Rehabilitation Interventions

Introduction[edit | edit source]

If we consider the definition of rehabilitation as "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”, then rehabilitation is in effect composed of multiple components or "interventions" to address issues related to all domains within the World Health Organisation's  International Classification of Functioning, Disability and Health (ICF) including: body functions and structures, capacity for activities, the performance of activities, participation, environmental/contextual factors, and personal factors.[1]

Most individuals participating in rehabilitation require interventions addressing one, many or all of the components of the ICF that are contributing to reduced functioning, with the overriding goal of rehabilitation being to utilise appropriate interventions that allow the individual to optimise their function.[1] Given this, individuals with health conditions or injuries may require rehabilitation at various points in time across the course of their lifespan. The timing and type of intervention that a rehabilitation provider selects depend greatly on several factors which include: the aetiology and severity of the person’s health condition; the prognosis; the way in which the person’s condition affects their ability to function in their environment; as well as the individual’s identified personal goals and what it is they want to achieve from the rehabilitation process.

Outcome Orientated[edit | edit source]

Goal setting in rehabilitation forms the basis for the selection of rehabilitation interventions which can include goals related to mobility, self-care, communication, and cognition and on more specific activities related to play, education, work, employment, socialisation, and quality of life. Different rehabilitation settings may vary in their capacities to provide specific intensities of therapies, and rehabilitation itself may vary in its intensity, generally measured by the frequency and duration of individual interventions or treatment sessions. The selection of rehabilitation interventions and intensity of rehabilitation should always be based on the individual patient's needs, which should include their tolerance of therapeutic activities. More importantly, rehabilitation interventions should be generally outcome-oriented, in that rehabilitation goals are developed to achieve a specific outcome that is based on the following five broad areas:

  • Prevention of the loss of function
  • Slowing the rate of loss of function
  • Improvement or restoration of function
  • Compensation for loss of function (compensatory strategies)
  • Maintenance of current function

Role of Rehabilitation Interventions[edit | edit source]

Rehabilitation intervention is provided across the whole range of healthcare settings including the primary care setting, in the acute hospital setting (during an inpatient episode or as an outpatient referral) or in the community settings. The breadth of rehabilitation means that a range of organisations may contribute to meeting a person’s individual needs. Rehabilitation intervention is essential in helping to address the impact of: [2]

  • Physical or Movement Problems such as impaired motor control; reduced range of movement; reduced balance, strength or cardiovascular fitness; loss of limbs; fatigue; pain or stiffness.
  • Sensory Problems such as impairment of vision or hearing; loss of or altered sensation of touch or movement; pain; sensory processing difficulties.
  • Cognitive or Behavioural Problems such as lapses in memory and attention; difficulties in organisation, planning and problem-solving.
  • Communication Problems such as difficulties in speaking; using language to communicate; understanding what is said or written.
  • Psychosocial and Emotional Problems such as the effects on the individual, carer and family of coping with a new health condition or living with a long-term condition. These can include stress, depression, loss of self-image and cognitive and behavioural issues.
  • Mental Health Conditions such as anxiety; depression; obsessive/compulsive disorders; schizophrenia; eating disorders; post-traumatic stress disorder and dementia.
  • Medically Unexplained Symptoms where a holistic approach is needed to ensure the best possible support for both mental and physical wellbeing.

Classification of Interventions[edit | edit source]

Rehabilitation interventions are hugely diverse and, except in rare instances, require the involvement of many different health and rehabilitation professionals and cross multiple disciplines often at the same time, which as a result make the classification of rehabilitation interventions quite complex. It is this complexity that makes the classification of rehabilitation interventions a challenge, and as a result, there is still no classification that has been universally accepted across all fields of rehabilitation currently, despite several attempts made to develop a classification system to fully describe rehabilitation interventions.[3]

Levack and Dean have outlined three key reasons for this:

  1. Firstly, rehabilitation interventions are not only about the intervention itself and what the healthcare professional does but are significantly influenced by experience and relationships and how the healthcare professional engages and interacts with the individual and other significant people in their lives. It is within these interactions that rehabilitation interventions now work towards changing how patients think about their disability, their motivation for rehabilitation, their self-efficacy and the way they participate within therapeutic activities.[3]
  2. Secondly, most rehabilitation interventions do not work on one component or domain alone but rather involve a number of interacting components.
    • Example: An occupational therapist may use a simple cooking activity to help an individual regain skills in activities of daily living following a stroke. While the primary focus may be on cooking, the activity itself also incorporates strengthening of weak muscles in a hemiplegic arm and leg (standing in the kitchen, lifting and using kitchen utensils, and bending and reaching); retraining of balance (standing and moving around the kitchen); cardiovascular exercise; conditioning and fatigue management; training in the use of assistive technology (mobility aids and adapted kitchen implements) and cognitive retraining (following a recipe, safe use of an oven). Concurrently, the occupational therapist may also use the same therapy session as an opportunity to provide some education on the nature of stroke and how to adjust for the loss of function on return home, as well as providing general emotional counselling and support. Furthermore, a collaborative approach can be taken to address the patient’s various functional limitations by using the same task but combining the session with another member of their rehabilitation team (e.g. the speech-language therapist or physiotherapist).[3]
  3. Finally, rehabilitation interventions can be provided for within a group environment or individually across a broad range of rehabilitation settings from a hospital environment, to primary care and community-based settings such as the home, work, local gym etc. Each approach has its own advantages and disadvantages but no matter what setting or structure is involved, rehabilitation should always be designed to meet the individual needs of each patient. Given this, being able to adapt, modify, create and be flexible are vital skills required by rehabilitation professionals in order to be able to adapt interventions and therapeutic activities depending not only on the particular spectrum of impairments that someone might present with, but also on the specific goals of rehabilitation for that individual, the environmental context under which a patient is performing targeted activities, and on their personality and personal interests.[3]
    • Example: An athlete following an ACL injury may start their early rehabilitation individually within the physiotherapy clinical for individual assessment and treatment. This may also be incorporated with some group-based activity with teammates within the gym, where they get to train with teammates while working on their own specific rehabilitation programme and goals. As they progress through their rehabilitation programme and work towards a return to play, rehabilitation may continue to include both individuals, small groups and team-based activities, but may be field or court-based to prepare for a return to competition.

Motivation and Adherence[edit | edit source]

The success of most, if not all, rehabilitation interventions is entirely dependent on the commitment and engagement of the people receiving the service[4]. For example, assistive technology or strength training is irrelevant if the person does not want to use the device or undertake exercises. Therefore, rehabilitation requires some level of patient motivation and adherence to be effective.[5] Motivation in physical rehabilitation has been classified into three broad groups based on:

  1. Patient motivation as an internal personality trait.
    • Clinicians might consider patients as coming to rehabilitation with a fixed degree of internal motivation, ranging from very high to very low. As such those with low motivation tend to be viewed as being less suitable for rehabilitation, while those with high motivation are viewed more as ideal candidates for rehabilitation, and consequentially spend more time with them. [6]
    • Where patient motivation is viewed primarily as a product of internal personality traits, clinicians tend to view motivation as something that they cannot influence to any great extent. Research has shown that clinicians treat patients differently based on how motivated or unmotivated they appeared, with a preference to interact more with those patients who appeared to be highly motivated and give less encouragement to those who appear to have low motivation.[7]
  2. Patient motivation as a behavioural response to social and environmental factors.
    • In this instance clinicians and the health service as a whole can be viewed as part of the patient’s social world, and therefore can be viewed as directly influencing their level of motivation to engage in rehabilitation activities.
    • Thus, the use of goal setting may directly influence patient motivation through:
      • becoming more aware of making tangible progress towards a goal or when a goal is achieved thus, patients are more motivated and tend to try harder with future rehabilitation activities after attaining or making progress towards a goal.[7][8] Likewise this can also work in the reverse, in that not making progress or achieving a goal may make the patient despondent and demotivated, and less likely to engage in further rehabilitation. "Any goals or aims that are identified must be realistic and achievable, as setting unrealistic goals is doomed to end in failure, causing further reinforcement of the sense of hopelessness" [9], although there is limited research available to support this.
      • becoming more motivated for rehabilitation when the goals of therapy are personally relevant. [7] [10][11] The more personally meaningful a rehabilitation goal is to a patient, the more likely to participate in activities that appear to lead towards it. As such, clinicians need to first identify the patient’s ‘life goals’ or 'overall goals' to ensure that the goals set by the rehabilitation team are explicitly aligned with these.[10]
      • just having a goal, which can directly influence a person’s level of effort, persistence and attention to therapeutic tasks, contributing to their self-regulation during rehabilitation. Effectively, people strive towards goals and just having the goals creates a point of focus for work. Basically just having the goal can exert an influence on an individuals behaviour before the goal is even achieved (or achievable). Evidence even suggests that difficult goals produce higher levels of effort and performance when compared with non-specific or specific, easy goals.[12]
  3. Patient motivation as an interaction between both internal personality traits and social/environmental factors.
    • In reality in day to day life, motivation and adherence to rehabilitation, is certainly more complex than just educating patients or providing them with more information about what they should or should not be doing and will always incorporate both internal personality traits and social/environmental factors. Taking the time to find out what underlies peoples’ motivation and their expectations of treatment can be very informative when planning the right rehabilitation intervention with the patient. As such it is vital that as clinicians we need to gain an understanding of the patient's beliefs about the cause of their condition and their expectations of recovery, and if need be helping them towards a more appropriate match, is a crucial part of the rehabilitation planning process. [3]

