What is rehabilitation? An empirical investigation leading to an evidence-based description

Derick T Wade, Derick T Wade

Abstract

Background: There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect.

Method: This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition.

Findings: The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated.

Conclusion: Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient's needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.

Keywords: Rehabilitation description; content; person-centred; process; therapy.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Rehabilitation: who benefits, what structures are needed, what processes occur, and what is the outcome?

References

    1. NHS England. Commissioning guidance for rehabilitation. Publications Gateway reference no: 04919, (accessed 2 December 2019).
    1. Wade DT, De Jong B. Recent advances in rehabilitation. BMJ 2000; 320: 1355–1358.
    1. Wade DT. Rehabilitation – a new approach: part four: a new paradigm, and its implications. Clin Rehabil 2016; 30(2): 109–118.
    1. Spruit MA, Singh SJ, Garvey C, et al. An Official American Thoracic Society/European Respiratory Society Statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188(8): e13–e64.
    1. Langhorne P, Pollock A. What are the components of effective stroke unit care? Age Ageing 2002; 31(5): 365–371.
    1. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2013; 9: CD000197.
    1. Puhan MA, Gimeno-Santos E, Cates CJ, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; 12: CD005305.
    1. McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015; 2: CD003793.
    1. Dowman L, Hill CJ, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev 2014; 10: CD006322.
    1. Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2014; 12: CD011273.
    1. Shields GE, Wells A, Doherty P, et al. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart 2018; 104: 1403–1410.
    1. Amatya B, Khan F, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2019; 1: CD012732.
    1. Boesen F, Norgaard M, Skjerbaek AG, et al. Can inpatient multidisciplinary rehabilitation improve health-related quality of life in MS patients on the long term – The Danish MS Hospitals Rehabilitation Study. Mult Scler. Epub ahead of print 5 November 2019. DOI: 10.1177/1352458519884244.
    1. Boesen F, Norgaard M, Trenel P, et al. Longer term effectiveness of inpatient multidisciplinary rehabilitation on health-related quality of life in MS patients: a pragmatic randomized controlled trial – The Danish MS Hospitals Rehabilitation Study. Mult Scler 2018; 24(3): 340–349.
    1. Rooney J, Byrne S, Heverin M, et al. A multidisciplinary clinic approach improves survival in ALS: a comparative study of ALS in Ireland and Northern Ireland. J Neurol Neurosurg Psychiatry 2015; 86(5): 496–501.
    1. Turner-Stokes L, Pick A, Nair A, et al. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 2015; 12: CD004170.
    1. Ferrazzoli D, Ortelli P, Zivi I, et al. Efficacy of intensive multidisciplinary rehabilitation in Parkinson’s disease: a randomised controlled study. J Neurol Neurosurg Psychiatry 2018; 89(8): 828–835.
    1. Nordstrom P, Thorngren KG, Hommel A, et al. Effects of geriatric team rehabilitation after hip fracture: meta-analysis of randomized controlled trials. J Am Med Dir Assoc 2018; 19(10): 840–845.
    1. Handoll HHG, Cameron ID, Mak JCS, et al. Multi-disciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev 2009; 4: CD007125.
    1. Khan F, Ng L, Gonzalez S, et al. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy. Cochrane Database Syst Rev 2008; 2: CD004957.
    1. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014; 9: CD000963.
    1. Marin TJ, Van Eerd D, Irvin E, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev 2017; 6: CD002193.
    1. Olsson Moller U, Beck I, Ryden L, et al. A comprehensive approach to rehabilitation interventions following breast cancer treatment – a systematic review of systematic reviews. BMC Cancer 2019; 19(1): 472.
    1. Scott DA, Mills M, Black A, et al. Multidimensional rehabilitation programmes for adult cancer survivors. Cochrane Database Syst Rev 2013; 3: CD007730.
    1. Tipping CJ, Harrold M, Holland A, et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med 2017; 43(2): 171–183.
    1. Arias-Fernandez P, Romero-Martin M, Gomez-Salgado J, et al. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci 2018; 30(9): 1193–1201.
    1. Fuke R, Hifumi T, Kondo Y, et al. Early rehabilitation to prevent post-intensive care syndrome in patients with critical illness: a systematic review and meta-analysis. BMJ Open 2018; 8: e019998,
    1. Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev 2018; 3: CD010754.
