Introduction to Rehabilitation
Original Editors - Joseph Ayotunde Aderonmu and Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Kim Jackson, Vidya Acharya, Lucinda hampton, Merinda Rodseth, Tarina van der Stockt, Ashmita Patrao, Oyemi Sillo, Candace Goh, Rucha Gadgil, Wanda van Niekerk and Aminat Abolade
Introduction[edit | edit source]
Rehabilitation is a concept that is widely discussed globally. This is by no means unexpected since over a billion people live with a form of disability, accounting for over 15% of the world population. Furthermore, according to a recent report, 2.41 billion individuals worldwide live with conditions that impact on their function in daily life and would benefit from rehabilitation services, which equates to 1 in 3 individuals requiring rehabilitation services throughout the course of their illness or injury.[1]
The proportion of the worldwide population over 60 will double in the next 30 years, the majority of whom will live with chronic diseases, particularly noncommunicable diseases. These changing health and demographic trends are contributing to rapid global increases in the numbers of people experiencing decline in functioning, resulting in enormous unmet rehabilitation needs. Much of these unmet needs are concentrated amongst the poorest and most vulnerable populations in low- and middle-income countries and conflict-affected settings, which are often ill equipped to cope with these increasing needs for rehabilitation services.[2][3]
According to the WHO, rehabilitation is one of the essential components of Universal Health Coverage (UHC), which features alongside “promotion of good health, prevention of diseases, treatment and palliative care”.[2] Thus, rehabilitation focuses on achieving functional independence in activities of daily living (ADL), participation in work, recreation and also education with individuals being able to achieve meaningful roles in daily life.[2] Clearly, rehabilitation is pivotal in achieving not only individual health benefits, but an overall universal health goal that permits the building of a healthy and functional global population.
Definition[edit | edit source]
Fundamentally, rehabilitation is founded on the philosophy that every individual has the inherent tendency and right to be experts of their own health care.[5] This therefore marks the distinction between acute care and rehabilitation; where acute care is concerned with an individual’s survival, while rehabilitation is concerned with the education and training of individuals to be able to carry out activities of daily living by themselves, thus promoting self care and functional independence.[6] There is currently no universal understanding of rehabilitation, and it is portrayed in many ways depending on the context including a development issue, disability issue, health issue, human rights issue, substance abuse issue and security issue to name a few and have been differently defined by different authorities:“Refers to services, and programmes designed to assist individuals who have experienced trauma or illness that results in an impairment that creates a loss of function (physical, psychological, social or vocational).” [7]
“Aims to restore, compensate, prevent or slow deterioration in functioning (sensory, physical, intellectual, mental, cognitive, or social) to help individuals to reach their optimal levels.” [1]
Rehabilitation is one of the core health strategies of the World Health Organisation, along with promotion, prevention, treatment, and palliative care who defines rehabilitation as ‘“A process to restore mental and/or physical abilities lost to injury or disease in order to function in a normal or near-normal way” [8]
" a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments.” [9]
Rehabilitation is then a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Health conditions can refer to disease (acute or chronic), injury or trauma, which may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition. It may be needed by anyone with a health condition who experiences some form of limitation in functioning, such as in mobility, vision or cognition and is characterized by interventions that address impairments, activity limitations and participation restrictions, as well as personal and environmental factors including assistive technology that have an impact on functioning.
Rehabilitation is a highly person-centred health strategy where treatment caters to the underlying health condition(s) as well as goals and preferences of the user. Information on functioning is essential to decision-making in rehabilitation at all levels of the health system since the goal of rehabilitation is to optimize functioning in light of impairments, injuries, and acute or chronic diseases:
- At user level, information on functioning guides goal setting and outcome evaluation across the continuum of rehabilitation care (primary, secondary and tertiary) and in the treatment phases (acute care, post-acute care and long-term care).
- At facility or programme level, information on functioning from users can be aggregated to help monitor clinical outcomes and improve service planning and quality assurance.
- At policy level, aggregated clinical information on functioning gives policy-makers a source of evidence for planning health and rehabilitation services and monitoring their impact.
By restoring, preventing or slowing deterioration in functioning (sensorial, physical, intellectual, mental, cognitive, or social), rehabilitation places the person at the centre of the process and contributes to people reaching their full potential and participating in society. Its impact is therefore not only on the individuals, but also on their families, communities, and economies.
Misconceptions about Rehabilitation[edit | edit source]
Several widely held misconceptions about rehabilitation undermine its potential impact on the health of populations.
Misconception: Rehabilitation is only for persons with disabilities (as defined by the CRPD).
