A model of person-centred rehabilitation
Last updated: November 15, 2025
Various reviews of ‘person-centred’ care reveal the wide range of interpretations of this attractive but deceptive phrase. A group in Auckland, New Zealand, have explored the concept and, between 2014 and 2024, published data-based papers setting out a strong description. This post was first published in 2022 after I had read the main one, Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature, as I was so impressed. This revision (2025) enlarges and improves the content while remaining focused on the central themes. In the original paper, they developed “a cross-professional model addressing the concept and practice of person-centeredness in adult rehabilitation, tackling both interpersonal interactions and service organization.” In this post, I summarise its features, draw on other papers from the group, link to other pages and posts on this website, and refer briefly to reviews and other papers.
Table of Contents
Introduction
What is person-centred healthcare? Rebecca Waters and Angus Buchanan analysed the term’s use in the literature and extracted seven themes:
- Honouring the person, acknowledging and respecting their experience and expertise
- Establishing social relationships with professionals
- Encouraging participation and engagement in the healthcare process
- Committing to social inclusion, involvement in the community and wider society
- Focusing on strengths and capacities
- Experiencing compassionate love, giving the person emotional support
- Having a person-centred organisational culture, for example, treating individual staff members following the themes above
In another review, Amy-Louise Byrne and colleagues asked, “Whose centre is it anyway? Defining person-centred care in nursing: An integrative review.” Their summarised results were that “there is no universally used definition within the nursing profession. This review has found three core themes which contribute to how PCC is understood and practiced, these are People, Practice and Power. This review uncovered a malalignment between the concept of PCC and the operationalisation of the term; this misalignment was discovered at both the practice level, and at the micro, meso and micro levels of the healthcare service.”
They extracted themes from 17 articles, which are similar to those mentioned above.
Person-centred healthcare has also recently been adopted by clinical genetics, with an increasing enthusiasm for the precise tailoring of biomedical treatments, primarily drugs based on gene and biochemistry. Another development is personalised healthcare (e.g., Personalised Care Institute), which appears to encompass sharing information and making decisions, as well as seeking and respecting a person’s views.
Polly Mitchell and colleagues took a more reflective and philosophical approach and considered that there is “A wide vocabulary for person-centred care”. They demonstrate the range of uses and meanings associated with the term, but argue that this can be positive as long as the sometimes-subtle distinctions are highlighted, and that no one accepts the term without questioning how it is being used.
Background.
Nicola Kayes and a group of colleagues have explored concepts of person-centred care for some time. For instance, William Levack et al (2014) published Establishing a person-centred framework of self-identity after traumatic brain injury: a grounded theory study to inform measure development, an empirical study based on qualitative data investigating how self-identity is altered after traumatic brain injury. The data suggested that injured adults valued having a coherent, complete sense of themselves, being respected and accepted as themselves by others, and achieving valued social roles in their world.
This blog post is based on an extensive systematic review, Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature. Tiago Jesus et al. (2022) developed a sound, theoretically based model of person-centred rehabilitation. I can only develop some central themes and messages in this post.
This is a foundational study, even though the authors describe their review as a scoping review, which suggests it is an early stage of work to be followed by more definitive research. The research team spent at least five years completing it. They extracted data from 147 papers and consulted experts extensively.
The authors conclude that person-centred rehabilitation “is a way of thinking about and providing rehabilitation services “with” the person.” This approach aligns with my belief that “rehabilitation is a way of thinking, not a way of doing,” a view I expressed in an editorial in 2002 and again in another in 2025.
Why does the way you think matter? The way you think about a problem has a pervasive influence over all decisions and actions. “To a man with a hammer, everything he sees is a nail.” This is the Law of the Instrument, a depressingly accurate description of many professionals. A patient with osteoarthritis of the hip, giving him pain and poor mobility, was once referred to me by a general practitioner who wrote, “I am sorry to trouble you. I referred this man to [an orthopaedic surgeon especially interested in osteoarthritis of the hip], and he replied that he could not operate, but he gave no further advice.”
Some rehabilitation practitioners consider rehabilitation purely as an intervention, something you do to, with, or for a patient. Others work using a problem-solving framework and try to understand what is going on and how they can improve matters. I discussed this issue when I asked, “Rehabilitation is holistic, or is it?” The former will focus on areas of professional expertise, offering specific interventions, whereas the latter will focus on thinking around the problem.
Why review person-centred practice?
