraged to enhance community outreach. At the institutional level, initiatives included training sessions for educational supervisors on service delivery protocols, the development of standardized evaluation tools by audiology, physiotherapy, speech therapy, and occupational therapy departments, and the appointment of a dedicated rehabilitation coordinator at the selected UCHC in the south of Tehran (Meisam Center). This coordinator was tasked with documenting evaluation outputs, monitoring patient referrals, and ensuring adherence to referral pathways through periodic follow-ups. These measures collectively aimed to institutionalize a robust framework for sustainable and equitable rehabilitation service provision. At this stage, the necessary equipment for each rehabilitation domain including audiometer, otoscope, Medical Caliper, scoliometer, parallel bar, visual acuity (chart chessboard type), foot scanner, along with various books, play materials, and educational tools was procured jointly by the SoR and the Southern Health Center for using in both screening and initial assessment. Furthermore, the age ranges for service provision within the clinics were established as follows: Physiotherapy from 7 years to geriatrics; Audiology from 3 years to geriatrics; Speech Therapy from 2 years to 18 years; and Occupational Therapy from birth to geriatrics. (Table 3 ) Table 3 Rehabilitation Services Domain Action Plan Table Action Activity Responsible Executive (SoR) Responsible Executive (DoPH) deliverables Developing rehabilitation services for age groups at UCHC Strengthening occupational therapy services in mental/social health (SERAJ program) Occupational Therapy Department Mental and social Health technical Group Periodic reports Identifying sensory disorders (preterm infants) and cognitive/mental disorders in children Occupational Therapy Department Mental and social Health technical Group N/A Hearing screening and counseling for children (4–5 years) and the elderly Audiology Department Family and Population health Group Quarterly reports (number screened, referrals, consultations) Screening/counseling for musculoskeletal disorders (ages 7–15) Physiotherapy Department Adolescent, Youth, and School Health Group Quarterly reports Balance disorder screening/counseling for the elderly Physiotherapy and Occupational Therapy Departments Family and Population health Group Quarterly reports Education/counseling for individuals aged 50 + at risk of osteoporosis Physiotherapy Department NCDs Group Quarterly reports Hearing screening for elementary students (5–12 years) Audiology Department Adolescent, Youth, and School Health Group Quarterly reports Screening/counseling for speech-language delays, stuttering, and developmental disorders Speech Therapy Department Family and Population health Group Quarterly reports (with referrals to developmental physicians) Cognitive disorder screening/counseling for the elderly Speech Therapy Department Family and Population health Group Quarterly reports SoR: School of Rehabilitation; DoPH: Deputy of Public Health; UCHC: Urban Comprehensive Healthcare Center; NCDs: Non-Communicable Diseases Results The Management and Groundwork Phase The outcomes of the management and preparatory phase to initiate the integrated rehabilitation program are summarized as follows: A MoU was assigned by the DoPH and the SoR on September 6, 2022, formalizing collaboration in research, education, and clinical services. Key activities included organizing the first orientation meeting at the office of the Technical Deputy of the Health Vice Chancellery, followed by subgroup meetings to outline shared capacities and expectations (September 19, 2022). Periodic joint meetings were held between representatives of the SoR and the DoPH to align priorities, alongside dedicated sessions with the Faculty’s academic departments and DoPH technical groups to emphasize the program’s significance. Strategic planning ensured the sustained integration of all rehabilitation disciplines (e.g., physiotherapy, occupational therapy, speech therapy) into primary healthcare services. A two-year rehabilitation action plan (October 2022–October 2024) was developed for the ICUHC Network, involving iterative revisions through joint meetings and final approval by the Executive Technical Committee, which included faculty academic leaders and technical teams from the DoPH. A Gantt chart was designed to operationalize specific objectives, reviewed and endorsed by the Health Education and Technical Committees. Needs assessments for infrastructure, equipment, and staffing were conducted by the SoR with resource allocation and funding secured through collaboration with the Southern Tehran Health Center. Human resources, including specialized rehabilitation professionals, were mobilized by SoR to support service delivery. These efforts established a robust framework for embedding rehabilitation services into the Iran health system, ensuring alignment with upstream policies and fostering equitable access to quality care. The Education Phase The outcomes of integrating rehabilitation services into the education framework are summarized in Tables 1 and 2 . Key achievements include: Development of the Education Section : Collaborative efforts between educational departments of the SoR and the Health Education and Promotion Department of DoPH of TUMS to design the operational plan’s education component. Curriculum Adaptation : Revision of student internship curricula by the faculty’s educational Departments to align with program objectives, client needs, and health system priorities, following joint meetings with DoPH stakeholders. Internship Implementation : Initiation of field internships across all rehabilitation disciplines (e.g., physiotherapy, audiology) at the Meysam Comprehensive Health Center starting in Fall 2022 (Table 4 ). Educational Material Preparation : Creation of public-facing educational pamphlets and certificates by the faculty’s educational Departments, approved by the Health Office’s media working group. • Targeted Workshops : Elderly-Focused Training : In-person workshops on physiotherapy, occupational therapy, and audiology for elderly care at the center (Table 5 ). Staff Capacity Building : Hybrid workshops and webinars for healthcare staff serving children, adolescents, and the elderly, covering all rehabilitation disciplines (Table 5 ). Educator Training : In-person workshops for educators specializing in child and adolescent health education (Table 5 ). Table 4 Information Related to Student Internships in the Education Sector Various Areas Number of Educational Supervisions Number of Students Therapist Presence per Week (Sessions) Therapist Presence During Project Execution (Sessions) Service Start Date Internship Start Date Audiology 12 48 2 138 16/10/2022 16/10/2022 Speech Therapy 5 21 1–2 130 01/11/2022 14/02/2023 Occupational Therapy 3 3 1 68 01/10/2022 01/10/2022 Physiotherapy 7 105 3–5 202 18/09/2022 01/10/2022 Total 27 177 - 538 - - Table 5 Percentage and Topics of Educational Workshops Conducted for Target Groups Target Group Workshop Topics Educators (25%) - Speech and language disorders in children and adolescents - Postural disorders in adolescents Health Staff (50%) - Occupational therapy for the elderly - Webinar on introduction to rehabilitation fields in healthcare - Balance and pelvic floor disorders in the elderly - Speech and language disorders in children General Public (25%) - Hearing loss in the elderly (Audiology group) - Balance disorders in the elderly (Occupational therapy group) Rehabilitation Services Phase As part of the pioneer initiative to incorporate rehabilitation services into primary healthcare systems, a total of 3,753 services had been delivered to enrolled patients by September 2024. Audiological assessment constituted the most frequently provided intervention, with additional service distribution and their respective quantities detailed in Fig. 1. The distribution of service recipients by gender revealed that 50.6% were male and 49.4% were female. Nationally, 93% of the administered services targeted Iranian nationals, while 7% were allocated to non-Iranian citizens residing in the country. Age-specific eligibility criteria for service initiation varied across disciplines: speech therapy interventions commenced at 2 years, audiometry at 3 years, physiotherapy at 7 years, and occupational therapy services were available from infancy onward. A comprehensive breakdown of service provision across age demographics is illustrated in Fig. 2 . Analysis of service delivery timelines revealed discipline-specific variations in session frequency and duration during the project period. Audiology services comprised 138 sessions, delivered twice weekly, with the shortest average session duration (15 minutes). Speech therapy interventions involved 130 sessions, administered 1–2 times per week, each averaging 30 minutes. Occupational therapy included 68 sessions, conducted once weekly and lasting 30 minutes per session. Physiotherapy accounted for the highest volume of sessions (202 sessions), scheduled 3–5 times weekly, with an average duration of 30 minutes per session. Figure 3 illustrates the approximated duration of service provision stratified by rehabilitation areas. Figure 4 illustrates the distribution of rehabilitation services provided across comprehensive health service centers, categorized by referral sources (e.g., Health center, community programs, or self-referrals, ..) The distribution of identified disorders among individuals assessed according to screening and evaluation protocols, categorized by rehabilitation domain, is presented in Table 4 . Within physiotherapy services, postural abnormalities of the upper and lower limbs constituted the highest proportion of diagnosed disorders (23.2%). In speech therapy, the majority of cases (69.3%) were identified with Developmental Language Disorder (DLD), followed by speech sound production disorders (16.4%) and stuttering (10.9%). In occupational therapy, 30.8% of clients were diagnosed with attention deficit hyperactivity disorder (ADHD)/attention deficit disorder, while psychomotor delay (19.6%) and learning disorders (8.0%) were the subsequent most prevalent conditions. Audiological assessments were conducted at the screening level, with 11.6% of individuals referred to audiology clinics for comprehensive diagnostic evaluation due to suspected hearing impairment. Stratified statistics indicated that the highest proportion of clients across all domains fell within the 5–18 years age group. The subsequent age group distribution differed significantly, with speech therapy and occupational therapy primarily serving the childhood age group (0–5 years), audiology consultations peaking in middle adulthood (30–60 years), and physiotherapy predominantly utilized by older adults (above 60 years) Furthermore, the highest proportion of referrals originated from the Comprehensive Rehabilitation Services Center and its satellite units for audiology (48.6%), occupational therapy (86.4%), and speech therapy (76.1%). In contrast, schools constituted the primary referral source for physiotherapy services (56.2%). Table 4 Assessment results in each rehabilitation area Service Disorder Type Identified disorder (n) Identified disorder (%) Physiotherapy Upper Limb Postural Disorders 71 7.9% Lower Limb Disorders 183 20.4% Spinal Postural Disorders 33 3.7% Lower Limb Disorders & Spinal Postural Disorders 54 6.0% Upper Limb Postural & Spinal Postural Disorders 32 3.6% Upper & Lower Limb Postural Disorders 208 23.2% Upper/Lower Limb & Spinal Postural Disorders 101 11.2% Shoulder Joint Problems 13 1.4% Knee Joint Problems 7 0.8% Lumbar Region Problems 21 2.3% Ankle and Wrist Region Problems 5 0.6% Neurological Problems 24 2.7% Normal Findings 146 16.3% Total 898 100.0% Speech Therapy DLD 456 69.3% Aphasia 6 0.9% Learning Disorder 6 0.9% Dysphagia 3 0.5% Speech Sound Production Disorders 108 16.4% Voice Disorders 2 0.3% Stuttering 72 10.9% Normal finding 5 0.8% Total 658 100.0% Occupational Therapy Musculoskeletal Disorders 16 5.6% Duchenne Muscular Dystrophy 1 0.3% Syndromes 7 2.4% Anxiety and Behavioral Disorders 22 7.7% Balance Disorder 5 1.7% ADHD 88 30.8% SPD 4 1.4% ASD 24 8.4% Psychomotor Delay 56 19.6% ID 8 2.8% Cerebral Palsy 19 6.6% Learning Disorder 23 8.0% Dementia 3 1.0% Normal Findings 10 3.5% Total 286 100.0% Audiology Suspected Hearing Loss (Referred for Audiologist) 221 11.6% Medical Ear Disorders (Referred to ENT Specialist) 198 10.4% Referred for Audiometry & ENT Specialist 39 2.0% Normal Findings 1,453 76.0% Total 1,911 100.0% DLD:Developmental Language Disorder; ADHD: Attention deficit hyperactivity disorder;SPD: Sensory Processing Disorder; ASD: Autism Spectrum Disorder, ID: Intellectual Disability; ENT: Ear, noise and Throat Discussion Managerial and Policy-Level Achievements One key innovation of this project was the establishment of Iran’s first multidisciplinary academic expert panel dedicated to rehabilitation policy and implementation within PHC. This group developed the first stepwise national framework that addressed the integration of rehabilitation services across policy, education, clinical service delivery, and research. This strategic approach was crucial in negotiating intersectoral