Fact: Rehabilitation is needed by anyone with a health condition, impairment or injury, acute or chronic, that limits functioning.
People with severe, long-term physical, mental, intellectual or sensory impairments may benefit substantially from rehabilitation and participate more intensively and for longer duration than other rehabilitation users across their lifespan. However, rehabilitation is needed by anyone with a health condition that limits functioning; be that after an acute illness or injury (such as a burn or musculoskeletal injury), if they have a chronic condition (such as low back pain, diabetes, or cardiac failure), or in order to facilitate recovery following surgery. Given its wide applicability, it is integral that rehabilitation is integrated into the health system and made available to all those who need it. While rehabilitation is for everyone, health systems should ensure that rehabilitation services are accessible to persons with disabilities in order to be compliant with the Convention on the Rights of Persons with Disabilities (CRPD), which may involve modifying the physical environment, or making rehabilitation information accessible in different formats.
Misconception: Rehabilitation is only a highly specialised service for athletes or a post-injury return-to-work service
Fact: Rehabilitation addresses the needs of a broad scope of people across the lifespan and aims to optimise function
Rehabilitation within the context of sport, be that elite or recreational sport, is well recognised and considered essential for professional athletes to return to high level performance and competition. Similarly return-to-work and vocational rehabilitation are also widely recognised as having significant social and economic benefits. Yet, while rehabilitation in both these fields is undoubtedly valuable, it represents only a fraction of the true scope of rehabilitation and of rehabilitation users.
Misconception: Rehabilitation is a luxury health service that can be ignored given competing demands for investment/resources
Fact: Rehabilitation is a core component of health care and is needed to achieve and maintain the best outcomes from other health interventions, such as surgery
The erroneous belief that rehabilitation is an expensive and luxurious addition to essential health services has meant that it has been undervalued in health system financing and development, and although it plays a critical role in optimizing health outcomes, advances in the field have lagged behind those in other areas of health. Rehabilitation has been recognized as a core component of Primary Health Care since the Alma Ata Declaration in 1978, yet its representation in primary care is relatively poor. Acknowledging the critical contribution rehabilitation makes to improving functioning and well-being, and its importance to the effectiveness of other health interventions, is fundamental to correcting this disparity.
Summary[edit | edit source]
Rehabilitation is without doubt a crucial aspect of health that is aimed at enhancing functionality and independence. As a field of health, it has evolved through different stages before arriving at its present model that incorporates different components of biological, societal and contextual factors that have effects on the health and functionality of individuals experiencing various health challenges. Regardless of who the beneficiary is, who delivers it, or the context in which rehabilitation is delivered, optimising functioning is the ultimate objective of rehabilitation and is instrumental to a patient's wellbeing, regardless of the underlying health condition. [10]
Resources[edit | edit source]
References [edit | edit source]
- ↑ 1.0 1.1 Duttine A, Battello J, Beaujolais A, Hailemariam M, Mac-Seing M, Mukangwije P, et al. Introduction to Rehabilitation Factsheet. Handicap International. 2016. Available from: https://humanity-inclusion.org.uk/sn_uploads/document/2017-02-factsheet-rehabilitation-introduction-web_1.pdf [Accessed on 8 January, 2020].
- ↑ 2.0 2.1 2.2 Shimizu Y. Rehabilitation. World Health Organization. 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/rehabilitation. [Accessed on 8 January, 2020].
- ↑ Cieza, Alarcos. "Rehabilitation the health strategy of the 21st century, really?." Archives of physical medicine and rehabilitation 100.11 (2019): 2212-2214.
- ↑ World Health Organisation (WHO). Rehabilitation is about health and functioning in everyday life. Available from: https://youtu.be/uG_VdZe9VNU[last accessed 26/06/2021]
- ↑ Gender AR. Scope of rehabilitation and rehabilitation nursing. Chin P, Finocchiaro D. Rosebrough, A. Rehabilitation nursing practice. New york: McGraw-Hill,.1996.
- ↑ Mauk KL. Overview of rehabilitation. Rehabilitation Nursing: A Contemporary Approach to Practice. 2011.
- ↑ Lubkin IM, Larsen PD, editors. Chronic illness: Impact and interventions. Jones & Bartlett Learning; 2006.
- ↑ National Cancer Institute. Rehabilitation. 2007. Available at: https://www.cancer.gov/search/results?swKeyword=rehabilitation. [Accessed on 8 January, 2020].
- ↑ World Health Organization. World Report on Disability 2011. Geneva: World Health Organization, 2011. Rehabilitation.
- ↑ Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Dec 19;396(10267):2006-17.