The authors’ goal was to “develop a cross-professional model framing the concept and practice of person-centered rehabilitation”. Their review’s protocol, published in 2016, demonstrated the lack of any clear conceptual basis for a patient-centred approach. The biopsychosocial model provides a theoretical and conceptual foundation for a patient-centred assessment as I have discussed on another page. Nonetheless, no comprehensive conceptual patient-centred framework existed for all aspects of rehabilitation.
They note that claiming to put the person at the centre of rehabilitation is rhetoric because there is substantial evidence that clinical teams are often not person-centred. They do not blame this failure on the lack of a solid theory but argue that rational conceptual frameworks are essential for improving low-quality clinical practice.
Their method was to identify studies investigating a patient-centred approach to rehabilitation and extract two core outputs. The first was a theoretical, conceptual understanding of what being patient-centred means. Simultaneously, they looked for an account of how individual rehabilitation professionals and their teams might practice patient-centred rehabilitation. This is similar to my approach to discovering what rehabilitation is, only they were somewhat more thorough!
A whole system approach
Patient-centred care is not just about the interaction between a patient and a professional. Truly patient-focused care requires the entire system to concentrate on the individual and their needs.
That may be the central message of this paper and the vital insight it provides. It is the logical consequence of the derived model, which has three levels:
- the macro-system, the organisation that the rehabilitation team works within
- the micro-system, the rehabilitation team that the patient is seeing and the professional works in
- the professional-person dyad, the relationship between the person and the other person, the professional being seen at the time.
The original paper’s conceptual model, shown in Figure 2 (page 111) and presented as a MindMap below, is limited to the host healthcare organisation (e.g., hospital, community healthcare service, and even social services). Their overview statement is: “PCR is a way of thinking about and providing rehabilitation services “with” the person.” [PCR = person-centred rehabilitation.]
However, patients are inevitably involved with multiple organisations. The patient’s experience will only be patient-centred if every person and every organisation with significant involvement in the process adopt the same approach.
Thus, their overview quotation needs to be adapted. I will use the word ‘care’ to refer to all interactions between a patient and a person, team, or organisation involved in their illness. A more accurate description is as follows.
“Person-centred care is a way of thinking about and providing care services ‘with’ the person.”
AND
“Person-centred care can only succeed when all people, teams, and organisations responsible for working with the patient think in a person-centred way.”
Basing all analysis, planning, and action on the biopsychosocial model is the first crucial step towards this Nirvana. Undertaking the initial assessment and formulation using the holistic biopsychosocial model increases the likelihood that the rehabilitation service will see the patient as a person. (see discussion here) Furthermore, taking a holistic approach makes it more likely that a professional will ask about the patient’s wishes, goals, aspirations, and interests. Thus, to achieve a person-centred approach, all professionals involved with people who are disabled (i.e., all staff in all healthcare and social service organisations!) must work within the biopsychosocial framework.
The second key feature is that all services supporting people with long-standing disabilities (including rehabilitation and care) must operate within a single, overarching organisation. Usually, this will be a rehabilitation network encompassing all major organisations. This promotes a person-centred culture across all organisations. Creating a comprehensive rehabilitation network where services focus more on the individual patient would be a significant advancement! (See also my second post on rehabilitation networks.)
Person-centred professional interactions
The authors identified five key features of the relationship between a patient and a professional that are central to a genuinely person-centred approach. I will list them here and then discuss each.
The five features, as written in their paper, were that the professional:
- is reflexive and adaptive to the situation at hand, not script-based.
- nurtures a supportive relationship that is compassionate, trusting and caring.
- is focused on meanings, hope, and strengths, going beyond addressing deficits.
- is collaborative, empowering and enabling, with co-constructed rehabilitation.
- is respectful of and tailored to the person, giving individualised interventions and more.
All healthcare and social care professionals should receive teaching that targets the inculcation of these five features from the outset. They would transform all care.
Indeed, we could use these five features to develop an effective training assessment tool that measures how well someone trained in rehabilitation (from any profession) interacts with a patient. This set of attitudes and behaviours should define excellent clinical practice across all health and social care sectors.
The five patient-centred features
The authors refer to a person-professional dyad. This reminds us that the relationship between a patient and their therapist is unitary, characterised by a mutual commitment to the therapeutic process. It is not a transaction between two individuals who have no other obligations to one another. For example, I will be polite and friendly towards the person giving me my newspaper when I pay for it, but that is not a dyadic relationship. If I visit a car showroom to discuss which car I might buy, the salesman will usually form a dyadic relationship with me, as they will then sell more cars.
They outline five main features.