    1. Doig E, Fleming J, Kuipers P, et al. Comparison of rehabilitation outcomes in day hospital and home settings for people with acquired brain injury – a systematic review. Disabil Rehabil 2010; 32(25): 2061–2077.
    1. Forster A, Young J, Langhorne P. Systematic review of day hospital care for elderly people. BMJ 1999; 318(7187): 837–841.
    1. Crocker T, Forster A, Young J, et al. Physical rehabilitation for older people in long-term care. Cochrane Database Syst Rev 2013; 2: CD004294.
    1. Langhorne P, Baylan S. Early supported discharge services for people with acute stroke. Cochrane Database Syst Rev 2017; 7: CD000443.
    1. Blair J, Corrigall H, Angus N, et al. Home versus hospital-based cardiac rehabilitation: a systematic review. Rural Remote Health 2011; 11(2): 1532,
    1. Hillier S, Inglis-Jassiem G. Rehabilitation for community-dwelling people with stroke: home or centre based? A systematic review. Int J Stroke 2010; 5: 178–186.
    1. Verweij L, van de Korput E, Daams JG, et al. Effects of postacute multidisciplinary rehabilitation including exercise in out-of-hospital settings in the aged: systematic review and meta-analysis. Arch Phys Med Rehabil 2019; 100(3): 530–550.
    1. Donovan WH. Spinal cord injury – past, present, and future. J Spinal Cord Med 2007; 30: 85–100.
    1. Silver JR. History of the treatment of spinal injuries. Postgrad Med J 2005; 81(952): 108–114.
    1. Bunketorp-Käll L, Lundgren-Nilsson Å, Samuelsson H, et al. Long-term improvements after multimodal rehabilitation in late phase after stroke. Stroke 2017; 48: 1916–1924.
    1. Hurley M, Dickson K, Hallett R, et al. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane Database Syst Rev 2018; 4: CD010842.
    1. Madureira BG, Pereira MG, Avelino PR, et al. Efeitos de programas de reabilitação multidisciplinar no tratamento de pacientes com doença de Alzheimer: uma revisão sistemática. [Effects of multidisciplinary rehabilitation programs on treatment of patients with Alzheimer’s disease: a systematic review]. Cad Saúde Colet 2018; 26: 222–232,
    1. Sá CDC, Silva DFD, Bigongiari A, et al. Eficácia da reabilitação cognitiva na melhoria e manutenção das atividades de vida diária em pacientes com doença de Alzheimer: uma revisão sistemática da literatura [Efficacy of cognitive rehabilitation in improving and maintaining daily living activities in patients with Alzheimer’s disease: a systematic review of literature]. J Bras Psiquiatr 2019; 68: 153–160,
    1. Salakari MRJ, Surakka T, Nurminen R, et al. Effects of rehabilitation among patients with advances cancer: a systematic review. Acta Oncol 2015; 54(5): 618–628.
    1. Wade DT, Halligan PW. The biopsychosocial model of illness: a model whose time has come. Clin Rehabil 2017; 31(8): 995–1004.
    1. Wade DT. A teamwork approach to neurological rehabilitation. In: Dietz V, Ward NS. (eds) Oxford textbook of neurorehabilitation. 2nd ed Oxford: Oxford University Press, 2020, pp. 9–21.
    1. Choi BCK, Pak AP. Multidisciplinary, interdisciplinary, and transdisciplinary in health research, services, education, and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Invest Med 2006; 29: 351–364.
    1. Strasser DC, Falconer JA, Herrin JS, et al. Team functioning and patient outcomes in stroke rehabilitation. Arch Phys Med Rehabil 2005; 86(3): 403–409.
    1. Tyson SF, Burton L, McGovern A. The effect of a structured model for stroke rehabilitation multi-disciplinary team meetings on functional recovery and productivity: a phase I/II proof of concept study. Clin Rehabil 2015; 29(9): 920–925.
    1. Levack WMM, Weatherall M, Hay-Smith EJC, et al. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev 2015; 7: CD009727.
    1. Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making 2015; 35(1): 114–131.
    1. Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns 2017; 100(1): 65–75.
    1. Kabboul NN, Tomlinson G, Francis TA, et al. Comparative effectiveness of the core components of cardiac rehabilitation on mortality and morbidity: a systematic review and network meta-analysis. J Clin Med 2018; 7(12): E514,
    1. Lacasse Y, Guyatt GH, Goldstein RS. The components of a respiratory rehabilitation program: a systematic overview. Chest 1997; 111(4): 1077–1088.
    1. Veerbeek JM, van Wegen E, van Peppen R, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS ONE 2014; 9(2): e87987,
    1. Veerbeek JM, Koolstra M, Ket JC, et al. Effects of augmented exercise therapy on outcome of gait and gait-related activities in the first 6 months after stroke. Stroke 2011; 42(11): 3311–3315.
    1. Lohse KR, Lang CE, Boyd LA. Is more better? Using metadata to explore dose–response relationships in stroke rehabilitation. Stroke 2014; 45(7): 2053–2058.
