E-1a Across condition treatments
The remaining 28 rehabilitation syllabus competencies are much more clinical and specific. They have been divided into competencies that apply across many conditions and condition competencies. I have subdivided the across-condition group into treatment and clinical problem competencies. This section concerns treatments used in many situations. Five come from a non-systematic review I undertook to characterise the treatment content of rehabilitation interventions proven to be effective. The remaining three are common across all conditions and can be considered services in their own right; vocational rehabilitation, palliative and end-of-life care, and assistive technology. This page introduces the section.
Table of Contents
Rehabilitation is a process focused on resolving problems, helping the patient adapt to their loss while preserving as much of their social identity and activities as possible This requires action from the team, some being unique to specific professions or even a particular professional within the team. Most actions are carried out frequently, often shared between team members or undertaken collaboratively, and the same activities are undertaken with patients with entirely different conditions.
My review identified five characteristic activities undertaken in most patients, whatever their underlying condition.
In addition, some additional rehabilitation interventions are needed by some patients with a significant persistent disability later in their illness, and three have been selected for inclusion in the syllabus.
Common across condition treatments.
The review aimed to describe rehabilitation by summarising the characteristics of the structures and processes described in reviews or other major rehabilitation studies where the rehabilitation was effective. In other words, what features were found in studies where rehabilitation worked?
Exercise carries two meanings in rehabilitation. The first is undertaking physical activities that require work and will increase cardio-respiratory demands; it makes you breathe more and increases your heart rate. With this meaning, the nature of the exercise is immaterial. Extensive evidence supports the benefit of exercise for everyone; the benefits arise irrespective of disability.
The second meaning of exercise in rehabilitation focuses on what the person is doing rather than the amount of work undertaken. The benefits of cardiorespiratory exercise will be similar whether you walk, run, lift weights, swim or whatever, provided you achieve the same increase in cardiorespiratory parameters.
The benefits of practice at a particular activity are also well established. Musicians practice playing their instruments. However, practising on a piano will not significantly improve your ability at drumming or playing the harp, although your cognitive musical ability may be enhanced. Similarly, practising typing will not improve piano playing, though both activities require fast, planned, complex finger movements.
Practice also improves cognitive skills, such as learning another language, how to play chess, or solving a cryptic crossword puzzle.
Psychosocial treatments are frequently mentioned but often need to be better described. Self-evidently, it encompasses both social interventions and psychological interventions. Still, these are equally imprecise terms, and some definitions highlight the critical mutual interdependence between psychological and social factors.
A brief Google search (“What does psychosocial mean?”) led to two representative descriptions and one discussion. Jane Upton gave examples of psychosocial factors, such as “social support, loneliness, marriage status, social disruption, bereavement, work environment, social status, and social integration.” Adriana Vizzotto and colleagues focus on the relationship in their definition of psychosocial characteristics as “a term used to describe the influences of social factors on an individual’s mental health and behavior.” Last, Francisco Eiroa-Orosa wrote about “Understanding Psychosocial Wellbeing in the Context of Complex and Multidimensional Problems.” as a preface to a series of articles on the topic.
This term concerns increasing a person’s ability to manage their condition and often the ability of family members or others to help the patient. The education covers a spectrum from reasonably straightforward information about the disease and prognosis to teaching skills on how to maintain or improve the performance of activities and how to manage new issues when they arise. Isaac Barker and colleagues found self-management was associated with lower use of healthcare resources. In 2015, the Health Foundation published “A practical guide to self-management support. Key components for successful implementation.”
The last feature of successful rehabilitation was a commitment to tailoring interventions to the patient; it was person-centred. Although not explicitly stated in many articles, this should include respecting the person’s goals, values, and culture.
It combines identifying a person’s various problems, considering what intervention could benefit each issue, and discussing with the person what should be tried. Within this, one must always be alert to the inter-relationship between different problems and treatments; for example, some treatments may benefit two or more problems or resolving one issue may also help another problem.
Three other across condition treatments
The five interventions covered so far will likely apply to almost all patients. The last three competencies in this group also apply across all conditions but will apply only to a minority of patients.
We all depend upon technology in almost every part of our life. One cannot draw a clear line between advising on widely available technologies and assessing for and providing technology targeted at people with disability. Indeed, some technologies initially used by people with a disability, such as television remote controls, are now universal. This competency requires the professional to consider how any technology might help a patient, including but not limited to technologies designed to overcome health-related losses.
In the United States, the field is entitled Rehabilitative and Assistive Technology. It “refers to tools, equipment, or products that can help people with disabilities successfully complete activities at school, home, work, and in the community.” This definition highlights that any technology that can help is included; the role of the rehabilitation is to consider what technology can help without restricting themselves to health-specific technology. The considerable impact the iPad has had on the lives of people with many different conditions is an overlooked example.
Vocational rehabilitation is “whatever helps someone with a health problem to stay at, return to and remain at work”; this definition was used for the massive review by Gordon Waddell and colleagues published in 2013.
An alternative definition put forward by the British Society of Physical and Rehabilitation Medicine in its 2021 guidance is “a process which enables persons with physical, cognitive and psychological impairments or health conditions to overcome obstacles to accessing, maintaining or returning to employment or other useful occupation.” This document interestingly included, as a core goal, “Supporting someone with a health problem to have a good exit from the workplace.”
Some vocational rehabilitation services will broaden their scope to include unpaid, satisfying activities, productive (e.g. sheltered employment, voluntary work) or non-productive (e.g. fishing, sport) activities.
Palliative and end-of-life care.
Palliation, the relief of suffering, is integral to all healthcare. The World Health Organisation’s topic entry says, “Palliative care is a crucial part of integrated, people-centred health services. Relieving serious health-related suffering, be it physical, psychological, social, or spiritual, is a global ethical responsibility.”
The speciality of palliative medicine arose in the field of cancer care and supporting patients with cancer who were dying from it, so there is a persisting conflation of palliative care with end-of-life care. The two are different.
Rehabilitation professionals should be excellent at palliative care, only needing to call on other experts rarely. In contrast, depending on their practice, many rehabilitation professionals will only occasionally be involved in end-of-life care. They need to know what might be required and when to refer to a more expert service.
This introduction outlines eight competencies that all rehabilitation professionals need because they apply to most patients regardless of the underlying disorder. Details on each will be found on the page devoted to the competency.