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:
The word rehabilitation was first used in about 1500, but only became associated with healthcare and disability in 1940. The meaning has changed and expanded. The diseases and conditions treated have also simply accrued over time, and the service for each has been separate. This historical evolution explain many of the difficulties facing rehabilitation. See here.
Given the uncertainty about the meaning of the word rehabilitation, one way to discover is to see how the word is used. This has been done, looking at a large number of studies that researched rehabilitation and found it effective. Then one looks at what it was that they included in the term. The answer is surprisingly clear. Look here.
One of the central common features of rehabilitation revealed by the evidence was the use of the biopsychosocial model of illness. So this page explores the model, and describes what it is. It shows that it is the best existing model of (and theory of) illness. It incorporates all other models within it. It is better than the culturally dominant biomedical model. Read more here.
The holistic nature of the biopsychosocial model of illness means that information about a very wide range of factors is needed when making decisions. Consequently a multi-disciplinary team in needed, where each member has expertise in rehabilitation, and in the condition or disorder being treated, and in their own profession. The nature of the team is discussed here.
Assessment and …
.. formulation. Rehabilitation is effective, and one reason is probably that rehabilitation teams generally undertake structured assessments and then share information to achieve a better, fuller understanding of the situation that any individual member of the team can achieve alone. This page considers the features of assessment and formulation … here.
While in relatively straightforward cases, with only one or two team members involved, planning is simple and can be done informally, in more complex cases a formal review and planning process is needed. And in all cases it is important to think about goals – long-, medium-, and short-term goals. These motivate the team and the patient. The process should also ensure all needed actions are identified, and that actions are coordinated. Read more here.
Most people think that rehabilitation is simply ‘giving therapy’. It is not, and any therapy given will be much more effective when the informational foundations are secure. As with building a house, the work involved in building foundations (e.g. assessment and formulation) takes time but is essential. This page then covers the general features of rehabilitation actions, based on the review of the evidence. Again there is surprising consistency across all fields, shown here.
One common feature in effective rehabilitation is that the interventions are tailored to the patient’s situation. Sometimes there are choices. Always it is important to check whether an intervention is helping. And the team as a whole needs to monitor that progress is being made and that actions are being or have been undertaken. Therefore a formal evaluation is needed – essential a review and reassessment, making rehabilitation a cycle. See here.
Rehabilitation, like education, should not continue indefinitely. On the other hand, just as most people continue learning through life and, from time-to-time need further formal education (called Continued Professional Development in some circles), so some patients will need episodes of help from an expert rehabilitation service. This page discusses when and how to stop an episode and how to retain access when or off needed. See here.
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.