Selection of Interventions[edit | edit source]

The Medical Research Council (MRC) [13] has published guidance on research related to the development, evaluation, and implementation of complex interventions to improve health. It recommends considering the following five key questions when developing a rehabilitation intervention, particularly in the case of complex healthcare. While the guidance was intended mostly to help researchers choose appropriate methods within research, and research funders to understand the constraints on evaluation design, the first four questions are also applicable and relevant to service managers and rehabilitation professionals to guide their selection of interventions. [13]

  1. Are you clear about what you are trying to do, what outcome you are aiming for, and how you will bring about change?
    • This is applicable whether we are looking at researching the impacts of an intervention, or are selecting an intervention for use in our daily clinical practice as rehabilitation professionals. When considering what rehabilitation interventions to use, the patient's wants and needs are key and their rehabilitation goals should be central to what it is we are trying to achieve with our intervention when selecting what we are doing. Incorporating a patient's cultural considerations, needs, and values is a necessary skill to provide best practice services[14].
  2. Does your intervention have a coherent theoretical basis that has been used to develop the intervention?
    • Evidence-based practice (EBP) is 'the integration of best research evidence with clinical expertise and patient's values with consideration for all circumstances related to patient management, practice management, and health policy decision-making'[15]. Rehabilitation professionals recognise the use of evidence-based practice as central to providing high-quality care and decreasing unwarranted variation in practice. The rehabilitation professional's knowledge and skills are a key part of this evidence-based process with the personal scope of practice consisting of interventions undertaken by them that are situated within their unique body of knowledge where the individual is educated, trained, and competent to perform that activity. Use of clinical decision-making and judgment is key[16]. Since the implementation of EBP in rehabilitation, there have been major advances in the quality of healthcare that is delivered, as well as patient outcomes.[17]
  3. Can you describe the intervention fully, so that it can be implemented properly for the purposes of your evaluation, and replicated by others?
    • While this is particularly vital in research so that studies can be replicated, or further developed within our clinical practice as rehabilitation professionals, this is also important so that other rehabilitation professionals working with a person have a good understanding of the interventions being used. It is also important if a person's rehabilitation is being transferred to another member of the team so that they can evaluate and continue to provide and build on rehabilitation interventions that have been effective.
  4. Does the existing evidence suggest that it is likely to be effective or cost-effective?
    • Ensuring we choose rehabilitation interventions that are both effective or cost-effective can be very important, particularly when selecting and developing interventions for use within low resource settings. We know in many cases there is often more than one intervention that can support a specific goal, and as clinicians, we need to be able to weigh up the intervention options available and be able to choose our options considering both the effectiveness of the intervention in optimising the function of the individual but also the cost implications for the interventions, both for the individual (particularly where the individual is having to cover the cost of the intervention) and/or the rehabilitation service.
  5. Can it be implemented in a research setting, and is it likely to be widely implementable if the results are favourable?

Principles of Good Rehabilitation Intervention[edit | edit source]

The Rehabilitation Team within NHS England developed Rehabilitation is Everyone’s Business: Principles and Expectations for Good Adult Rehabilitation 26 utilising consensus group methods with: [18]

  • individuals and their carers (with a range of medical conditions and differing rehabilitation needs and experiences)
  • clinicians regarded as experts (with a range of health and rehabilitation professionals)
  • therapy clinical managers (representing both acute and community settings)
  • allied health professional national bodies

From this piece of work, ten principles were developed that describe what good practice looks and feels like from the perspective of individuals, their carers, therapists, service providers and commissioners of rehabilitation services and can be applied to any rehabilitation service that a patient uses, either for single or multiple episodes of care or intervention.

