Rehabilitation Matters

The Rehabilitation Matters category is a catch-all group. Categorising posts is like categorising patients; it is impossible because each post and patient is unique, although they may have much in common with other patients or posts. The differences matter. Knowing that no system is perfect, broad categories may seem a way out, but the risk is that one places every post into most categories. I have compromised by (a) putting most posts into a group, (b) rarely classifying a post into two categories, and (c) using a catch-all category for posts that do not easily fit into the existing groups. Over time, new categories will be made, and existing categories may be merged or abandoned.

Rehabilitation Matters’ goal is to stimulate thought, raise questions, educate, and improve rehabilitation in any way possible. The posts are usually written in response to some event, personal experience, publication, or other exciting things. The posts in this category should all fall into that group. I hope the post titles give a clear idea of the content of a post.

Introduction.

Social sciences, humanities, business studies, and other academic disciplines contain ideas, theories, methods, or data that could influence and improve rehabilitation. Articles from disciplines outside rehabilitation are rarely published in rehabilitation journals. Conversely, many rehabilitation research projects are published in medical, surgical, or other specialist journals. Any rehabilitation expert who confines their reading to rehabilitation texts and journals will have an incomplete education, missing vital knowledge and skills.

The Rehabilitation Matters website hopes to introduce all people practising rehabilitation to the world outside of rehabilitation. The posts in this class are a significant part of this strategy. Many of the posts discuss topics that, at first glance, are not central to the clinical knowledge and skills needed for rehabilitation. Or so it may seem. Reading and thinking about ideas outside direct clinical practice will significantly enhance your ability to help patients.

People who know little about rehabilitation may skim over any rehabilitation material in their preferred journals. So, a second aim of the Rehabilitation Matters posts is to capture the interest of people outside the speciality. Posts that cover sociology, law, ethics, or psychology may attract readers from outside. I use keywords and phrases that may attract people searching for something in another discipline, hoping they will read a rehabilitation post and explore this site.

Rehabilitation matters; a broader perspective

Everyone in rehabilitation says that they are holistic. However, I have asked whether rehabilitation services are always holistic. Holism means “the theory that parts of a whole are in intimate interconnection, such that they cannot exist independently of the whole, or cannot be understood without reference to the whole, which is thus regarded as greater than the sum of its parts.” [Oxford English Dictionary] The term was introduced by Jan Smuts in his book on Holism and Evolution.

Holism requires us to see the person as a whole but also to know the person as a part of a greater whole. We must set them in two contexts. The person is a part of society, which means we must place them in the context of their family and friends, work colleagues, neighbours, and broader Society. The person facing us has a past and a future. We must consider the past to understand them and the future to consider how we can help them now and in years or decades.

Posts in this category will cover anything surrounding rehabilitation and our patient interaction. For example, how does one make difficult decisions when there is no good choice? Two posts concern this. Wisdom is one manifestation of a holistic approach, and I have discussed it. Another post covers an impossible decision a judge faced, an extreme example of hard decisions we must make regularly.

Challenging orthodoxy

My parents despaired of me as a child. I was always asking, why? And when answered, I then asked, yes, but why? And so on. I have kept the habit.

To be orthodox means “following or conforming to the traditional or generally accepted rules or beliefs of a religion, philosophy, or practice”. [Oxford English Dictionary (OED)] It combines the Greek orthos, meaning straight or right, and doxa, meaning opinion. It is probably correct if orthodox practice is based on sound evidence or irrefutable logic.

Rehabilitation has weak foundations, and it probably had none when I started. Nevertheless, people held strong views about what was right and what was wrong. This was equally true of most healthcare up to 1950. There are still many areas of clinical practice where people’s beliefs and the opinions of eminent people have significant influence in rehabilitation and much of healthcare.

My tweets on behalf of Clinical Rehabilitation (@ClinicalRehab) often mention papers where the results contradict the received wisdom, as do my tweets (@derickwaderehab).

Many of the posts in this group will use a paper or event to review some area of practice in more depth than is possible in a tweet. They may suggest new ways to think of a problem or new ways to treat people, or they may make no suggestion other than an implication that a current approach needs revising.

For example, I have asked whether frailty is a sound or even valid concept and whether convalescence should have been abandoned in healthcare many years ago.

The posts

The most recent eight Rehabilitation Matters posts are below; more can be loaded using the button at the end.

Beliefs, capacity, and best interests

Two recent judgements from the Court of Protection have concerned the conflict between a person’s deep-held beliefs and what the clinical team judged to be in the person’s best...

Personal factors in rehabilitation

The World Health Organisation’s International Classification of Impairment, Disability and Handicap, published in 1980, was an early interpretation of the biopsychosocial model of illness. It was soon criticised for...

A patient’s rehabilitation curriculum?

A patient’s father recently asked me, “What is the usual rehabilitation curriculum for someone with problems like my son’s?”. Until then, I had only considered a rehabilitation curriculum in...

Loneliness and disability

Rehabilitation services should pay attention to loneliness. It is common, associated with many long-term conditions in rehabilitation, including chronic pain, more common in people with disabilities, and associated with...

Slow-stream rehabilitation.

What is slow-stream rehabilitation? Dr John Burn is leading a group in writing guidance and standards for nursing homes (care home, skilled nursing facilities) that undertake rehabilitation for some...

Assessment competency

At 02.00 hrs on November 29th, I had an epiphany, “a moment of sudden and great revelation or realisation”. [OED] For many years, I have emphasised a distinction between...

Wisdom in rehabilitation

In May 2021, Dr Sabena Yasmin Jameel published her University of Birmingham PhD thesis on Enacting Phronesis in General Practitioners. John Launer wrote about it on November 2nd, and...