What is rehabilitation?
First published: March 10, 2022
Last updated: March 4, 2025
Complete the sentence, “I think rehabilitation is …“. Most people will find that difficult. Yet people are happy to ask for rehabilitation; some people are willing to pay for it, researchers research rehabilitation, doctors specialise in it, and so on. Each time you use a word, it has a meaning to you, but typically, the listener or reader will likely give it a different meaning. This problem arises because rehabilitation is simply a word, and words have multiple meanings, usually differing with changes in context. Alternative meanings are more likely when a word covers an essential but difficult-to-define concept like justice.
I have already argued that a single definition of rehabilitation is impossible, and one must describe the intended meaning in the context you are using it (here). Even the proponents of a definition restrict its use to ‘in research’. (here) This section of the site will explore what rehabilitation is from different perspectives. None is right or wrong. Each is a different way of thinking about it. The last section covers a theoretical approach, introducing the General Theory of Rehabilitation I published in 2024. The page introduces the other pages within this group, shown in a table.
Table of Contents
Introduction
History explains everything—our successes, our failures, and why we have the difficulties we do. It also describes how a word has acquired its current meaning, and I review the evolutionary history of rehabilitation on a later page.
Context determines the meaning of a word and how rehabilitation is perceived. Rehabilitation occurs in a social context. Healthcare is a socially determined activity, and the meaning of the words used is determined socially. For example, malady, illness, disease, and disability have closely related meanings with crucial differences.
Rehabilitation is a minor part of healthcare, so the critical social context is healthcare services and structures. They influence the expectations of patients, families, and commissioners about what rehabilitation is. The expectations affect the priority given to rehabilitation.
Rehabilitation has only recently had any influence on societal expectations. This page outlines the main features of rehabilitation as perceived by people who specialise in it.
What is rehabilitation? An ‘official’ answer.
As an illustration of exactly how little rehabilitation is understood, consider how NHS-England answered the question, “What is rehabilitation?” in their guide on commissioning rehabilitation, which was published in 2016 (see here):
“A modern healthcare system must do more than just stop people dying. It needs to equip them to live their lives, fulfil their maximum potential and optimise their contribution to family life, their community and society as a whole.
Rehabilitation achieves this by focusing on the impact that the health condition, developmental difficulty or disability has on the person’s life, rather than focusing just on their diagnosis.
It involves working in partnership with the person and those important to them so that they can maximise their potential and independence, and have choice and control over their own lives. It is a philosophy of care that helps to ensure people are included in their communities, employment and education rather than being isolated from the mainstream and pushed through a system with ever-dwindling hopes of leading a fulfilling life. “
That was supposed to help commissioners understand what they were buying. The NHS also wrote it for people likely to use rehabilitation services, so they could judge whether they received sufficient rehabilitation as users.
With that answer to the question, what is rehabilitation, in your mind, consider:
- if you were a commissioner paying for rehabilitation, would you know what you would expect to pay for or what the service might achieve?
- if you were a service provider and wanted to set up a rehabilitation service, would you know what you should provide and what resources (space, equipment, people) you might need?
- if you were a patient, or a patient’s friend or relative, would you know what you should expect, what benefits you might gain, and how you would judge the quality?
Since this page was first written, the British Society of Physical and Rehabilitation Medicine has published guidance on rehabilitation in nursing homes. The working party developed a method to evaluate whether a service provides rehabilitation, and I have published an article, and pages on this site cover the issue.
Can rehabilitation be defined?
Many people, including me, have attempted to define rehabilitation in the past. I have argued elsewhere (here) that it is simply that it is simply impossible to answer the question, What is rehabilitation? using a definition..
We use words to convey meaning. The meaning is a construct that carries the essence of some purpose. A bed can be used for everything from a four-poster Middle Ages bed to a folding light-weight camp bed, from a waterbed to a hammock. The essence is ‘the object where I rest to sleep’.
Rehabilitation encompasses many meanings centred on its original restoration concept. Although the central meaning has changed somewhat over time, it retains the idea of change for the better. However, the word is used in many contexts, and its interpretation will differ in each context.
Indeed, rehabilitation is a term widely used outside healthcare. While criminals in prison are supposed to receive rehabilitation, others have used the word to describe the restoration of land, economies, countries, and other objects and phenomena. When used about people, the principles applied in healthcare rehabilitation will apply; indeed, prisoners (for example) would benefit if they received holistic rehabilitation based on the biopsychosocial framework used in healthcare.