    1. Schneider EJ, Lannin NA, Ada L, et al. Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. J Physiother 2016; 62(4): 182–187.
    1. Anderson L, Thompson DR, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2016; 1: CD001800.
    1. Larun L, Brurberg KG, Odgaard-Jensen J, et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2017; 4: CD003200.
    1. Searle A, Spink M, Ho A, et al. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2015; 29(12): 1155–1167.
    1. Bleakley CM, Taylor JB, Dischiavi SL, et al. Rehabilitation exercises reduce reinjury post ankle sprain, but the content and parameters of an optimal exercise program have yet to be established: a systematic review and meta-analysis. Arch Phys Med Rehabil 2019; 100(7): 1367–1375.
    1. Anderson L, Brown JPR, Clark AM, et al. Patient education in the management of coronary heart disease. Cochrane Database Syst Rev 2017; 6: CD008895.
    1. Murphy LA, Harrington P, Taylor SJ, et al. Clinical-effectiveness of self-management interventions in chronic obstructive pulmonary disease: an overview of reviews. Chron Respir Dis 2017; 14(3): 276–288.
    1. Lenferink A, Brusse-Keizer M, van der Valk PD, et al. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 8: CD011682.
    1. Fryer CE, Luker JA, McDonnell MN, et al. Self management programmes for quality of life in people with stroke. Cochrane Database Syst Rev 2016; 8: CD010442.
    1. Cheng KKF, Lim YTE, Koh ZM, et al. Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database Syst Rev 2017; 8: CD011152.
    1. Huang J, Han Y, Wei J, et al. The effectiveness of the Internet-based self-management program for cancer-related fatigue patients: a systematic review and meta-analysis. Clin Rehabil 2019; 34(3): 287–298.
    1. Mulligan H, Wilkinson A, Chen D, et al. Components of community rehabilitation programme for adults with chronic conditions: a systematic review. Int J Nurs Stud 2019; 97: 114–129.
    1. Ramsay P, Salisbury LG, Merriweather JL, et al. A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial. Trials 2014; 15: 38,
    1. Schmidt AM, Terkildsen Maindal H, Laurberg TB, et al. The Sano study: justification and detailed description of a multidisciplinary biopsychosocial rehabilitation programme in patients with chronic low back pain. Clin Rehabil 2018; 32(11): 1431–1439.
    1. Westerhof-Evers HJ, Visser-Keizer AC, Fasotti L, et al. Social cognition and emotion regulation: a multifaceted treatment (T-ScEmo) for patients with traumatic brain injury. Clin Rehabil 2019; 33(5): 820–833.
    1. Wells M, Williams B, Treweek S, et al. Intervention description is not enough: evidence from an in-depth multiple case study on the untold role and impact of context in randomised controlled trials of seven complex interventions. Trials 2012; 13(1): 95,
    1. Peiris CL, Taylor NF, Shields N. Additional Saturday Allied Health Services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopedic conditions: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93(8): 1365–1370.
    1. Peiris CL, Taylor NF, Shields N. Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study. J Physiother 2012; 58(4): 261–268.
    1. Hsu C-D, Cohn I, Caban R. Reduction and sustainability of cesarean section surgical site infection: an evidence-based, innovative, and multidisciplinary quality improvement intervention bundle program. Am J Infect Control 2016; 44(11): 1315–1320.
    1. Chaudhary N, Varma V, Kapoor S, et al. Implementation of a surgical safety checklist and postoperative outcomes: a prospective randomized controlled study. J Gastrointest Surg 2015; 19(5): 935–942.
    1. Waters RA, Buchanan A. An exploration of person-centred concepts in human services: a thematic analysis of the literature. Health Policy 2017; 121(10): 1031–1039.
    1. The American Geriatrics Society Expert Panel on Person-Centered Care. Person-centered care: a definition and essential elements. J Am Geriatr Soc 2016; 64(1): 15–18.
    1. Olsson L-E, Jakobsson Ung E, Swedberg K, et al. Efficacy of person-centred care as an intervention in controlled trials – a systematic review. J Clin Nurs 2013; 22(3-4): 456–465.
    1. Ballard C, Corbett A, Orrell M, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial. PLoS Med 2018; 15(2): e1002500.
    1. Spoorenberg SLW, Wynia K, Uittenbroek RJ, et al. Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: a randomised controlled trial on Embrace. PLoS ONE 2018; 13(1): e0190751.
    1. Guidetti S, Ranner M, Tham K, et al. A ‘client-centred activities of daily living’ intervention for persons with stroke: one-year follow-up of a randomized controlled trial. J Rehabil Med 2015; 47(7): 605–611,

Source: PubMed

3
S'abonner