Respectful of and tailored to the person
The key word here is person. This aspect of person-centred rehabilitation highlights the importance of a “culture of service focused on the needs of the whole person, not merely those arising from patients as objects of biomedical conditions and interventions.” and that everything should be guided by “the unique characteristics and circumstances of the person (perspectives, preferences, values, experiences, worldview)“—going “beyond consisting of individualised interventions addressing the impairments or symptoms of unique patients.”
Being respectful is the first trait discussed in detail, emphasising the crucial role that both team and organisational culture play in realising a patient-centred approach.
Adapt to the situation
“Patient-centred care cannot be fully guided, standardised, or dictated. Rather than merely being protocol-driven or a “1-size-fits-all” approach, it is antireductionist and adaptive to situations at hand.”
This quotation, tucked away in the middle of a paragraph, captures the essence of this characteristic. Interestingly, it aligns with my concern that rehabilitation is losing its holistic, person-centred approach by creating specific programmes or treatments for particular deficits. For example, ‘upper limb’ (how I dislike that phrase!) courses for individuals after a stroke.
The word situation must not simply cover the considerable variation between patients in their specific clinical features, losses, and strengths; the rehabilitation offered must also adapt to their social context and culture, where they live, etc.
Compassionate, trustful, and caring.
“Patient-centred rehabilitation entails time for reciprocal interactions, conveying the professional’s personhood. Professionals use open minds and hearts to understand the person’s perspective, without fearing exposure to personal vulnerabilities.”
Again, hidden at the end of a paragraph, this sentence conveys the crucial feature of “nurturing a supportive relationship”. The behaviour indicates to the patient that you, the professional, are a person with a life outside your professional role.
It later says, “Open, honest, transparent, and reassuring communication may also securely unfold about interventions, unfavourable prognosis, recovery expectations, or slower progress.” In other words, once the patient realises that a professional is also a person, they are more likely to disclose matters concerning themselves and are more likely to expect and accept open, honest conversations in return.
This feature necessitates a direct educational and training requirement. The professional must be taught how and when to disclose personal information sufficiently to establish personhood. Simultaneously, educators must instruct them on how to maintain a professional relationship. It is a skill acquired gradually.
We need to teach how to develop this more personal relationship before the professional either encounters difficulty by sharing too much or becomes unapproachable and ultimately ineffective.
Meanings, hope, and strengths
Patients often say that rehabilitation teams repeatedly assess what they cannot do, which impairments are present, and how serious their problems are. The team’s focus on failure upset people, mainly because no one pays attention to what the person can do, what they have not lost, and how well they perform other activities. This criticism was probably fair thirty years ago. I suspect it still is.
The professional should consider what purpose gives meaning to the patient’s life, in the past and now. In a paper, Purposefulness as a critical factor in functioning, disability and health, Joshua Lee and colleagues explored the importance of purpose and meaning in rehabilitation, and the vital role of a sense of purpose is dramatised in David Wozney’s account of his recovery.
I have also recently argued that we should pay much more attention to hope in rehabilitation.
In a person-centred clinical encounter, the professional encourages “supported self-explorations, as much as the person wants, to addressing issues such as one’s life story, situation, life goals, or occupational choices” because “This helps to frame impairments within a continuum of life changes, link one’s past and present to hopes for a meaningful future, and foster the person’s capacity to envision relevant life goals and agency-based paths toward their achievement.“
Being collaborative, empowering, and enabling.
The feature relates to goal-setting and shared decision-making, which teams already use within rehabilitation. The authors highlight the need to see goal-setting and shared decision-making as flexible, adaptive, and ongoing practices and “not 1-off tick-box exercises“. It also emphasises that “meaningful changes are not necessarily numerically based but experienced by the person.”
The SMART method of setting goals differs from this attribute. It is a one-time process, not an evolving and adaptable one. Furthermore, it requires a fixed and measurable outcome that seldom considers the patient’s experience.
The other message is that the process involves educating the patient about their condition and prognosis, and negotiating with them as an equal partner.
Micro-system, team-based features.
The paper discusses the microsystem, stating: “Person-professional interactions occur within a microsystem, often involving significant others, multiple professionals, and support staff.” They suggest that this system includes the people involved in their care. I interpret this as not only an identified, specific multiprofessional team but also people from other teams, organisations, and the family, as shown in my diagram of the patient’s rehabilitation team below.
Therefore, everyone involved must be considered, even if they are not part of the lead rehabilitation team’s organisation. The inpatient microsystem will include other members of the full service who may occasionally interact with the patient. Importantly, the inpatient microsystem will also incorporate people from outside the rehabilitation team, such as a social worker, a diabetes specialist, or a home care organiser.