Principle 1[edit | edit source]

Optimise physical, mental and social wellbeing, and maximise outcome, independence and quality of life for both the patients and their carers or parents.

Principle 2[edit | edit source]

Promote collaborative partnership working between all stakeholders, including the voluntary and community sectors, directed by the patient, their carers and relatives as appropriate (including the provision of equipment and accommodation).

Principle 3[edit | edit source]

Use an individualised, person-centred goal-setting approach, empowering the patient and/or their carers to take informed control over their rehabilitation (including vocational rehabilitation).

Principle 4[edit | edit source]

Support and enable self-management and secondary prevention through education and information, including appropriate self-re-referral.

Principle 5[edit | edit source]

Deliver early and ongoing assessment and review, identify rehabilitation needs, provide appropriate therapeutic interventions to enable improved outcomes and seamless transitions.

Principle 6[edit | edit source]

Have an appropriately educated and trained team, able to utilise a range of interventions and skills that are underpinned by a sound evidence base.

Principle 7[edit | edit source]

Deliver a needs-led, cost-effective and efficient rehabilitation service using integrated, multi-agency pathways and 7-day services. Communication with and about patients is clear, sensitive, respectful and robust.

Principle 8[edit | edit source]

Have strong leadership and accountability at all levels – with effective communication.

Principle 9[edit | edit source]

Share good practice (locally, regionally, nationally and internationally), collect data and contribute to the evidence base by undertaking scientifically valid research, evaluation and audit.

Principle 10[edit | edit source]

Have robust systems of measurement and monitoring that are standardised, consistent and comparable, enabling local, regional and national interpretation and comparison. Examples are:

  • clinical outcomes
  • suitability and competence
  • culture
  • evidence-based tools
  • staff numbers and skill mix
  • participation in national audit
  • patient and public feedback
  • reduction of inequalities
  • safety and quality standard with a way of measuring compliance
  • understanding the impact of the intervention (clinical outcome measures, patient-reported outcome measures, waiting times, patient-focused/centred)

Intervention Packages[edit | edit source]

The World Health Organisation consider rehabilitation a core health service for individuals with health conditions throughout the life course, and across the continuum of care, such as children with developmental disorders, people with chronic conditions and living with the consequences of injuries or older people. Given that it is vital that all countries across the globe are equipped with both the technical guidance to establish and strengthen rehabilitation service delivery in line with their specific population needs, and also be able to identify and prioritise what rehabilitation interventions should be integrated into the health system, and the resources required to deliver them safely and effectively.[19]

ICF Intervention Table[edit | edit source]

The ICF Intervention Table can facilitate the coordination of interventions, roles and resources within a multidisciplinary team. It provides a comprehensive overview of all the intervention targets, as represented by ICF categories, the interventions themselves and the corresponding rehabilitation professional(s) who may be assigned to address each intervention target. It also shows the initial ICF qualifier rating of the intervention targets, the goal value i.e. the ICF qualifier expected to be achieved after the intervention, and the end or final value i.e. the ICF qualifier rating at a second assessment or evaluation. More than one rehabilitation professional may be assigned to a specific intervention target. Figure.1 shows an example of the ICF Intervention Table in use, including the range of intervention and rehabilitation team members involved.

Figure.1 ICF Intervention Table

Essential Package of Interventions[edit | edit source]

The essential package of interventions, based on both the International Classification of Functioning, Disability and Health [20] and the International Classification of Health Interventions [21] was an initial attempt to compile rehabilitation interventions into a minimum essential set of services incorporating three service delivery platforms: community, primary health centres, and inpatient hospitals.

Interventions were not mapped to a specific diagnosis or condition but rather were developed to be utilised in the context of many health conditions. Nor was it all-encompassing, as it did not incorporate many important adjuncts commonly used in rehabilitation, such as prescription of medication. It also did not identify what specific rehabilitation disciplines would be responsible for providing the interventions, in order to be applicable within the broadest range of settings and levels of rehabilitation workforce capability.[19] Although targeted at resource-constrained or low resource settings, those countries with greater resource availability were encouraged to expand on the scope, quality, and availability of interventions beyond those essential interventions identified in the package.

