We all (think we) know what surgery is, and what a surgeon does. We think we know what psychiatry does. But most people will admit that they do not really know what rehabilitation is or what someone working in rehabilitation does. Some people assume that rehabilitation is really just a posh word for ‘therapy’, or even just physiotherapy. This lack of understanding of rehabilitation has consequences. One is the low priority given to rehabilitation. This section of the website will explain what rehabilitation is …
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 guide commissioners in understand what they were buying. It was also written for people likely to use rehabilitation services so that, as users, they could judge whether they received sufficient and effective rehabilitation. With that in mind, consider:
- if you were a commissioner, paying for rehabilitation, would you have any idea what you would expect to pay for or what the service might achieve?
- if you were a service provider and you wanted to set up a rehabilitation service, would you have any idea what you should be providing and what resources (space, equipment, people) you might need?
- if you were a patient, or a patient’s friend or relative, would you have any idea about what you should expect to receive, what benefits you might gain, and how you would judge the quality.
This section of the website will explore ‘what’ rehabilitation is. The fundament principles underlying this description are that (a) “we should be guided by the evidence” and (b) the description is as specific and explicit as possible. There are eight separate pages, and they cover these topics:
Assessment and …
A description of rehabilitation derived from the section is as follows:
Rehabilitation is an active problem-solving process that focuses on the patient’s functional activities that are limited. This process is undertaken by a multi-disciplinary team with expertise in rehabilitation and the conditions seen by the team. The team bases all analysis and action on the biopsychosocial model of illness. The team plans and undertakes a series of interventions working towards goals of importance to the patient. The team works collaboratively across all organisational and geographic boundaries, because rehabilitation can be delivered wherever the patient is. The overall goal aimed for is a good quality of life, which is usually associated with an absence of pain and distress and achieving the levels of social autonomy and social engagement wanted by the patient.