Thus, rehabilitation is a word centred on an idea, but there are no boundaries around the central idea. A definition attempts to set limits and criteria that separate some parts of the meaning from other components. For example, is baclofen or botulinum toxin used to reduce spasticity part of rehabilitation? Rehabilitation may try to reduce spasticity, so it must be. Nonetheless, some people may state that drug treatments are not part of rehabilitation.
Consequently, whatever definition is used, some activities that are part of rehabilitation will be excluded, and others that are not will be included. This is inevitable because no criterion can be accurate in every circumstance.
Second, the nature of the definition will depend upon the reason for defining rehabilitation. Is it to decide who will pay, or if anyone should pay? Is it to determine whether your service will take responsibility for the patient? Is it to limit the actions that the service is willing to undertake?
If a definition is used for one of these reasons, the patient will suffer because a single service will rarely help them with all their problems. Effective rehabilitation requires input from many people working in different agencies and organisations.
What is rehabilitation? An empirical approach.
Almost all words in a dictionary describe, not define, the meaning of a word. They do not define it. One way forward is to investigate how the word is used and extract the central essence(s) of rehabilitation in healthcare. I have done this. (here)
The method was straightforward. I searched for any systematic reviews of rehabilitation interventions. If the authors said they were studying rehabilitation, then I accepted that. I imposed no criteria because I wanted to see what was included. Of the reviews identified, I selected those with reasonable evidence of benefit in some domain. I did not use the nature of the benefit as a selection criterion. In addition, to cover some areas of practice where there were no systematic reviews, I identified extensive rehabilitation studies with positive findings.
One set of findings was that rehabilitation is effective:
- when it is delivered in any setting. The patient does not need to go to an inpatient of outpatient unit specifically.
- for patients with almost any disease. Some diseases are rare, and only common diseases have been studied extensively, but diseases of all organ systems benefit.
- at any stage of a patient’s illness. The benefit is not restricted to the acute phase (as many people assume), and it may well be beneficial until the terminal end-of-life phase.
- in any and every phase of the condition. It can benefit patients whose disorder is acute onset, slowly progressive, fluctuant, or static and stable.
- whatever the type or severity of impairment. There are no levels of severity or types of impairment that cannot be benefited. Specifically, the presence of cognitive loss does not preclude successful rehabilitation.
- at any age. There is relatively sparse evidence for children, but rehabilitation is effective in people aged over 65 years. (Up until about 1985-90, 65 was considered the oldest person who should have rehabilitation.)
Therefore, rehabilitation can benefit any patient, regardless of age, condition, phase of illness, and setting.
In terms of positive, descriptive characteristics, the main findings were that rehabilitation depended upon:
- multi-disciplinary teamwork. This was almost universal. The features of teamwork are discussed later in this section.
- use of the biopsychosocial model of illness. This was almost universally stated or implied.
- use of team meetings for goal setting, rehabilitation planning, and coordinating actions.
- Expertise in the condition being seen. The condition may have been a disease or set of diseases (e.g. neurological conditions). Still, it can also be defined by impairments (e.g. amputation, cognitive loss and challenging behaviour) or activity limited (e.g. communication aid services and wheelchair services).
Only a few studies explicitly mention the process. Nonetheless, expressly or implicitly, the following features of the process were present in successful rehabilitation:
- structured protocols determining how patients were assessed and how common problems were managed (this is closely allied to teamwork)
- active involvement of the family. This was mentioned less often but reasonably strongly supported.
- regular education for team members
The specific patient-centred interventions (treatments) recorded fell into four main groups that were present in most studies:
- exercise, referring to physical exertion to increase cardio-respiratory work. This was very commonly associated with benefits, usually across many domains. Evidence supporting the rehabilitation benefits of exercise continues to accumulate.
- practice of activities, which sometimes necessarily involved exercise and may have been described as exercise. Nevertheless, repeating an activity under various circumstances is crucial to achieving benefits, often called task-specific practice.
- psychosocial interventions. These were rarely well described but encompass treatment for disturbed emotions and actions to increase socialisation.
- education, usually of the patient and the family. This was closely related to self-management as a skill to be taught.
However, the most critical aspect of rehabilitation treatment is that clinicians must tailor interventions to the patient’s needs and wishes.
This tailoring took two forms:
- Tailoring the four groups of interventions listed above to the needs and circumstances of the individual patient.