responsibilities, fostering stakeholder alignment, and defining clear referral and screening pathways. Free service provision in an underprivileged Tehran district removed major financial barriers and advanced WHO’s Universal Health Coverage (UHC) agenda, providing a model for scalable community-based empowerment and access ( 5 , 15 ). Educational Integration: Curriculum and Internship Innovation A significant educational achievement was the structured internship experience for 177 rehabilitation students across all four disciplines—an expansion compared to prior models which typically focused on limited fields such as physiotherapy or occupational therapy ( 16 ). The internships not only provided hands-on training but also fostered interprofessional teamwork, improved readiness for community-based practice, and enhanced problem-solving skills specific to PHC settings ( 12 ). The content and delivery of these internships, as well as targeted workshops (e.g., 25% for teachers on speech/language and posture, 50% for health staff on geriatric therapy and fundamentals of rehabilitation), were adapted based on a detailed needs assessment and the demographic characteristics of the local population. This community-driven approach led to the revision and contextualization of core curricula to reflect the most prevalent disorders (e.g., increased emphasis on pediatric language disorders and ADHD, geriatrics, community-based screening), ensuring that future professionals are equipped to address real local health challenges. Integration of faculty with PHC staff fostered ongoing capacity-building for both sectors. Service Utilization & Demographics The successful integration of rehabilitation services into Iran’s primary healthcare system, as evidenced in this pioneer project, addresses a significant gap in the delivery of comprehensive health services in low- and middle-income countries (LMICs). This initiative, which delivered a total of 3,753 rehabilitation service sessions —comprising audiology, physiotherapy, speech therapy, and occupational therapy interventions—demonstrates both the feasibility and necessity of embedding rehabilitation in PHC to improve health equity, prevention, and early intervention. Across the 3,753 services, the distribution was nearly equal by gender ( 50.6% male, 49.4% female ), and the project reached marginalized populations, with 93% Iranian nationals and 7% non-Iranian residents , including refugees and immigrants. The age profile revealed tailored access: children (0–5 years) formed the primary group for speech and occupational therapy; adults (30–60 years) accessed most audiology services; the elderly (> 60 years) predominantly utilized physiotherapy. Audiology registered the highest uptake (1,911 sessions), with 11.6% suspected hearing loss identified for further assessment, and 10.4% referred to ENT Specialist for medical intervention. Although in some countries, including our country, there is a history of performing newborn screening in primary health centers( 17 , 18 ), this study showed the need to pay attention to other age groups for performing hearing screening in these centers. Speech therapy (658cases): In this study, Developmental Language Disorder (DLD) was the most prevalent finding (69.3%). DLD is one of the most common neurodevelopmental( 19 ) that it is estimated that 60% of children with DLD go undiagnosed ( 20 ). So, the presence of speech therapists in primary health care centers is a noteworthy strategy, as it enables early detection and timely intervention for speech and language disorders. Occupational therapy (286 cases): 30.8% ADHD diagnoses and significant rates of psychomotor delays (19.6%) underscored the importance of child-focused rehabilitation. ADHD is indeed the most common neurodevelopmental disorder diagnosed in children especially in mental health domain( 21 ). The global prevalence of ADHD in children and adolescents is estimated to be around 8% in umbrella review( 22 ). The prevalence of psychomotor delays in children varies significantly across different populations and contexts. For example, A study by Mitiku et al showed an 16.3% prevalence of gross motor developmental delay among under-five children attending health facilities in Ethiopia ( 23 ). Also, the prevalence of developmental delays which includes psychomotor delays among children aged 2–36 months in a PHC Center in Egypt was found to be 9.3%( 24 ). Physiotherapy (898 cases): Upper and lower limb postural disorders together accounted for 28.3% of the cases, reflecting a significant community burden. The prevalence of upper and lower limb postural disorders in children and adolescents is a significant concern, as various studies indicate a high incidence of such disorders during this developmental stage. Factors contributing to these issues include rapid growth, poor postural habits, and musculoskeletal imbalances. A study in Australia highlights that musculoskeletal conditions, affecting 4.9% of pediatric primary care encounters and upper and lower limb conditions were the most common. This study reports the experience of managing musculoskeletal disorders by general practitioners in PHC ( 25 ). The high prevalence of musculoskeletal disorders, especially in students, could also be influenced by the timing of our sampling (after the COVID-19 period) due to the high use of smart phones( 26 ), which were widely used in virtual education.It is worth noting that in this study, individuals who visited speech therapy and occupational therapy clinics were generally those with existing difficulties, as their parents already suspected the presence of a disorder. In contrast, those attending physiotherapy and audiology clinics represented the general population. Therefore, the higher reported prevalence of disorders in the domains of occupational therapy and speech therapy may be attributed to this factor. These quantitative findings not only align with the projected needs of populations in similar LMIC contexts, but also emphasize the diversity and reach enabled by integrated, multidisciplinary care. Musculoskeletal conditions and sensory impairments account for the largest proportion of RNs, both of which are largely amenable to rehabilitation at the primary health care (PHC) level; however, rehabilitation is poorly integrated at this level of care in most countries ( 27 ). Operational Results and Service Models The program adopted age-tailored protocols — occupational therapy from infancy, speech therapy from age 2, audiology from age 3, and physiotherapy from age 7 — ensuring appropriate entry points across the life span. The referral system, primarily from Comprehensive Rehabilitation Service Centers and schools, supported continuity of care, though 47–86% of referrals originated from within the PHC structure, pointing to meaningful uptake but also revealing ongoing challenges with cross-sectoral coordination. Service delivery was enhanced by implementing a hybrid model : In-person sessions were supported by digital learning and telehealth platforms reaching 50% of health personnel , thus bridging geographic and resource limitations. This blended approach is corroborated by evidence from Pakistan and other LMICs that emphasize the value of tele-rehabilitation for capacity building and access ( 28 ) . Challenges and Barriers Despite its successes, the project faced persistent challenges, typical for innovative programs in LMICs: Organizational Gaps : The absence of a dedicated organizational structure for rehabilitation within PHC led to inefficiencies in service integration, referral fragmentation, and insufficient role clarity ( 9 ). Resource Constraints : Funding issues, shared budget responsibility, and slow equipment procurement (e.g., audiometers, scoliometers) slowed full implementation. Human Resources : Limited rehabilitation literacy and insufficient PHC staff familiarity with rehabilitation concepts necessitated extensive upskilling and ongoing advocacy. Outcome Measurement : The short (two-year) pilot phase and limited resources did not allow for comprehensive tracking of long-term clinical, functional, or quality-of-life outcomes, a direction that must be prioritized in future work. Cultural Adaptation : The inclusion of 7% non-Iranian clients (including refugees) highlighted the need for culturally and linguistically adapted interventions. Comparative Context While similar pilots—such as Chile’s RehabPHC—demonstrated success in integrating physiotherapy and occupational therapy at the community level ( 16 ), the current study broadened the scope to include all four major rehabilitation domains and demonstrated the value and acceptability of such a fully multidisciplinary approach. The model reflected and extended the WHO’s Rehabilitation 2030 priorities, showing that with strong academic-public health partnerships, impactful service expansion is possible ( 13 ). Recommendations and Path Forward For sustainable scale-up, policy actions should anchor rehabilitation as an explicit component of national PHC policy, leveraging the WHO six building blocks framework ( 15 ). Decentralized funding models, standardized outcome measurement (in line with the WHO Minimal Rehabilitation Dataset), and expanded roles for community health workers (CHWs) are critical. Evidence from some countries supported task-shifting to CHWs to improve reach and sustainability ( 29 , 30 ). Although, the purpose of this task-shifting in integrating rehabilitation services into PHC is to increase the familiarity of primary care providers’ (PCPs) with rehabilitation disorders and the initial screening of individuals for referral to rehabilitation specialists. Future implementation should incorporate longitudinal tracking of disability, functional outcomes, and cost-effectiveness ( 6 ), while continuing to iterate educational curricula to meet evolving community needs. As mentioned, this is an ongoing study. Therefore, in the new phase, an attempt has been made to address the challenges of the first phase, such as recording information and assessment results in the integrated system of the Ministry of Health and viewing it by family medicine, the challenges of referral and entering a higher and more specialized level of service provision, and the entry of the geriatric health field into the health network to cover various aspects of aging. Also, in the next phase we want to integrate higher level of rehabilitation in the intervention (treatment) stage in PHC according to development CBR. Conclusion In summary, this comprehensive pilot demonstrates the feasibility, efficacy, and multidimensional benefits of integrating rehabilitation into PHC in Iran. It offers a reproducible model for LMICs seeking to fulfill the WHO Rehabilitation 2030 vision, particularly in terms of equity, early intervention, interdisciplinary workforce development, and community empowerment. With strengthened policy, investment in workforce and infrastructure, and continued research, Iran’s model can inform rehabilitation scale-up throughout the region. Abbreviations • ADHD Attention Deficit Hyperactivity Disorder • ASD Autism Spectrum Disorder • CHC Comprehensive Healthcare Center • CBR Community-Based Rehabilitation • DLD Developmental Language Disorder • DoPH Deputy of Public Health • ENT Ear, Nose, and Throat • HEP Health Education and Promotion Group • ICUHC Integrated Comprehensive Universal Healthcare Network • ID Intellectual Disability • IHS Iranian Health System • LMICs Low- and Middle-Income Countries • MoU Memorandum of Understanding • NCDs Non-Communicable Diseases • NGOs Non-Governmental Organizations • PHC Primary Health Care • PCPs Primary Care Providers • RNs Rehabilitation Needs • SoR School of Rehabilitation • SPD Sensory Processing Disorder • TC Technical Committee • TUMS Tehran University of Medical Sciences • UCHC Urban Comprehensive Healthcare Center • UHC Universal Health Coverage • WHO World Health Organization Declarations Ethics approval and consent to participate No information that could reveal personal details of the participants was collected. All participants entered the study with full informed consent. Written ethical consent forms were obtained from all participants. All services were provided to patients free of charge. All procedures were conducted in accordance with the terms of the agreement and were approved by the Ethics Committee of the Vice-Chancellor for Health (Approval No. 1401/11/76/31). The study was conducted in accordance with the Helsinki. Clinical trial number: not applicable Consent for publication Not applicable Competing interests The author declared no competing interests Funding no Author Contribution V.R. conceptualized and designed the study, developed the manuscript outline, performed data gathering and analysis, and drafted the initial manuscript. A.V. and A.K. contributed to the study's conceptualization and design. A.O.M. contributed to the conceptualization. All authors critically reviewed, provided substantive feedback on subsequent drafts, and approved the final version of the manuscript for submission. Acknowledgements Thanks to Dr. Azita Karimi, Ms. Mortazavi, Ms. Haghshenas, and Ms. Ansari for their help in the design and data collection. Also, many thanks to Dr. Naqdi, Dr. Raji, Dr. Khodami, and Dr. Mohammadkhani from the Faculty of Rehabilitation for their participation in the redesign of educational curricula. Data Availability The datasets generated during this study are available from the corresponding author upon reasonable request. References Kamenov K, Mills JA, Chatterji S, Cieza A. Needs and unmet needs for rehabilitation services: a scoping review. Disabil Rehabil. 