When a patient undergoes rehabilitation at home, the micro-system will probably be larger and include more people from various organisations. In this context, the importance of the macro-system also being patient-centred becomes clear.
The authors identified three main characteristics:
- Inclusive of significant others
- articulated through a patient-centred rehabilitation (multiprofessional) team
- delivered in a welcoming and secure environment.
I will review each and conclude at the end of this subsection.
“Inclusive of significant others.”
I hope and believe that most rehabilitation teams already involve family. Fewer may actively involve close friends or other important people. The ‘significance’ of another person is a matter for the patient to decide, where possible, and one must take care not to assume that blood relatives are necessarily the closest.
The text highlights additional points to consider. Where feasible, the patient’s wishes regarding further involvement should be identified and, as a general rule, honoured. The team must be alert to family members employing subtle persuasion or influence. Conversely, the rehabilitation team should consider how the patient’s preferred choice might affect significant others. For instance, if someone wishes to return home when those at home are unable to provide the necessary care without risking their well-being.
“Articulated through a PCR team.”
The authors could have described this theme more clearly. I don’t know if the authors mean the team should be patient-centred or that the input should be from a patient-centred team.
They discuss some suggestions, such as “all professionals who deliver interventions to the person demonstrate a shared commitment to PCR, listen to the person, and work toward common or articulated rehabilitation goals (beyond disciplinary-based agendas).“ Most of the suggestions are features of good collaboration, rather than being specific to being patient-centred.
I have discussed the concept of a multidisciplinary team and whether it should be multidisciplinary, interdisciplinary, or transdisciplinary.
“Delivered in a welcoming and secure environment.’
This feature of a rehabilitation service is obviously positive. It does not directly relate to person-centred care, except that a lack of effort to be welcoming suggests a service that dismisses patients.
The suggestion suggests that the authors consider rehabilitation an activity usually occurring in hospital inpatients. However, they mention being at home as good, “because of its homeliness, personally relevant aspects for rehabilitation can naturally emerge.”
Microsystem aspects - comment and conclusion
The three suggested features that should apply at a microsystem level are all reasonable characteristics of an exemplary rehabilitation system. However, little of the content focuses on being patient-centred. The five features already identified for the patient-professional dyad would capture most of the features given.
Although not stated very forcefully, the key aspect is for the patient’s rehabilitation team to adopt an embedded person-centred culture. The essential part of this is that the patient’s team will often include people who are not part of the multiprofessional team.
Macrosystem (organisational level).
The authors do not clearly specify what they include – whether it is the local organisation of the rehabilitation team, such as departmental management; the broader organisation, including the hospital and all healthcare systems; or societal organisation and culture. I will discuss this matter later.
Meanwhile, I will discuss the three attributes identified:
- Inclusive of persons and staff in service design, evaluation, and improvement
- Creating the context for person-centeredness
- Organised for continued, coordinated, and tailored services.
Involving all interested parties in service management
I have revised the original phrase to better clarify their meaning. The authors describe collecting feedback from patients and ‘significant others’ involved. However, many other personnel are also deeply involved, not just clients (an interesting terminology shift here). For example, employed staff, researchers, managers, community teams, and referring services are all relevant parties.
This certainly seems like good practice, but it will not necessarily influence how patient-centred a service is. It may be a marker that an organisation is patient-centred, but only if any suggestions made by the assembled interested parties are listened to and acted on. Experience suggests that consultation is standard, but the organisation needs to pay more attention to the output; otherwise, this activity ticks a box but no more.
Creating a person-centred culture.
I have also adapted the original “creating a context” to a phrase that I believe reflects the theme more explicitly and accurately. The authors state that the organisation should give “staff the means, opportunity, confidence, competencies, and accountability to deliver and improve PCR. Frontline staff need to feel safe, confident and supported to provide PCR.“
The authors then emphasise that “organisational leaders and managers need to show commitment to PCR approaches, beyond lip service.” This is a crucial recommendation; if this does not happen, all else will fail. They argue that organisations adopt an embedded, biomedical approach that strongly opposes a person-centred approach. They write, “it takes whole organisational shifts to move from service-centred, disciplinary-based ‘treatments’ to PCR.”
I discuss this issue extensively on this site and have recently proposed an explicit move from biomedical to biopsychosocial healthcare.
