Rehabilitation Matters blog
Rehabilitation Matters blog posts cover a wide range of topics, almost anything that interests me. Sometimes, they add to an existing page; at other times, they may be the first step towards a new page or section in the main site. Some concerns are ephemeral, and I have already removed about 30 posts because they were no longer relevant. The style has changed and improved as I gain more experience. They are intended to provoke thought, raise doubts about your beliefs, or provide you with information or ideas you may have yet to come across before. Most posts have or will soon have a comment box at the bottom; I will check comments to ensure they are polite and relevant but not otherwise censored before being available for anyone to read. As always, there are links at the bottom for you to use to contact me.
Table of Contents
Rehabilitation Matters is all about rehabilitation. It is also about all rehabilitation. The posts are all linked to rehabilitation and will collectively interest anyone interested in rehabilitation. These three features mean that these posts can cover almost anything!
Who are the people interested in rehabilitation? The people with the most interest, often overlooked, are patients needing or receiving rehabilitation and their families. I assume that professionals involved in rehabilitation are interested in learning more about it. However, many healthcare and Social Care professionals who do not work in rehabilitation might be interested because so many patients or clients need it; a few will receive it.
Other people who may be interested are healthcare commissioners, public and private, healthcare managers and policymakers, local and national, charities whose members are disabled, and so on.
In other words, everyone has an interest. People not receiving rehabilitation now should be very interested because the day will come when they need it!
What is within scope? The nature and extent of rehabilitation are covered elsewhere, and that section of the website will show how broad the spectrum is. However, the range of matters that are or should be relevant to rehabilitation is much more extensive. Points of philosophy and the meaning of words, legal and ethical concerns, and social concerns, for example, about loneliness, are all within my scope.
Consequently, the only way I can judge whether a post is about rehabilitation is by asking myself, do I find this interesting to me as a rehabilitation professional? In other words, if I think it is relevant to anyone undertaking or receiving rehabilitation, it is about rehabilitation.
The first way is to look through all published posts. On this page, they are given in reverse chronological order. At the top, the different categories are shown, and you can select each category from the whole list to reduce the number.
Second, you can use the navigation menu to go directly to a page showing only your category of interest. Again, they are sorted in reverse chronological order.
Last, you can search the site using the search button at the right side of the header. The search includes posts and pages.
Rehabilitation matters blog categories.
Today (October 7th 2023), I just altered the categorisation of the Rehabilitation Matters blog posts. My earlier initial categorisation could probably have been more intuitive for any visitor to the site, and I could only sometimes remember what a category was about!
Finding a reasonably small number of categories for such a broad range of topics is impossible. I have started afresh with seven types; a few more may be added. Most posts will fit into a single category reasonably well; some may be placed into two categories.
The titles will usually give a good idea of a post’s content. Therefore, I have arranged the display of posts by category, sorted in reverse chronological order (i.e. most recent first). You can look at all posts or just posts in a single class.
You can also search the website using the search box on the right of the menu in the header.
Posts in this category will be mainly concerned with a particular clinical issue, such as the nature of consciousness and a prolonged disorder of consciousness or the diagnosis and management of pain. They will usually be precipitated by an article I have read or an issue I have recently had to consider in depth during my clinical work. For example, a post on whether people in a prolonged disorder of consciousness feel pain arose after I was asked informally; they were interested in a legal case reported from the Court of Protection.
Education and training.
I have always enjoyed teaching. I was chair of the Rehabilitation Medicine Specialist Advisory Committee 2016-2022, a challenging six years when we wrote a new curriculum using a fundamentally different framework. We also attracted relatively few doctors to apply for training in Rehabilitation Medicine in 2016, but by 2022, we were attracting many more. I was also editor of Clinical Rehabilitation 1994-2021, which included publishing educational articles.
My interest in teaching extends well beyond doctors. I have lectured to, taught, and run seminars for almost all professions and quite a few for patients, families, and the public. I am convinced that rehabilitation training should be available as an addition to professional training for all professions, not just doctors, and my posts reflect this philosophy. For example, “rehabilitation is a way of thinking, not a way of doing.” I wrote a post on rehabilitation thinking.
Models of illness and rehabilitation.
My interest in how we think and the models, theories, and words we use is visible in almost everything I write. The posts in this section are particularly about models of illness and any associated ideas or concepts. Many are concerned with the biopsychosocial model of illness, which was taken up by rehabilitation within a few years of its first publication by Engel; read it if you have not done so—other posts concern concepts, such as the distinctions between disease, illness, sickness, and disability.
This is another significant interest of mine – a hobby horse I ride often. [For anyone unfamiliar with this English expression, it refers to a topic the person (me) goes on and on about, even when it is inappropriate!] You will note I use the word multi-professional rather than multi-disciplinary; I do so to emphasise the need to include different professions because multidisciplinary is often used for doctors from other specialities. The need for different professions is expanded in a chapter I have written. This category includes posts about individual professions discussing their unique team contributions. I have written about what doctors contribute.
This category covers all aspects of planning, including the setting of goals. The class illustrates how posts extend beyond the immediate topic. I include a post stimulated by a patient’s father, who asked why the person had not been given a curriculum to guide his rehabilitation. Another discusses how we might set long-term, overarching goals (aims). The two most read posts discuss goal attainment scaling and whether a team is multidisciplinary, interdisciplinary, or transdisciplinary. The latter post was written in response to a therapist who asked my opinion on which type of team she worked in.
Rehabilitation can only succeed if it is well organised as a team or service and fully integrated into all healthcare services. I have been interested in service design and delivery since 1980, when I undertook my first research, investigating the effects of providing stroke rehabilitation to people at home. This research introduced me to the complexity of health service organisation. I have published on this and have been involved in national working groups since 1980. My most recent two posts concern the potential benefits of well-organised rehabilitation networks.
This final category is a catch-all, somewhere to put posts that do not easily fit into any other category. Unsurprisingly, it contains more posts than any other category. This might illustrate my incompetence at developing and using categories; it simply shows how difficult categorisation is. Further, many are included in different categories, and I may reduce double categories. They cover issues such as loneliness and disability, wisdom in rehabilitation, and slow-stream rehabilitation.
Encouraging a broader perspective.
The common theme across all Rehabilitation Matters blog post categories, and indeed through Rehabilitation Matters, is that all rehabilitation professionals must reduce their focus on professional matters, the here-and-now, the easy short-term actions and pay much more attention to the significant and challenging issues, the long-term, the person’s life. We must remember that we are a brief episode in a long life for many patients. We may see someone for a year or so, but our younger patients may live 30 or more years.
Our failure to consider the situation holistically is often evident. We are concerned about making our goals SMART, despite the originator of this acronym emphasising one crucial point: it is better to set an essential goal than a SMART goal. We have fixed rehabilitation programmes, for example, for fatigue or memory difficulties. We consider whether a patient is suitable for our service, not what help we can offer the patient.
This restricted view may be attributed to ‘management’ or ‘funders’, but we have told them this approach is reasonable.
I hope many posts will challenge readers to question their practice and beliefs by thinking of the patient and how they and the family see things.