2019;41(10):1227–37. Jesus TS, Landry MD, Hoenig H. Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017. Int J Environ Res Public Health. 2019;16(6). Dee M, Lennon O, O'Sullivan C. A systematic review of physical rehabilitation interventions for stroke in low and lower-middle income countries. Disabil Rehabil. 2020;42(4):473–501. Gimigliano F, Negrini S. The World Health Organization Rehabilitation 2030: a call for action. Eur J Phys Rehabil Med. 2017;53(2):155–68. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021;396(10267):2006–17. Bright T, Wallace S, Kuper H. A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries. Int J Environ Res Public Health. 2018;15(10). Rodes CH, Kurebayashi R, Kondo VE, Luft VD, Góes ÂBd, Schmitt ACB. The access and rehabilitation working process in Primary Health Care. Fisioterapia e Pesquisa. 2017;24:74–82. Etemadi M, Gorji HA, Kangarani HM, Ashtarian K. Power structure among the actors of financial support to the poor to access health services: Social network analysis approach. Soc Sci Med. 2017;195:1–11. Shahabi S, Kiekens C, Etemadi M, Mojgani P, Teymourlouei AA, Lankarani KB. Integrating rehabilitation services into primary health care: policy options for Iran. BMC Health Serv Res. 2022;22(1):1317. Farahbod M, Masoudi Asl I, Tabibi SJ, Kamali M. The Status of Rehabilitation in Iran: Barriers and Facilitators. Iran J Ageing. 2023;18(2):218–33. McColl MA, Shortt S, Godwin M, Smith K, Rowe K, O'Brien P, et al. Models for integrating rehabilitation and primary care: a scoping study. Arch Phys Med Rehabil. 2009;90(9):1523–31. Dubouloz C-J, Savard J, Burnett D, Guitard P. An interprofessional rehabilitation university clinic in primary health care: a collaborative learning model for physical therapist students in a clinical placement. J Phys Therapy Educ. 2010;24(1):19–24. Organization W. Rehabilitation 2030 initiative World Health Organization WHO 2025 [Available from: [Available from: https://www.who.int/initiatives/rehabilitation-2030 Hajebi A, Sharifi V, Asgardoon MH, Damari B. The Effectiveness of the Pilot Implementation of Iran's Comprehensive Mental and Social Health Services (the SERAJ Program): A Controlled Community Trial. Iran J Psychiatry. 2021;16(2):168–76. World Health O. Rehabilitation in health systems. Rehabilitation in health systems2017. p. 92-. Seijas V, Hrzic KM, Neculhueque XZ, Sabariego C. Improving access to and coverage of rehabilitation services through the implementation of rehabilitation in primary health care: a case study from Chile. Health Syst Reform. 2023;9(1):2242114. Khan NB, Joseph L, Adhikari M. The hearing screening experiences and practices of primary health care nurses: Indications for referral based on high-risk factors and community views about hearing loss. Afr J Prim Health Care Fam Med. 2018;10(1):e1–11. Rahimi V, Mohammadkhani G, Javadi F. Improving universal newborn hearing screening outcomes by conducting it with thyroid screening. Int J Pediatr Otorhinolaryngol. 2018;111:111–4. McGregor KK. How We Fail Children With Developmental Language Disorder. Lang Speech Hear Serv Sch. 2020;51(4):981–92. Hall NE. Developmental language disorders. Semin Pediatr Neurol. 1997;4(2):77–85. Francés L, Quintero J, Fernández A, Ruiz A, Caules J, Fillon G, et al. Current state of knowledge on the prevalence of neurodevelopmental disorders in childhood according to the DSM-5: a systematic review in accordance with the PRISMA criteria. Child Adolesc Psychiatry Ment Health. 2022;16(1):27. Ayano G, Demelash S, Gizachew Y, Tsegay L, Alati R. The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. J Affect Disord. 2023;339:860–6. Mitiku K, Nega T, Arefaynie M, Tilahun D, Kefale B, Damtie Y, et al. Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia. BMC Pediatr. 2023;23(1):638. Abdelbaky OA, Deifallah S, Amin G, Marzouk D. Screening for developmental delays in children 2–36 months of age in a primary health care center in Cairo, Egypt. J High Inst Public Health. 2022;52(2):53–8. Henschke N, Harrison C, McKay D, Broderick C, Latimer J, Britt H, et al. Musculoskeletal conditions in children and adolescents managed in Australian primary care. BMC Musculoskelet Disord. 2014;15:164. Mokhtarinia HR, Torkamani MH, Farmani O, Biglarian A, Gabel CP. Smartphone addiction in children: patterns of use and musculoskeletal discomfort during the COVID-19 pandemic in Iran. BMC Pediatr. 2022;22(1):681. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10267):2006–17. Surya N, Someshwar HP. Low-Cost telerehabilitation in low-and middle-income countries (LMICs): Overcoming barriers to access and improving healthcare delivery. NeuroRehabilitation. 2025:10538135241303349. Coales K, Jennings H, Afaq S, Arsh A, Bhatti M, Siddiqui F, et al. Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries: a qualitative evidence synthesis. Global health action. 2023;16(1):2228112. Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour health. 2017;15:1–13. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 10 Nov, 2025 Editor invited by journal 17 Oct, 2025 Editor assigned by journal 14 Oct, 2025 Submission checks completed at journal 14 Oct, 2025 First submitted to journal 26 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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recipients\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7722508/v1/93d4a7f2e10c01ed9cabdd2c.jpeg\"},{\"id\":96330870,\"identity\":\"d2c05a48-4f74-4ff1-a885-2ce5c489d34f\",\"added_by\":\"auto\",\"created_at\":\"2025-11-20 00:53:20\",\"extension\":\"jpeg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":139431,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eService Delivery Time (minutes) in various areas of rehabilitation\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage3.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7722508/v1/cf0ff36c770c193f45ba166e.jpeg\"},{\"id\":96330871,\"identity\":\"220da64d-811d-45fa-8295-7ebe4ba627e3\",\"added_by\":\"auto\",\"created_at\":\"2025-11-20 00:53:20\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":68515,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eService allocation rates categorized by referral location\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7722508/v1/5cc8511925c0471c2d3f8ccd.png\"},{\"id\":96367416,\"identity\":\"36c07a75-328d-4b99-ace0-d73e53829657\",\"added_by\":\"auto\",\"created_at\":\"2025-11-20 10:12:44\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2048092,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7722508/v1/4e5d1614-1225-4978-88d4-5115215a9238.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Integration of academic rehabilitation services in primary health care: the first implementation report of an ongoing initiative in Iran\",\"fulltext\":[{\"header\":\"Backgound\",\"content\":\"\\u003cp\\u003eRehabilitation is a key pillar of the health system that aims to optimize function, increase independence, reduce disability, and improve the quality of life of people who are faced with functional, emotional or cognitive limitations due to congenital anomalies, diseases, injuries, and accidents(\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Rehabilitation services include a wide range of specialized interventions; from physiotherapy, occupational therapy, and speech therapy to psychosocial support and life skills training that may be needed for anyone with health problems in movement, vision, hearing, speech, swallowing, or cognition (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). These services are not only used for rehabilitation after illness or accidents, but also play a preventive role in reducing the severity of disability, disease progression, and independence. On the other hand, rehabilitation interventions are cost-effective, require minimal resources, and can be used as successful models of care (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eDemographic transition has led to an increase in chronic diseases in adults, which has exceeded the need for rehabilitation services. Meanwhile, the need for rehabilitation services has increased with the increscent in hearing and developmental disorders such as autism, learning disabilities, and disorders due to physical development and growth impairment in children (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). While the demand for rehabilitation services is increasing worldwide, access to it still faces challenges and the need for rehabilitation services significantly outstrips the supply of services, leaving many people with unmet basic needs for rehabilitation (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). According to a study published in The Lancet, in 2019, 2.41\\u0026nbsp;billion people worldwide had conditions requiring rehabilitation services, equivalent to almost one-third of the world\\u0026rsquo;s population (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). In low- and middle-income countries, 50% of people currently do not have access to the rehabilitation services they need. These trends should encourage health policy makers to prioritize rehabilitation services(\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003ePrimary health care (PHC) includes preventive, curative, rehabilitative, and palliative services according to the needs of individuals. Rehabilitation in community health centers can be a window for timely identification and provision of required services to the patients(\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). Iranian PHC network ,which is well structured and distributed at rural and urban areas, affiliated to the universities of medical sciences and health services, mainly financed by the government, and most of the services are free of charge. More than 90% of Iranians are covered by social health insurance organizations, including Iran Health Insurance Organization, the Social Security Organization, and the Armed Forces Health Insurance Organization (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e). Therefore, it can be a suitable platform for making rehabilitation services available. The integration of rehabilitation services into PHC has been considered as an effective solution to respond to this widespread need. The aim of this integration is to facilitate equitable access, reduce individual and health system costs, improve the quality of services, and intervene early to prevent progressive disabilities. Experience from different countries has also shown that rehabilitation is most effective when it is initiated in the early stages of the disease and at the community level (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eUnfortunately, in the Iranian health system (IHS), rehabilitation services are largely provided at the secondary and tertiary levels and have a small share in the PHC network. This lack of integration has led to lost opportunities, increased long-term costs, and reduced quality of life for many people in need (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). In 2009, McColl et al. presented a review of models for integrating rehabilitation and primary health care. The team of researchers discussed six different models for delivering primary health care and rehabilitation services in an integrated approach: clinic, development, self-management, community-based rehabilitation, collaborative care, and patient management. Rehabilitation providers interested in working at primary care may benefit from considering these models (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). To achieve proper and systematic integration of rehabilitation in health centers and full implementation of community-based rehabilitation in countries, especially in low- and middle-income countries, and to ensure that well trained future health professionals are ready to participate in interdisciplinary work, it is also necessary the integration occurs in the education of students in these fields. An experience reported in 2010 by Dabaloz et al. in Canada, with the creation of a model of interdisciplinary academic rehabilitation clinics in health centers for collaborative learning for physiotherapy students in a clinical setting (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). Therefore, it seems that integration should be carried out at the university education levels of rehabilitation disciplines in the form of integrating rehabilitation internships alongside service provision. In this regard, the first official experience of integrating academic rehabilitation services into the PHC network has begun in one of the selected areas of Tehran capital city. This approach was taken in response to the Rehabilitation 2030 initiative and \\\"Call to Action\\\" in Iran and attempted to respond to some of the priority areas expressed by WHO in this program(\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThis article aims to introduce and analyze this experience, examine its implementation process, challenges, opportunities, and initial results, and attempt to provide solutions for the sustainable development of this novel model at the national and global levels.