- It was insufficient to say, “You have condition X, and therefore, you should do this specific exercise for this amount.” You should say, “In the light of your preferred lifestyle, your attitudes, the resources available to you, and your clinical features, then I recommend ….”
- Tailoring an additional set of interventions outside the group listed above.
What is rehabilitation? A theoretical analysis.
A rehabilitation theory is vital; no comprehensive theory existed until recently. A theory facilitates a better understanding of rehabilitation, so there is less disagreement about its borders, goals, and processes. In 2024, I published a General Theory of Rehabilitation that is covered in detail in the Academic section of the site, starting here.
The conclusion of my introductory web page says:
“The basic premise is that people adapt to illness and that rehabilitation is an expert healthcare service that facilitates adaptation to optimise the person’s long-term outcome. The starting point is that adaptation is a natural response to any change in a person’s situation, and illness is one change distinguished from others because it involves the person and thus may directly limit the person’s ability to adapt. The main additional building block is that the person has a central homeostatic network to maintain an equilibrium in a person’s five main areas of need. It compares progress towards and achievement of needs with the five areas and influences behaviour to achieve the needs. Rehabilitation provides a better understanding of the causes and interactions leading to the situation and provides information on prognosis and ways to optimise the person’s adaptive changes. Rehabilitation activities include catalytic activities, where the degree of alteration in outcome is unrelated to the rehabilitation time and effort involved, and others that assist directly with a weak dose-response relationship.”
The figure below illustrates the theory, showing the normal adaptive and homeostatic mechanism present in everybody, how homeostasis can be disrupted, and different points where rehabilitation may facilitate natural adaptation.
The second figure, below, details the actions a rehabilitation service may be involved in.
What is rehabilitation? A second theory.
A second relevant theory is the Donabedian framework of structure, process, and outcome. This builds on the theory and descriptions already given.
What are the rehabilitation structures?
The traditional understanding of structures is the buildings and equipment needed for a process. Rehabilitation does have to happen somewhere, but as shown in the empirical investigation above, it can occur anywhere. A building is necessary, but it does not need any specific features or much specific equipment. Certain interventions will require special equipment, and heavily dependent patients will need typical buildings and equipment, but their rehabilitation does not.
The more critical structures are conceptual frameworks that enable successful rehabilitation. Rehabilitation occurs within a healthcare context, but it differs from most healthcare in many ways. As demonstrated elsewhere, most healthcare is based on a biomedical model of illness, which focuses on disease. In contrast, rehabilitation is based on the biopsychosocial model of illness, which enforces a patient-centred approach.
Thus, the biopsychosocial model of illness is an essential structure for successful rehabilitation, and many pages on this site are devoted to describing it and how it guides rehabilitation.
One consequence of the biopsychosocial model of illness is the need for a multi-professional team to undertake the process. You should note that I have said multi-professional, not the more usual descriptor, multi-disciplinary. A multi-professional team is more accurate. A multi-disciplinary team may involve many people but often only one or two professions. Rehabilitation inevitably requires a wide range of expert knowledge, skills, and occupations.
The need for a multi-professional team follows from the breadth of matters the rehabilitation process will cover. They range from disease diagnosis and management at one end through many different activities, such as walking, working, and socialising, to housing and helping develop social networks. It is a second essential feature.
What is the rehabilitation process.?
Rehabilitation is analogous to all other healthcare processes – surgery, acute medicine, psychiatry etc. A patient presents with a problem, and rehabilitation clinicians and services try to resolve the issue. Each speciality has its distinguishing feature. For example, surgery sees patients who may need surgical intervention to help them.
The rehabilitation process is illustrated in the figure below. The crucial points are that it is much more than a treatment and that it is reiterative.
I will discuss the distinguishing features of rehabilitation in more detail on other pages. In brief,
- the process focuses on disability and distress rather than disease,
- its goals are centred on social outcomes, and
- it has an explicitly long-term and holistic approach to resolving problems.
Otherwise, the process is no different from any other problem-solving process in its phases. Two features differentiate rehabilitation from most but not all other healthcare specialities:
- the team needs to deliver multiple interacting interventions, not just one or two; and
- the team’s interventions cover many different illness domains – symptom control, equipment, housing, employment, etc. – not just one.
What are the rehabilitation outcomes?
Not unreasonably, all healthcare services will say that they wish to improve a patient’s quality of life, and rehabilitation is no different.
