Context of Rehabilitation
Last updated: March 8, 2025
Rehabilitation’s emergence and evolution has been driven by misfortune, the consequences of war, and illness. It concerns a response to something not wanted. However, though that is the immediate, proximate context, all rehabilitation must be placed in a larger context. Just as the modern holistic approach of rehabilitation considers every aspect of the person’s situation when analysing it, so we must place current rehabilitation in a broader context. We can only answer what rehabilitation is when we can see it in its full context. This page gives an overview; later pages will explore particular aspects as shown in the table of pages in this section.
Table of Contents
Introduction to context of rehabilitation
Rehabilitation does not occur in a vacuum. Rehabilitation has a context, Most obviously, rehabilitation of many so-called physical illnesses is usually with medical and surgical healthcare, most psychiatric rehabilitation is within mental healthcare services, prisoners are rehabilitation in the justice system; rehabilitation of offenders after a criminal or other offense is primarily social, and rehabilitation of polluted land and damaged countryside depends on technology. The context of the rehabilitation dictates its nature.
Moreover, many other contexts such as cultural, historical, economic, political, and geographical circumstances significantly impact its meaning, goals, methods, and goals. The individual professional, patient, and family members will all have different understandings of rehabilitation, and, within a team, each person’s context will differ.
Further, we need to separate what , we must consider a host of contextual factors when considering what rehabilitation is, and these factors often encompass general and specific aspects
Factors include:
- The history of rehabilitation both in general, and in the particular situation
- Culture, both generally and specifically the culture of the person asking
- Healthcare system, especially its funding
- Economic, both societal and personal
- Political, which influences priorities and social support
- Environmental, such as geography and social support
Evolution of rehabilitation
Rehabilitation did not just appear fully-fledged as it is now (2025). Just over the last 40 years , I have seen significant changes in rehabilitation. In 1982, most people considered rehabilitation only to apply to people aged between 16 and 65 with acute-onset conditions. In 2025, most people agree that any person of any age may need rehabilitation with any disease, especially progressive conditions. Moreover, since about 2010, rehabilitation has been included in the intensive care unit, palliative care, and end-of-life care services. There has been a revolution.
Evolution also explains why things are the way they are. We have a backbone and bilaterally symmetrical bodies because we evolved from some animal in the Cambrian era. The UK has a constitutional monarchy because our government developed as it did, including, for instance, Cromwell’s failure to institute a republic.
I outline the development of rehabilitation from the Roman era, when gladiators and soldiers were rehabilitated, to the modern era. One factor stands out: war and trauma precipitated many significant developments and, unfortunately, still do.
Theories and ideas have developed that are less well recognised but possibly more influential. Rehabilitation has always been a practical speciality, focusing on ‘how can we best help’. However, pragmatic enthusiasm is more effective when guided by a good understanding of how a problem arose and how it can be resolved.
One page in this section considers rehabilitation and related concepts; other pages discuss ‘rehabilitation theory, what and why’ and the history of ‘rehabilitation in 14 key concepts’.
The most significant single conceptual advance was undoubtedly the original publication of the biopsychosocial model of illness in 1977. Rehabilitation rapidly adopted it, for example, as the principal influence on the WHO International Classification of Impairment, Disability, and Handicap. Other work preceded it, and the model has been improved to be more holistic and applicable to rehabilitation. This site has a table showing all the significant pages, which you can use to read more about the model.
Local history; a vital context of rehabilitation
The extensive general history behind rehabilitation has a significant contextual effect on how rehabilitation is conceived and provided. Each country and smaller locality has its history, which also has a considerable impact.
For instance, when the UK started its National Health Service (NHS) in 1948, the Ministry of Health decided that each hospital department and speciality should be responsible for rehabilitating its patients. In many ways, this was a good approach. Unfortunately, political and economic reality struck, probably immediately, and a biomedical approach dominated the healthcare system, with rehabilitation receiving few resources.
In other countries, rehabilitation was associated with surgery, rheumatology, and physical treatments such as spas, massage, and manipulation. It became physical medicine and, in the private sector, associated with treatments and investigations that generated income. Thus, many countries have many rehabilitation specialists and services, but the clinical caseload is often musculoskeletal and, relative to neurological practice, not very complex.
Local influence extends to cities and towns. Some places have excellent services, others do not, and this usually results from a historical accident. For example, spinal cord injury services were developed outside London to avoid the risk of being bombed. The Rivermead Rehabilitation Centre in Oxford grew because a Victorian infectious disease hospital became available, and an interested geriatrician led the service.
Thus, the local historical context profoundly influences rehabilitation for a potential patient.
Conclusion
This brief discussion highlights that history explains why rehabilitation is as it is. The concept and content of rehabilitation, as practiced worldwide, have evolved. Initially, the process had no name, and when it first emerged, it was concerned with restoring a person’s social status after a social misdemeanour led to a loss of status. World War I led to the use of rehabilitation after trauma (physical and psychological), and it has broadened to cover all illnesses over the last 30 years.
However, in any geographic locality, the concept and content of rehabilitation is hugely influenced by local historical developments and many other factors such as:
- the healthcare system, especially its funding mechanism
- the family and, to a lesser extent, friends and acquaintances
- the political and legal systems
- the dominant model of illness used in the society concerned
- the culture and beliefs of the staff providing rehabilitation
Therefore, one must appreciate that the question of what rehabilitation is has many answers, determined by whether one wants to know about now or some time in the past, where one lives and the many socioeconomic factors associated with that, the culture of the social group concerned, such as the team or the family, etc. Consequently, there is no correct answer, and the answers will differ considerably depending on the context.