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e This is descriptive implementation study using a case study approach which reviewed 2 years implementation of a pioneer initiative began on September 16, 2022, that is still ongoing. The information gathered by desk review of the existing documents, interviews to the stakeholders and the secondary data sheets. Content analysis of the qualitative data were done by research team and SPSS 26 used for descriptive analysis of the quantitative data.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eOrganizational agreement\\u003c/h2\\u003e\\u003cp\\u003eThe School of Rehabilitation (SoR) and the Deputy of Public Health (DoPH) at Tehran University of Medical Sciences (TUMS) signed a Memorandum of Understanding (MoU) in October 2022. Under this agreement, the SoR has been providing academic services, including counseling and screening for disorders, with the goal of enhancing rehabilitation services within the framework of the Integrated Comprehensive Universal Healthcare Network (ICUHC). Additionally, the MoU aims to expand student internships in urban UCHC centers, fostering the integration of rehabilitation into healthcare through both service delivery and medical education.The MoU considered proposed policy solutions regarding each World Health Organization (WHO) six building blocks framework (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). Accordingly, four target groups were designed for this project: 1) Managers, experts, and health service providers,2) Students in rehabilitation fields, 3) service users to UCHC, and 4) the defined population of UCHC.\\u003c/p\\u003e\\u003cp\\u003eIn accordance with the target group, 3 areas were defined in this project: 1- Management area and project development and definition 2- Educational area 3- Therapeutic area\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eManagement area and project definition\\u003c/h3\\u003e\\n\\u003cp\\u003eIn the management domain, the implementation process began with the formation of an inter-sectoral technical committee (TC), established on the basis of the MoU aligned with national health plans ie: Non-Communicable Diseases (NCDs, elderly health, Ear health, and etc. Official representatives from the SoR and the DoPH were nominated. Key instructions of the MoU were identified by TC. (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003eAn introductory meeting was held to orient all stakeholders, followed by subgroup meetings to map shared capacities and define expectations. A detailed meeting schedule was developed for both executive and monitoring subcommittees. Knowledge management was ensured through systematic documentation and reporting of all sessions. Regular executive committee meetings served to raise awareness, provide structured training, and discuss the integration of rehabilitation into the academic primary health care. The process culminated in the formulation and operationalization of an action plan integrating rehabilitation within the ongoing UCHC programs.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eManagement Domain Action Plan\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAction\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eActivities\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eResponsible Party\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003edeliverables\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAgreed priorities\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eStrengthen inter-sectoral coordination to implement national agreements (NCDs, Elderly Health, Mental Health).\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e- Deputy of Public Health\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAppoint Representatives\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAssign representatives from the SoR and DoPH\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eDoPH\\u0026thinsp;+\\u0026thinsp;SoR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eOfficial correspondence and meeting minutes.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eForm Technical Committee\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDraft initial terms of the agreement.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eDoPH Technical Committee (Deputy Head, NCD Unit, South Tehran Health Center)\\u0026thinsp;+\\u0026thinsp;The Technical/Executive Committee of the SoR (SoR Representative - Dean of the SoR, Vice President for Administration and Finance of the SoR, Vice President for Education of the SoR)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eDraft agreement clauses.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFirst Orientation Meeting\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eConduct meeting at the DoPH.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eDoPH\\u0026rsquo;s Technical Assistant\\u0026thinsp;+\\u0026thinsp;Rehabilitation Faculty Representative\\u003c/p\\u003e\\u003cp\\u003e(Rehabilitation Faculty\\u0026rsquo;s Treatment Manager)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMeeting minutes and action plan.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSubgroup Meeting\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDefine shared capacities and expectations.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNCD Unit\\u0026thinsp;+\\u0026thinsp;South Tehran Health Center\\u0026thinsp;+\\u0026thinsp;SoR scientific groups\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMeeting minutes and shared expectations list.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDevelop Meeting Calendar\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePrepare a schedule for technical/executive and quarterly monitoring meetings.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNCD Unit\\u0026thinsp;+\\u0026thinsp;SoR representative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eApproved meeting calendar.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eKnowledge Management \\u0026amp; Reporting\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDocument meetings and prepare reports.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNCD Unit\\u0026thinsp;+\\u0026thinsp;SoR representative\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eArchived meeting minutes and periodic reports.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eExecute Technical Committee\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOperationalize rehabilitation services (training, screening, primary treatment and referrals).\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eDoPH Technical Groups (Mental Health, NCDs, Family Health)\\u0026thinsp;+\\u0026thinsp;The Technical/Executive Committee of the SoR (SoR Representative, All Educational Department of Rehabilitation)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eService protocols, performance reports.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMonitoring \\u0026amp; Evaluation\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eTrack key performance indicators (meeting frequency, report quality).\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eDoPH\\u0026thinsp;+\\u0026thinsp;SoR\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eChecklists and monitoring reports.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEnd\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eOutcome: Functional inter-sectoral coordination framework and quarterly reports.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFinal report and approved strategic plan.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eSoR: School of Rehabilitation; DoPH: Deputy of Public Health; NCD: Non-Communicable Diseases,\\u003c/p\\u003e\\n\\u003ch3\\u003eEducation Area\\u003c/h3\\u003e\\n\\u003cp\\u003eThe operational plan developed in the field of education is shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. Since this internships program was the first experience to cover all areas of rehabilitation in an integrated manner and was closed in the form of a two-year program, in the first step it was necessary to review the educational curricula in the SoR and how to establish the health center as an integrated educational field. It was done by participation of the Health Education and Promotion Group (HEP) of the DoPH.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eEducation Domain Action Plan Table\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAction\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eActivities\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eResponsible Party\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eDeliverables\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAcademic Field Training\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eReview internship course plans and implement student internships in the field.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eHEP Group / Health Network Management Group\\u0026thinsp;+\\u0026thinsp;SoR Educational Groups (Physiotherapy, Audiology, Speech Therapy, Occupational Therapy)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eOfficial correspondence and meeting Times.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHealth Promotion Training for Service Providers\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDesign educational packages and flowcharts for training healthcare staff and the target population.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSoR\\u0026thinsp;+\\u0026thinsp;Health Vice Chancellery\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6 pamphlets, 3 flowcharts, and media committee approval documents.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAwareness-Raising Training\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eConduct training sessions to enhance service providers' awareness in agreed-upon areas.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSoR\\u0026thinsp;+\\u0026thinsp;Health Vice Chancellery\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eTwo webinars or workshops (scheduled for June 2023 and February 2024).\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSystematic Health Education\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDeliver targeted education to vulnerable groups (pregnant women, children, elderly) and the general public.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSoR\\u0026thinsp;+\\u0026thinsp;Southern Tehran Health Center\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eThree webinars (May 2023, November 2023, May 2024) and satisfaction surveys.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCurriculum Development\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIntegrate preventive rehabilitation strategies into primary healthcare services.\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eTechnical Health Groups\\u0026thinsp;+\\u0026thinsp;SoR Educational Groups\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eApproved strategic plan and training modules.\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003eSoR: School of Rehabilitation; HEP : Health Education and Promotion Group\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eRehabilitation Services Area\\u003c/h3\\u003e\\n\\u003cp\\u003eTo address the need for delivering rehabilitation services to target populations, the implementation of a structured operational plan became imperative. The initial phase involved the systematic development of this plan through collaborative efforts between the TC of the SoR and multidisciplinary teams from the DoPH. These joint meetings aimed to align the plan with national development frameworks, institutional mandates, and the specific requirements outlined in upstream policy documents. Key components of the operational strategy, as detailed in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, included resource mobilization for procuring specialized rehabilitation equipment, coordination with stakeholders at UCHC, and the cooperation to the social workers, psychologists, and psychiatrists affiliated with the community mental health center (comprehensive social and mental health services, entitled \\u0026ldquo;SERAJ Program\\u0026rdquo;(\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e)).\\u003c/p\\u003e\\u003cp\\u003eThe plan further emphasized establishing interdepartmental referral protocols within primary health centers, extending to the secondary and tertiary care facilities affiliated to TUMS through consultations to the designated Early Childhood Growth and Development Center at Ziaeian teaching hospital. MoU was formalized with the regional education department to facilitate student access to rehabilitation services, while partnerships with non-governmental organizations (NGOs) and comprehensive healthcare centers (CHC) were leveraged to enhance community outreach.