Their review emphasises the need to train staff who may lack skills in developing personal relationships for various reasons. Additionally, many individuals might believe they are already highly person-centred when they are not (as per the criteria outlined earlier). Thirdly, the shift poses a challenge to many long-established practices. Lastly, person-centred care can sometimes be reduced to ticking boxes on a form rather than genuinely becoming more person-centred.
Ensuring long-term personal coordinated care
The third attribute is also vital. It involves organising services so that the person can stay with the same team for as long as needed, rather than shifting from one service to another (despite how person-centred each service is). Services should be designed to be coordinated and to ensure continuity of care, so the person does not feel abandoned after discharge from rehabilitation services.
The main challenge is to balance a financial and managerial need to break down all services into measurable, predictable, and usually fixed-sized packages, with a philosophy of being flexible and able to adapt to the specific needs and preferences of the patient.
The controlling management fears losing control and anticipates significant costs. My personal experience, along with a few research trials, indicates that empowering patients results in lower resource utilisation, not higher.
Discussion: insights and conditions
The article proposes a new model for understanding person-centred rehabilitation, outlining its key features. It introduces some novel ideas and suggestions that could significantly enhance rehabilitation. The paper offers two new insights and presents two conditions that, if met, will promote progress towards person-centred rehabilitation.
Two insights
The first is the list of attributes that, if present, indicate a truly patient-centred approach is likely to be present. This list of features concerns the patient-professional interaction. Someone should develop an observational tool to analyse how patient-centred a clinician is. Someone should also develop training in being person-centred, centred on the five attributes.
The second and more important insight is the factors that determine the success of any individual professional being patient-centred. The researchers have, in my view, convincingly demonstrated that a patient will only receive patient-centred rehabilitation if every organisation responsible for providing a service to a disabled person makes being patient-centred the primary goal of all their work.
Two conditions to achieve success
Therefore, person-centred care will only occur if two conditions are satisfied. That is the only conclusion I can draw, assuming the model developed in the paper is valid.
The first condition is that each professional rehabilitation engagement with the patient possesses the five attributes outlined, and the professional adheres to these characteristics in all interactions. Although the attitudes and behaviours needed may not be universally present in all rehabilitation staff, achieving this condition is possible.
The second condition is that all organisations involved in a patient’s rehabilitation must have a patient-centred approach embedded in their culture, from the most senior executives to the newly joined junior assistant in the office.
To make this clear, this:
- includes any organisation that provides rehabilitation; however, the service is named (see here for a list of common names used for rehabilitation services)
- needs to be led from the very top of the organisation
- needs to be embedded in all policies concerned with patients
- includes all interventions with disabled people, including the provision of equipment and delivery of personal care and support,
- must include the ‘front-line services’, the people and the teams involved
Discussion: the way forwrd
Is the framework valid? The evidence used to develop it is substantial, though more is needed to prove validity. The most robust evidence of reality is that almost all attempts to improve patient-centred care have failed. And none of the attempts has tried to change a whole organisation.
Most of the remaining attributes identified are valid attributes of good service, but are not specific to being patient-centred.
Organisations are unlikely to establish being patient-centred as their central value immediately. Organisations that intend to deliver patient-centred services do not look at every policy and decision to ask, “Is this decision focused on delivering a patient-centred approach?”
Here are a few suggestions that might start change:.
- The individual clinical attributes can be taught to all healthcare staff, who can be trained in the skills needed to succeed.
- An assessment tool should be developed based on the five attributes to assess how patient-centred a professional is and to give constructive feedback on performance.
- expert multiprofessional teams can discuss how each member can learn the skills needed, and then how the group can be more patient-centred in its policies and procedures
- . The managers of rehabilitation teams can be educated in this model and the biopsychosocial model of illness, because it is central to patient-centred care
Conclusion
Reviewing the paper more than three years after publication and revising my initial post have convinced me of the importance of the work; the investment of about six years was worthwhile. Patient care and outcomes could be significantly improved. Two barriers, unfortunately, make success difficult.
The persistent dominance of a biomedical approach has two main effects. More healthcare professionals in positions of influence are deeply committed to the model, and their advice to politicians, the public, and policymakers will be given undue weight. Politicians and policymakers tend to favour the biomedical model because it is culturally ingrained, and they have not been educated to consider alternative options.
The persistent dominance of a commercial, profit-driven, and process-oriented healthcare system further hinders change. Biopsychosocial healthcare, especially when it is explicitly person-centred, is inherently less predictable and more difficult to control. These characteristics stand in stark contrast to the standardised, protocol-driven healthcare model often seen as the ideal in commercial settings.
I must remain hopeful!