Rehabilitation typically aims to optimise social participation. In other words, a rehabilitation service will be concerned with establishing or re-establishing a person’s social networks, reducing loneliness, and increasing role participation. These goals are rarely explicitly targeted in most other services.
Rehabilitation also differs from most healthcare services in its immediate, proximate goals. Rehabilitation’s proximate goal is usually to increase performance in functional activities, whereas the comparable goal of most other services is to reduce disease and symptoms. Most patients are more concerned about function than symptoms, except for pain and distress. A change in function is more likely to improve quality of life than a change in disease or impaired physiological function.
Thus, rehabilitation goals will generally be more concordant with a patient’s priorities. Of course, a patient will want their disease cured or controlled if possible, but that is a necessary but not sufficient outcome from a patient’s perspective. Curing the disease but not the disability will not satisfy a patient.
Table of the pages in this section
The table below shows the pain first and second order pages in this section, expannding further on various aspects of rehabilitation. The left column has a link
| Item/link | Title | Comment |
| 1o | Context of Rehabilitation | Introduces following three pages |
| 1A | Rehabilitation and related concepts | Discusses the many different names used to desscribe rehabilitation |
| 1B | Evolution of rehabilitation | Reviews the developmeent of rehabilitation from Roman times and the develop of the meaning of the word since 1533 |
| 1C | Defining disability | Discusses the meaning of disability in different contexts |
| 2o | The structures of rehabilitation | Discusses the context and eight types of structure supporting orr affecting rehabilitation |
| 2A | The multidisciplinary team | Considers different types of team |
| 2B | Biopsychosocial model introduction | Introduces the biopsychosocial model of rehabilitation |
| 2Ba | Validity of the BPS model | Looks at the evidence supporting the concetual framwork and answers criticisms |
| 2Bb | Time & biopsychsocial theory | Considers the importance of adding the temporal context to the original model |
| 2Bc | Patient-centred assessment | Demonstrates, building on a publication, how the model fosters a patient-centred approach |
| 3o | Process of rehabilitation | An introduction to the process; each step has a more detailed page (or more) |
| 3A | Assessment in rehabilitation | Condiders the goals or assessment; moves on to measurement; introduces the OCCAM. Has an additional page on person-ceentred assessment |
| 3B | Formulation and analysis | Highlights the importance of achieving a clear anaalysis and understanding of the situation; leads into many subsidiary pages on analysis |
| 3C | Rehabilitation planning meetings | Sometimes called goal lanning meetings - andd many other names. Stresses their importance in coordination |
| 3D | Intervention in rehabilitation. | Draws a distinction betwee care (mainatins safeety and well-being) and treatment (causes a sustained changee) |
| 3E | Rehabilitatin review and transfer | Emphasises that reiteration must end with transfer (better than discharge) eventually to sustainable long-term state |
| 4o | Outcome | Considers different aspects of outcome; views as the goals of rehabilitation |
Conclusion
This analysis allows one to understand why there is no simple, universally-applicable answer to the question, “What is rehabilitation?” The answer depends on which aspect of rehabilitation you are interested in:
- the individual interventions given to a specific patient
- the main categories of intervention given across all rehabilitation
- the processes involved in rehabilitation
- the structures needed for rehabilitation to succeed
- the outcomes aimed for
- the people who may benefit
- design and organisation of services
- research
- theory
Nevertheless, it is possible to give a description.
Rehabilitation is a healthcare process that:
- facilitates a person’s adaptation to an illness
- benefits any person affected by a health condition,
- is effective in all settings, at any stage of illness, and any age
- is an active problem-solving process
- focuses on the patient’s functional activities
- is undertaken by a multi-professional team with expertise in rehabilitation and the conditions seen by the team
- works within the framework of the biopsychosocial model of illness.
On this page, I have outlined a description of rehabilitation that shows its role within healthcare and that the underlying process is like that used in all healthcare. It is distinguished by its explicitly holistic approach based on the biopsychosocial framework discussed widely on this site. This leads to the following key characteristics: it requires a multiprofessional team, its focus is on disability, and its goal is to optimise social participation. I have also made it clear that rehabilitation is not “just therapy”; the interventions are different from those used in other areas of healthcare, but this is a consequence of a different approach. As is discussed widely on this site, success is critically dependent on the whole, active involvement of the patient and family at all stages, which is another crucial characteristic that differentiates rehabilitation from usual biomedical healthcare.