\\u003c/p\\u003e\\u003cp\\u003eAt the institutional level, initiatives included training sessions for educational supervisors on service delivery protocols, the development of standardized evaluation tools by audiology, physiotherapy, speech therapy, and occupational therapy departments, and the appointment of a dedicated rehabilitation coordinator at the selected UCHC in the south of Tehran (Meisam Center). This coordinator was tasked with documenting evaluation outputs, monitoring patient referrals, and ensuring adherence to referral pathways through periodic follow-ups. These measures collectively aimed to institutionalize a robust framework for sustainable and equitable rehabilitation service provision.\\u003c/p\\u003e\\u003cp\\u003eAt this stage, the necessary equipment for each rehabilitation domain including audiometer, otoscope, Medical Caliper, scoliometer, parallel bar, visual acuity (chart chessboard type), foot scanner, along with various books, play materials, and educational tools was procured jointly by the SoR and the Southern Health Center for using in both screening and initial assessment.\\u003c/p\\u003e\\u003cp\\u003eFurthermore, the age ranges for service provision within the clinics were established as follows: Physiotherapy from 7 years to geriatrics; Audiology from 3 years to geriatrics; Speech Therapy from 2 years to 18 years; and Occupational Therapy from birth to geriatrics. (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eRehabilitation Services Domain Action Plan Table\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAction\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eActivity\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eResponsible Executive (SoR)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eResponsible Executive (DoPH)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003edeliverables\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"8\\\" rowspan=\\\"9\\\"\\u003e\\u003cp\\u003eDeveloping rehabilitation services for age groups at UCHC\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eStrengthening occupational therapy services in mental/social health (SERAJ program)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eOccupational Therapy Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMental and social Health technical Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ePeriodic reports\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIdentifying sensory disorders (preterm infants) and cognitive/mental disorders in children\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eOccupational Therapy Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eMental and social Health technical Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eN/A\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHearing screening and counseling for children (4\\u0026ndash;5 years) and the elderly\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eAudiology Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFamily and Population health Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eQuarterly reports (number screened, referrals, consultations)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eScreening/counseling for musculoskeletal disorders (ages 7\\u0026ndash;15)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePhysiotherapy Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eAdolescent, Youth, and School Health Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eQuarterly reports\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eBalance disorder screening/counseling for the elderly\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePhysiotherapy and Occupational Therapy Departments\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFamily and Population health Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eQuarterly reports\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eEducation/counseling for individuals aged 50\\u0026thinsp;+\\u0026thinsp;at risk of osteoporosis\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePhysiotherapy Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eNCDs Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eQuarterly reports\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHearing screening for elementary students (5\\u0026ndash;12 years)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eAudiology Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eAdolescent, Youth, and School Health Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eQuarterly reports\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eScreening/counseling for speech-language delays, stuttering, and developmental disorders\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSpeech Therapy Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFamily and Population health Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eQuarterly reports (with referrals to developmental physicians)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCognitive disorder screening/counseling for the elderly\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eSpeech Therapy Department\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFamily and Population health Group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eQuarterly reports\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eSoR: School of Rehabilitation; DoPH: Deputy of Public Health; UCHC: Urban Comprehensive Healthcare Center; NCDs: Non-Communicable Diseases\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eThe Management and Groundwork Phase\\u003c/h2\\u003e\\u003cp\\u003eThe outcomes of the management and preparatory phase to initiate the integrated rehabilitation program are summarized as follows: A MoU was assigned by the DoPH and the SoR on September 6, 2022, formalizing collaboration in research, education, and clinical services. Key activities included organizing the first orientation meeting at the office of the Technical Deputy of the Health Vice Chancellery, followed by subgroup meetings to outline shared capacities and expectations (September 19, 2022). Periodic joint meetings were held between representatives of the SoR and the DoPH to align priorities, alongside dedicated sessions with the Faculty\\u0026rsquo;s academic departments and DoPH technical groups to emphasize the program\\u0026rsquo;s significance. Strategic planning ensured the sustained integration of all rehabilitation disciplines (e.g., physiotherapy, occupational therapy, speech therapy) into primary healthcare services. A two-year rehabilitation action plan (October 2022\\u0026ndash;October 2024) was developed for the ICUHC Network, involving iterative revisions through joint meetings and final approval by the Executive Technical Committee, which included faculty academic leaders and technical teams from the DoPH. A Gantt chart was designed to operationalize specific objectives, reviewed and endorsed by the Health Education and Technical Committees. Needs assessments for infrastructure, equipment, and staffing were conducted by the SoR with resource allocation and funding secured through collaboration with the Southern Tehran Health Center. Human resources, including specialized rehabilitation professionals, were mobilized by SoR to support service delivery. These efforts established a robust framework for embedding rehabilitation services into the Iran health system, ensuring alignment with upstream policies and fostering equitable access to quality care.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eThe Education Phase\\u003c/h3\\u003e\\n\\u003cp\\u003eThe outcomes of integrating rehabilitation services into the education framework are summarized in Tables\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e and \\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. Key achievements include:\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eDevelopment of the Education Section\\u003c/b\\u003e: Collaborative efforts between educational departments of the SoR and the Health Education and Promotion Department of DoPH of TUMS to design the operational plan\\u0026rsquo;s education component.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eCurriculum Adaptation\\u003c/b\\u003e: Revision of student internship curricula by the faculty\\u0026rsquo;s educational Departments to align with program objectives, client needs, and health system priorities, following joint meetings with DoPH stakeholders.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eInternship Implementation\\u003c/b\\u003e: Initiation of field internships across all rehabilitation disciplines (e.g., physiotherapy, audiology) at the Meysam Comprehensive Health Center starting in \\u003cb\\u003eFall 2022\\u003c/b\\u003e (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eEducational Material Preparation\\u003c/b\\u003e: Creation of public-facing educational pamphlets and certificates by the faculty\\u0026rsquo;s educational Departments, approved by the Health Office\\u0026rsquo;s media working group.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e\\u0026bull; \\u003cb\\u003eTargeted Workshops\\u003c/b\\u003e:\\u003c/h2\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eElderly-Focused Training\\u003c/b\\u003e: In-person workshops on physiotherapy, occupational therapy, and audiology for elderly care at the center (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eStaff Capacity Building\\u003c/b\\u003e: Hybrid workshops and webinars for healthcare staff serving children, adolescents, and the elderly, covering all rehabilitation disciplines (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eEducator Training\\u003c/b\\u003e: In-person workshops for educators specializing in child and adolescent health education (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eInformation Related to Student Internships in the Education Sector\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"7\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVarious Areas\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNumber of Educational Supervisions\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNumber of Students\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eTherapist Presence per Week (Sessions)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eTherapist Presence During Project Execution (Sessions)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eService Start Date\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eInternship Start Date\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAudiology\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e48\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e138\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e16/10/2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e16/10/2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpeech Therapy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1\\u0026ndash;2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e130\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e01/11/2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e14/02/2023\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOccupational Therapy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e68\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e01/10/2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e01/10/2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePhysiotherapy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e105\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3\\u0026ndash;5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e202\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e18/09/2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e01/10/2022\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTotal\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e177\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e538\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e-\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003ePercentage and Topics of Educational Workshops Conducted for Target Groups\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTarget Group\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eWorkshop Topics\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEducators (25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e- Speech and language disorders in children and adolescents\\u003c/p\\u003e\\u003cp\\u003e- Postural disorders in adolescents\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHealth Staff (50%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e- Occupational therapy for the elderly\\u003c/p\\u003e\\u003cp\\u003e- Webinar on introduction to rehabilitation fields in healthcare\\u003c/p\\u003e\\u003cp\\u003e- Balance and pelvic floor disorders in the elderly\\u003c/p\\u003e\\u003cp\\u003e- Speech and language disorders in children\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGeneral Public (25%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e- Hearing loss in the elderly (Audiology group)\\u003c/p\\u003e\\u003cp\\u003e- Balance disorders in the elderly (Occupational therapy group)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eRehabilitation Services Phase\\u003c/h2\\u003e\\u003cp\\u003eAs part of the pioneer initiative to incorporate rehabilitation services into primary healthcare systems, a total of 3,753 services had been delivered to enrolled patients by September 2024.