Rehabilitation does not occur in a vacuum. Rehabilitation has a context: it has a past; it occurs in a cultural and economic setting, and the significance and expectations of rehabilitation depend on the circumstances. These are not trivial matters; they will affect what is available, what the clinicians consider appropriate or inappropriate, and many other issues. This page introduces the topic of the context of rehabilitation, linking to other pages giving more detail.
The importance of context
One-third of people receiving placebo Covid vaccinations in a recent trial experienced systemic side effects. (here) These all depend upon context: fear of Covid and fear of vaccination, public expectation of so-called side effects coupled with the information given as part of the research and detailed inquiry about new symptoms, and so no. Much of the context arises from history – problems reported with previous mass vaccinations causing, for example, Guillan-Barre syndrome.
Context affects much more than the expectations of the person concerned. It will influence the expectation of other people, such as family and friends, the clinical team members, and the people paying. It will be one of many factors determining access to the rehabilitation service. For example, is a rehabilitation service available in the locality, will this person be funded, what is the service good or not so good at, and so on.
History is another, much more pervasive contextual factor — this covers both history on a large and long-term scale and much more local historical aspects. For example, one local hospital increased its rehabilitation services after a senior manager experienced the disabling effects of a traumatic brain injury. More generally, rehabilitation first developed during and after war, which led to an initial focus on acute disability in working-age adult men.
Evolution of rehabilitation.
Rehabilitation did not just appear fully-fledged as it is now. I have seen significant changes in rehabilitation over the last 40 years. In 1982, most people considered rehabilitation only to apply to people aged between16 years and 65 with acute-onset conditions. In 2022 most people agree that any person of any age may need rehabilitation with any disease, especially progressive conditions. There has been a slow revolution.
Evolution also explains why things are as they are. We have a backbone and bilaterally symmetrical body because we evolved from some animal in the Cambrian era. The UK has a monarchy because our government developed as it did, with the failure of an attempt by Cromwell to institute a republic.
Therefore, I outline the development of rehabilitation from the Roman era, when gladiators and soldiers had rehabilitation through to the modern era. One factor stands out: war and trauma have precipitated many significant developments.
Evolution of the words and concepts
Words both have their context and also form part of the context of rehabilitation as a word. The term rehabilitation did not suddenly appear, nor was it used initially with its present healthcare meaning.
Though the word itself has not changed – it is spelt and pronounced now as it ever was – the constructs included within it have changed.
More importantly, I will also review the relationship between the various ideas incorporated with rehabilitation, now and in the past, and different other words that either used to cover what rehabilitation now covers or which now cover constructs that rehabilitation also covers.
Appreciating the similarities and differences between the words used and the concepts included by different terms is vital because the changing meaning of words and the changing words used to cover the same construct causes great confusion.
The importance of the social context was illustrated by the example of its effect on side effects from placebo vaccination; it was vaccination, not the vaccine, that led to the symptoms experienced.
The social context of rehabilitation is extensive. It covers:
- 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
You may read more about each of these different aspects of context:
- evolution of rehabilitation – a short history
- words and concepts – a short review
- social conext – it is covered in the page on structures