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eAudiological assessment constituted the most frequently provided intervention, with additional service distribution and their respective quantities detailed in Fig.\\u0026nbsp;1. The distribution of service recipients by gender revealed that 50.6% were male and 49.4% were female. Nationally, 93% of the administered services targeted Iranian nationals, while 7% were allocated to non-Iranian citizens residing in the country. Age-specific eligibility criteria for service initiation varied across disciplines: speech therapy interventions commenced at 2 years, audiometry at 3 years, physiotherapy at 7 years, and occupational therapy services were available from infancy onward. A comprehensive breakdown of service provision across age demographics is illustrated in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003eAnalysis of service delivery timelines revealed discipline-specific variations in session frequency and duration during the project period. Audiology services comprised 138 sessions, delivered twice weekly, with the shortest average session duration (15 minutes). Speech therapy interventions involved 130 sessions, administered 1\\u0026ndash;2 times per week, each averaging 30 minutes. Occupational therapy included 68 sessions, conducted once weekly and lasting 30 minutes per session. Physiotherapy accounted for the highest volume of sessions (202 sessions), scheduled 3\\u0026ndash;5 times weekly, with an average duration of 30 minutes per session. Figure\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e illustrates the approximated duration of service provision stratified by rehabilitation areas.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eFigure\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e illustrates the distribution of rehabilitation services provided across comprehensive health service centers, categorized by referral sources (e.g., Health center, community programs, or self-referrals, ..)\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe distribution of identified disorders among individuals assessed according to screening and evaluation protocols, categorized by rehabilitation domain, is presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e. Within physiotherapy services, postural abnormalities of the upper and lower limbs constituted the highest proportion of diagnosed disorders (23.2%). In speech therapy, the majority of cases (69.3%) were identified with Developmental Language Disorder (DLD), followed by speech sound production disorders (16.4%) and stuttering (10.9%). In occupational therapy, 30.8% of clients were diagnosed with attention deficit hyperactivity disorder (ADHD)/attention deficit disorder, while psychomotor delay (19.6%) and learning disorders (8.0%) were the subsequent most prevalent conditions. Audiological assessments were conducted at the screening level, with 11.6% of individuals referred to audiology clinics for comprehensive diagnostic evaluation due to suspected hearing impairment. Stratified statistics indicated that the highest proportion of clients across all domains fell within the 5\\u0026ndash;18 years age group. The subsequent age group distribution differed significantly, with speech therapy and occupational therapy primarily serving the childhood age group (0\\u0026ndash;5 years), audiology consultations peaking in middle adulthood (30\\u0026ndash;60 years), and physiotherapy predominantly utilized by older adults (above 60 years) Furthermore, the highest proportion of referrals originated from the Comprehensive Rehabilitation Services Center and its satellite units for audiology (48.6%), occupational therapy (86.4%), and speech therapy (76.1%). In contrast, schools constituted the primary referral source for physiotherapy services (56.2%).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eAssessment results in each rehabilitation area\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eService\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDisorder Type\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eIdentified disorder (n)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eIdentified disorder (%)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePhysiotherapy\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eUpper Limb Postural Disorders\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e71\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7.9%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eLower Limb Disorders\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e183\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e20.4%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSpinal Postural Disorders\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e33\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.7%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eLower Limb Disorders \\u0026amp; Spinal Postural 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colname=\\\"c4\\\"\\u003e\\u003cp\\u003e11.2%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eShoulder Joint Problems\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eKnee Joint Problems\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.8%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eLumbar Region Problems\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAnkle and Wrist Region Problems\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" 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colname=\\\"c4\\\"\\u003e\\u003cp\\u003e16.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTotal\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e898\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e100.0%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSpeech Therapy\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eDLD\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e456\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e69.3%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAphasia\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.9%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eLearning Disorder\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.9%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDysphagia\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.5%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSpeech Sound Production Disorders\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e108\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e16.4%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eVoice Disorders\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eStuttering\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e72\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e10.9%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNormal finding\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.8%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTotal\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e658\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e100.0%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eOccupational Therapy\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMusculoskeletal Disorders\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDuchenne Muscular Dystrophy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSyndromes\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAnxiety and Behavioral Disorders\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e22\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e7.7%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eBalance Disorder\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.7%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eADHD\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e88\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e30.8%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSPD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eASD\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e8.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003ePsychomotor Delay\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e56\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e19.6%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eID\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.8%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCerebral Palsy\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e6.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eLearning Disorder\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e23\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e8.0%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDementia\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1.0%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNormal Findings\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.5%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTotal\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e286\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e100.0%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAudiology\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSuspected Hearing Loss (Referred for Audiologist)\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e221\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e11.6%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMedical Ear Disorders (Referred to ENT Specialist)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e198\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e10.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eReferred for Audiometry \\u0026amp; ENT Specialist\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e39\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2.0%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNormal Findings\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1,453\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e76.0%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eTotal\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e1,911\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e100.0%\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003eDLD:Developmental Language Disorder; ADHD: Attention deficit hyperactivity disorder;SPD: Sensory Processing Disorder; ASD: Autism Spectrum Disorder, ID: Intellectual Disability; ENT: Ear, noise and Throat\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eManagerial and Policy-Level Achievements\\u003c/h2\\u003e\\u003cp\\u003eOne key innovation of this project was the establishment of Iran\\u0026rsquo;s first multidisciplinary academic expert panel dedicated to rehabilitation policy and implementation within PHC. This group developed the first stepwise national framework that addressed the integration of rehabilitation services across policy, education, clinical service delivery, and research. This strategic approach was crucial in negotiating intersectoral responsibilities, fostering stakeholder alignment, and defining clear referral and screening pathways. Free service provision in an underprivileged Tehran district removed major financial barriers and advanced WHO\\u0026rsquo;s Universal Health Coverage (UHC) agenda, providing a model for scalable community-based empowerment and access (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eEducational Integration: Curriculum and Internship Innovation\\u003c/h2\\u003e\\u003cp\\u003eA significant educational achievement was the structured internship experience for \\u003cb\\u003e177 rehabilitation students\\u003c/b\\u003e across all four disciplines\\u0026mdash;an expansion compared to prior models which typically focused on limited fields such as physiotherapy or occupational therapy (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). The internships not only provided hands-on training but also fostered interprofessional teamwork, improved readiness for community-based practice, and enhanced problem-solving skills specific to PHC settings (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e The content and delivery of these internships, as well as targeted workshops (e.g., 25% for teachers on speech/language and posture, 50% for health staff on geriatric therapy and fundamentals of rehabilitation), were adapted based on a detailed needs assessment and the demographic characteristics of the local population. This community-driven approach led to the \\u003cb\\u003erevision and contextualization of core curricula\\u003c/b\\u003e to reflect the most prevalent disorders (e.g., increased emphasis on pediatric language disorders and ADHD, geriatrics, community-based screening), ensuring that future professionals are equipped to address real local health challenges. Integration of faculty with PHC staff fostered ongoing capacity-building for both sectors.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eService Utilization \\u0026amp; Demographics\\u003c/h2\\u003e\\u003cp\\u003eThe successful integration of rehabilitation services into Iran\\u0026rsquo;s primary healthcare system, as evidenced in this pioneer project, addresses a significant gap in the delivery of comprehensive health services in low- and middle-income countries (LMICs). This initiative, which delivered a total of \\u003cb\\u003e3,753 rehabilitation service sessions\\u003c/b\\u003e\\u0026mdash;comprising audiology, physiotherapy, speech therapy, and occupational therapy interventions\\u0026mdash;demonstrates both the feasibility and necessity of embedding rehabilitation in PHC to improve health equity, prevention, and early intervention.\\u003c/p\\u003e\\u003cp\\u003eAcross the 3,753 services, the distribution was nearly equal by gender (\\u003cb\\u003e50.6% male, 49.4% female\\u003c/b\\u003e), and the project reached marginalized populations, with \\u003cb\\u003e93% Iranian nationals\\u003c/b\\u003e and \\u003cb\\u003e7% non-Iranian residents\\u003c/b\\u003e, including refugees and immigrants. The age profile revealed tailored access: children (0\\u0026ndash;5 years) formed the primary group for speech and occupational therapy; adults (30\\u0026ndash;60 years) accessed most audiology services; the elderly (\\u0026gt;\\u0026thinsp;60 years) predominantly utilized physiotherapy.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eAudiology\\u003c/b\\u003e registered the highest uptake (1,911 sessions), with 11.6% suspected hearing loss identified for further assessment, and 10.4% referred to ENT Specialist for medical intervention. Although in some countries, including our country, there is a history of performing newborn screening in primary health centers(\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e), this study showed the need to pay attention to other age groups for performing hearing screening in these centers.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eSpeech therapy\\u003c/b\\u003e (658cases): In this study, Developmental Language Disorder (DLD) was the most prevalent finding (69.3%). DLD is one of the most common neurodevelopmental(\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e) that it is estimated that 60% of children with DLD go undiagnosed (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). So, the presence of speech therapists in primary health care centers is a noteworthy strategy, as it enables early detection and timely intervention for speech and language disorders.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eOccupational therapy\\u003c/b\\u003e (286 cases): 30.8% ADHD diagnoses and significant rates of psychomotor delays (19.6%) underscored the importance of child-focused rehabilitation. ADHD is indeed the most common neurodevelopmental disorder diagnosed in children especially in mental health domain(\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). The global prevalence of ADHD in children and adolescents is estimated to be around 8% in umbrella review(\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). The prevalence of psychomotor delays in children varies significantly across different populations and contexts. For example, A study by Mitiku et al showed an 16.3% prevalence of gross motor developmental delay among under-five children attending health facilities in Ethiopia (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). Also, the prevalence of developmental delays which includes psychomotor delays among children aged 2\\u0026ndash;36 months in a PHC Center in Egypt was found to be 9.3%(\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePhysiotherapy\\u003c/b\\u003e (898 cases): Upper and lower limb postural disorders together accounted for 28.3% of the cases, reflecting a significant community burden. The prevalence of upper and lower limb postural disorders in children and adolescents is a significant concern, as various studies indicate a high incidence of such disorders during this developmental stage. Factors contributing to these issues include rapid growth, poor postural habits, and musculoskeletal imbalances. A study in Australia highlights that musculoskeletal conditions, affecting 4.9% of pediatric primary care encounters and upper and lower limb conditions were the most common. This study reports the experience of managing musculoskeletal disorders by general practitioners in PHC (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). The high prevalence of musculoskeletal disorders, especially in students, could also be influenced by the timing of our sampling (after the COVID-19 period) due to the high use of smart phones(\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e), which were widely used in virtual education.It is worth noting that in this study, individuals who visited speech therapy and occupational therapy clinics were generally those with existing difficulties, as their parents already suspected the presence of a disorder. In contrast, those attending physiotherapy and audiology clinics represented the general population. Therefore, the higher reported prevalence of disorders in the domains of occupational therapy and speech therapy may be attributed to this factor.\\u003c/p\\u003e\\u003cp\\u003eThese quantitative findings not only align with the projected needs of populations in similar LMIC contexts, but also emphasize the diversity and reach enabled by integrated, multidisciplinary care. Musculoskeletal conditions and sensory impairments account for the largest proportion of RNs, both of which are largely amenable to rehabilitation at the primary health care (PHC) level; however, rehabilitation is poorly integrated at this level of care in most countries (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eOperational Results and Service Models\\u003c/h2\\u003e\\u003cp\\u003eThe program adopted \\u003cb\\u003eage-tailored protocols\\u003c/b\\u003e \\u0026mdash; occupational therapy from infancy, speech therapy from age 2, audiology from age 3, and physiotherapy from age 7 \\u0026mdash; ensuring appropriate entry points across the life span. The referral system, primarily from Comprehensive Rehabilitation Service Centers and schools, supported continuity of care, though 47\\u0026ndash;86% of referrals originated from within the PHC structure, pointing to meaningful uptake but also revealing ongoing challenges with cross-sectoral coordination.\\u003c/p\\u003e\\u003cp\\u003eService delivery was enhanced by implementing a \\u003cb\\u003ehybrid model\\u003c/b\\u003e: In-person sessions were supported by digital learning and telehealth platforms reaching \\u003cb\\u003e50% of health personnel\\u003c/b\\u003e, thus bridging geographic and resource limitations. This blended approach is corroborated by evidence from Pakistan and other LMICs that emphasize the value of tele-rehabilitation for capacity building and access (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e) .\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eChallenges and Barriers\\u003c/h2\\u003e\\u003cp\\u003eDespite its successes, the project faced persistent challenges, typical for innovative programs in LMICs:\\u003c/p\\u003e\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eOrganizational Gaps\\u003c/b\\u003e: The absence of a dedicated organizational structure for rehabilitation within PHC led to inefficiencies in service integration, referral fragmentation, and insufficient role clarity (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eResource Constraints\\u003c/b\\u003e: Funding issues, shared budget responsibility, and slow equipment procurement (e.g., audiometers, scoliometers) slowed full implementation.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eHuman Resources\\u003c/b\\u003e: Limited rehabilitation literacy and insufficient PHC staff familiarity with rehabilitation concepts necessitated extensive upskilling and ongoing advocacy.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eOutcome Measurement\\u003c/b\\u003e: The short (two-year) pilot phase and limited resources did not allow for comprehensive tracking of long-term clinical, functional, or quality-of-life outcomes, a direction that must be prioritized in future work.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e\\u003cb\\u003eCultural Adaptation\\u003c/b\\u003e: The inclusion of \\u003cb\\u003e7% non-Iranian clients\\u003c/b\\u003e (including refugees) highlighted the need for culturally and linguistically adapted interventions.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eComparative Context\\u003c/h2\\u003e\\u003cp\\u003eWhile similar pilots\\u0026mdash;such as Chile\\u0026rsquo;s RehabPHC\\u0026mdash;demonstrated success in integrating physiotherapy and occupational therapy at the community level (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e), the current study broadened the scope to include all four major rehabilitation domains and demonstrated the value and acceptability of such a fully multidisciplinary approach. The model reflected and extended the WHO\\u0026rsquo;s Rehabilitation 2030 priorities, showing that with strong academic-public health partnerships, impactful service expansion is possible (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eRecommendations and Path Forward\\u003c/h2\\u003e\\u003cp\\u003eFor sustainable scale-up, policy actions should anchor rehabilitation as an explicit component of national PHC policy, leveraging the WHO six building blocks framework (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). Decentralized funding models, standardized outcome measurement (in line with the WHO Minimal Rehabilitation Dataset), and expanded roles for community health workers (CHWs) are critical. Evidence from some countries supported task-shifting to CHWs to improve reach and sustainability (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). Although, the purpose of this task-shifting in integrating rehabilitation services into PHC is to increase the familiarity of primary care providers\\u0026rsquo; (PCPs) with rehabilitation disorders and the initial screening of individuals for referral to rehabilitation specialists. Future implementation should incorporate longitudinal tracking of disability, functional outcomes, and cost-effectiveness (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e), while continuing to iterate educational curricula to meet evolving community needs.\\u003c/p\\u003e\\u003cp\\u003eAs mentioned, this is an ongoing study. Therefore, in the new phase, an attempt has been made to address the challenges of the first phase, such as recording information and assessment results in the integrated system of the Ministry of Health and viewing it by family medicine, the challenges of referral and entering a higher and more specialized level of service provision, and the entry of the geriatric health field into the health network to cover various aspects of aging. Also, in the next phase we want to integrate higher level of rehabilitation in the intervention (treatment) stage in PHC according to development CBR.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn summary, this comprehensive pilot demonstrates the feasibility, efficacy, and multidimensional benefits of integrating rehabilitation into PHC in Iran. It offers a reproducible model for LMICs seeking to fulfill the WHO Rehabilitation 2030 vision, particularly in terms of equity, early intervention, interdisciplinary workforce development, and community empowerment. With strengthened policy, investment in workforce and infrastructure, and continued research, Iran\\u0026rsquo;s model can inform rehabilitation scale-up throughout the region.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eADHD\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eAttention Deficit Hyperactivity Disorder\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eASD\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eAutism Spectrum Disorder\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eCHC\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eComprehensive Healthcare Center\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eCBR\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eCommunity-Based Rehabilitation\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eDLD\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eDevelopmental Language Disorder\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eDoPH\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eDeputy of Public Health\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eENT\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eEar, Nose, and Throat\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eHEP\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eHealth Education and Promotion Group\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eICUHC\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eIntegrated Comprehensive Universal Healthcare Network\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eID\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eIntellectual Disability\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eIHS\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eIranian Health System\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eLMICs\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eLow- and Middle-Income Countries\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eMoU\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eMemorandum of Understanding\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eNCDs\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eNon-Communicable Diseases\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eNGOs\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eNon-Governmental Organizations\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003ePHC\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003ePrimary Health Care\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003ePCPs\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003ePrimary Care Providers\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eRNs\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eRehabilitation Needs\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eSoR\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eSchool of Rehabilitation\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eSPD\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eSensory Processing Disorder\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eTC\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eTechnical Committee\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eTUMS\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eTehran University of Medical Sciences\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eUCHC\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eUrban Comprehensive Healthcare Center\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eUHC\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eUniversal Health Coverage\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003e\\u0026bull; \\u003cb\\u003eWHO\\u003c/b\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eWorld Health Organization\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003cp\\u003eNo information that could reveal personal details of the participants was collected. All participants entered the study with full informed consent. Written ethical consent forms were obtained from all participants. All services were provided to patients free of charge. All procedures were conducted in accordance with the terms of the agreement and were approved by the Ethics Committee of the Vice-Chancellor for Health (Approval No. 1401/11/76/31). The study was conducted in accordance with the Helsinki.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003ch2\\u003eClinical trial number:\\u003c/h2\\u003e\\u003cp\\u003enot applicable\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003ch2\\u003eConsent for publication\\u003c/h2\\u003e\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003ch2\\u003eCompeting interests\\u003c/h2\\u003e\\u003cp\\u003eThe author declared no competing interests\\u003c/p\\u003e\\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\u003cp\\u003eno\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eV.R. conceptualized and designed the study, developed the manuscript outline, performed data gathering and analysis, and drafted the initial manuscript. A.V. and A.K. contributed to the study's conceptualization and design. A.O.M. contributed to the conceptualization. All authors critically reviewed, provided substantive feedback on subsequent drafts, and approved the final version of the manuscript for submission.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e\\u003cp\\u003eThanks to Dr. Azita Karimi, Ms. Mortazavi, Ms. Haghshenas, and Ms. Ansari for their help in the design and data collection. Also, many thanks to Dr. Naqdi, Dr. Raji, Dr. Khodami, and Dr. Mohammadkhani from the Faculty of Rehabilitation for their participation in the redesign of educational curricula.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe datasets generated during this study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eKamenov K, Mills JA, Chatterji S, Cieza A. Needs and unmet needs for rehabilitation services: a scoping review. Disabil Rehabil. 2019;41(10):1227\\u0026ndash;37.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eJesus TS, Landry MD, Hoenig H. Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017. Int J Environ Res Public Health. 2019;16(6).\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDee M, Lennon O, O'Sullivan C. A systematic review of physical rehabilitation interventions for stroke in low and lower-middle income countries. Disabil Rehabil. 2020;42(4):473\\u0026ndash;501.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGimigliano F, Negrini S. The World Health Organization Rehabilitation 2030: a call for action. Eur J Phys Rehabil Med. 2017;53(2):155\\u0026ndash;68.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021;396(10267):2006\\u0026ndash;17.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBright T, Wallace S, Kuper H. A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries. Int J Environ Res Public Health. 2018;15(10).\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRodes CH, Kurebayashi R, Kondo VE, Luft VD, G\\u0026oacute;es \\u0026Acirc;Bd, Schmitt ACB. The access and rehabilitation working process in Primary Health Care. Fisioterapia e Pesquisa. 2017;24:74\\u0026ndash;82.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eEtemadi M, Gorji HA, Kangarani HM, Ashtarian K. Power structure among the actors of financial support to the poor to access health services: Social network analysis approach. Soc Sci Med. 2017;195:1\\u0026ndash;11.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eShahabi S, Kiekens C, Etemadi M, Mojgani P, Teymourlouei AA, Lankarani KB. Integrating rehabilitation services into primary health care: policy options for Iran. BMC Health Serv Res. 2022;22(1):1317.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFarahbod M, Masoudi Asl I, Tabibi SJ, Kamali M. The Status of Rehabilitation in Iran: Barriers and Facilitators. Iran J Ageing. 2023;18(2):218\\u0026ndash;33.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMcColl MA, Shortt S, Godwin M, Smith K, Rowe K, O'Brien P, et al. Models for integrating rehabilitation and primary care: a scoping study. Arch Phys Med Rehabil. 2009;90(9):1523\\u0026ndash;31.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDubouloz C-J, Savard J, Burnett D, Guitard P. An interprofessional rehabilitation university clinic in primary health care: a collaborative learning model for physical therapist students in a clinical placement. J Phys Therapy Educ. 2010;24(1):19\\u0026ndash;24.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eOrganization W. Rehabilitation 2030 initiative World Health Organization WHO 2025 [Available from: [Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.who.int/initiatives/rehabilitation-2030\\u003c/span\\u003e\\u003cspan address=\\\"https://www.who.int/initiatives/rehabilitation-2030\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHajebi A, Sharifi V, Asgardoon MH, Damari B. The Effectiveness of the Pilot Implementation of Iran's Comprehensive Mental and Social Health Services (the SERAJ Program): A Controlled Community Trial. Iran J Psychiatry. 2021;16(2):168\\u0026ndash;76.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eWorld Health O. Rehabilitation in health systems. Rehabilitation in health systems2017. p. 92-.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSeijas V, Hrzic KM, Neculhueque XZ, Sabariego C. Improving access to and coverage of rehabilitation services through the implementation of rehabilitation in primary health care: a case study from Chile. Health Syst Reform. 2023;9(1):2242114.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eKhan NB, Joseph L, Adhikari M. The hearing screening experiences and practices of primary health care nurses: Indications for referral based on high-risk factors and community views about hearing loss. Afr J Prim Health Care Fam Med. 2018;10(1):e1\\u0026ndash;11.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eRahimi V, Mohammadkhani G, Javadi F. Improving universal newborn hearing screening outcomes by conducting it with thyroid screening. Int J Pediatr Otorhinolaryngol. 2018;111:111\\u0026ndash;4.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMcGregor KK. How We Fail Children With Developmental Language Disorder. Lang Speech Hear Serv Sch. 2020;51(4):981\\u0026ndash;92.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHall NE. Developmental language disorders. Semin Pediatr Neurol. 1997;4(2):77\\u0026ndash;85.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFranc\\u0026eacute;s L, Quintero J, Fern\\u0026aacute;ndez A, Ruiz A, Caules J, Fillon G, et al. Current state of knowledge on the prevalence of neurodevelopmental disorders in childhood according to the DSM-5: a systematic review in accordance with the PRISMA criteria. Child Adolesc Psychiatry Ment Health. 2022;16(1):27.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAyano G, Demelash S, Gizachew Y, Tsegay L, Alati R. The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. J Affect Disord. 2023;339:860\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMitiku K, Nega T, Arefaynie M, Tilahun D, Kefale B, Damtie Y, et al. Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia. BMC Pediatr. 2023;23(1):638.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAbdelbaky OA, Deifallah S, Amin G, Marzouk D. Screening for developmental delays in children 2\\u0026ndash;36 months of age in a primary health care center in Cairo, Egypt. J High Inst Public Health. 2022;52(2):53\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eHenschke N, Harrison C, McKay D, Broderick C, Latimer J, Britt H, et al. Musculoskeletal conditions in children and adolescents managed in Australian primary care. BMC Musculoskelet Disord. 2014;15:164.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMokhtarinia HR, Torkamani MH, Farmani O, Biglarian A, Gabel CP. Smartphone addiction in children: patterns of use and musculoskeletal discomfort during the COVID-19 pandemic in Iran. BMC Pediatr. 2022;22(1):681.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10267):2006\\u0026ndash;17.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSurya N, Someshwar HP. Low-Cost telerehabilitation in low-and middle-income countries (LMICs): Overcoming barriers to access and improving healthcare delivery. NeuroRehabilitation. 2025:10538135241303349.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCoales K, Jennings H, Afaq S, Arsh A, Bhatti M, Siddiqui F, et al. Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries: a qualitative evidence synthesis. Global health action. 2023;16(1):2228112.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSeidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour health. 2017;15:1\\u0026ndash;13.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-primary-care\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"famp\",\"sideBox\":\"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://author-welcome.nature.com/12875\",\"title\":\"BMC Primary Care\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Integrated Rehabilitation, Primary Health Care, Multidisciplinary Service, Health Systems Strengthening, Community base rehabilitation (CBR)\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7722508/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7722508/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eAccess to rehabilitation in low- and middle-income countries (LMICs) is limited, highlighting the need for integration into primary health care (PHC). This study reports the first academic initiative in Iran to embed multidisciplinary rehabilitation\\u0026mdash;including physiotherapy, occupational therapy, speech therapy, and audiology\\u0026mdash;within urban PHC, aiming to improve both community health and professional education.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eThis descriptive implementation study, designed as a case study, was initiated in a Tehran district through a memorandum of understanding between the School of Rehabilitation and the Deputy of Public Health of Tehran University of Medical Sciences. The integration plan addressed three domains: (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e) management and policy development through intersectoral coordination and standardized protocols; (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e) education via internship programs and capacity-building workshops; and (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e) rehabilitation services through supervised student-led clinics at a comprehensive health center. Data were documented daily and analyzed with SPSS 26.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003e In the management domain, a governance framework was established, including technical committees, policy guidelines, and monitoring mechanisms. In education, 177 students from all rehabilitation fields completed structured internships, curricula were revised to reflect local health priorities, and targeted workshops were delivered to staff, teachers, and the public. In the service domain, 3,753 free rehabilitation services were provided over two years (Sep 2023\\u0026ndash;2025), with audiology comprising the largest share (1,911), followed by physiotherapy (898), speech therapy (658), and occupational therapy (286). Commonly identified conditions included developmental language disorder (69.3%), ADHD (30.8%), and postural limb disorders (28.3%).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eIntegrating rehabilitation into PHC proved feasible and effective across management, education, and service delivery. This model provides a scalable blueprint for LMICs while underscoring the need for long-term evaluation and scale-up. 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