A broad spectrum of skills, largely dependent on the complexity of the needs of the person (such as the presence of comorbidities, and severity of the health condition), were identified as being needed to deliver many of the interventions, with the effectiveness of these interventions heavily reliant on the skills, experience, and clinical reasoning skills of the rehabilitation providers. But the minimum requirement for all interventions was the need for them to be delivered on the basis of the person’s underlying health condition in order to be most effective, with interventions ideally customized to specific conditions, individual needs and goals to ensure optimal function and participation.[19]

Figure.2 Essential Package Musculoskeletal & Cardiorespiratory
Figure.3 Essential Package Neurological and Assistive Devices
Figure.4 Essential Package Cross-Cutting Areas

Package of Rehabilitation Interventions[edit | edit source]

As part of the World Health Organisation Rehabilitation 2030 call for action, the WHO Rehabilitation Programme started to develop a Package of Rehabilitation Interventions to address some of the key actions by providing information that is required to strengthen rehabilitation planning and implementation at national and subnational levels, facilitating the integration of rehabilitation into the health sector and Universal Health Care to effectively meet population needs.[22] An evidence-based approach that draws on the expertise of rehabilitation professionals has been used with a six-step collaborative approach having rehabilitation experts and consumers from all world regions involved through each part of the process including:

  1. Selection of health conditions for which rehabilitation interventions will be included in the Package of Rehabilitation Interventions based on prevalences, related levels of disability, and expert opinion;
  2. Identification of rehabilitation interventions and related evidence for the selected health conditions from Clinical Practice Guidelines and Cochrane Reviews;
  3. Expert agreement on the inclusion of rehabilitation interventions in the Package of Rehabilitation Interventions;
  4. Description of resources required for the provision of selected interventions;
  5. Peer review process, and
  6. Production of an open-source web-based tool. Rehabilitation experts and consumers from all world regions will collaborate in the different steps.

The final resource will be open access and contain evidence-based rehabilitation interventions that will facilitate the integration of rehabilitation interventions across all service delivery platforms and also cater for different target audiences including: Ministries of Health will be able to plan the integration of rehabilitation interventions in their national health services; Researchers will be able to identify rehabilitation research gaps; Academics will be able to develop curricula for the training of rehabilitation professionals; and Service providers will be able to plan and implement specific rehabilitation interventions in their rehabilitation programmes.

Figure.5 WHO Package of Rehabilitation Interventions - Rehabilitation Domains

While there has been recognition of the global need for the development of a Package of Rehabilitation, there has also been some concerns highlighted with the use of health conditions as a starting point for the selection of interventions rather than on functioning domains[23], which suggests a focus on the medical model rather than the social or more importantly biopsychosocial model of disability. Although the authors of the WHO Package of Rehabilitation Interventions suggest that the use of health conditions facilitates the search for the evidence behind interventions targeting functioning domains, which then allow them to identify the limitations in functioning, thus ensuring the final package of rehabilitation interventions will allow the use both of health conditions and functioning domains as entry points.[24]

The development of the Package of Rehabilitation not only addresses the need for information on effective rehabilitation interventions but also the need for information on the resources required to implement these interventions, which will help support the implementation of rehabilitation within health systems.[22]

Summary[edit | edit source]

Rehabilitation interventions should always be considered multidimensional, interactive, experiential, comprehensive and as rehabilitation professionals, we should always be flexible. In order to ensure a person-centred approach, rehabilitation intervention selection and prioritisation should be developed from the patient assessment and goal-setting processes with an evidence-based approach always considered in the design of any rehabilitation plan. Given that rehabilitation needs are very individualised, rehabilitation professionals need to be open to exploring new avenues for intervention and seek creative solutions to problems with activity limitation and participation restrictions, which may involve interventions to address impairments of body structure and function, but equally may involve interventions to address environmental barriers to function or even to address personal factors that may interfere with patients achieving their life goals. [3][25]

The rehabilitation process is a dynamic one that requires health professionals to actively engage with patients and their families in the planning and implementation of interventions. Rehabilitation is about providing opportunities and solving problems. Rehabilitation professionals need to be creative and flexible in their work and develop robust plans for treatment or intervention, based on the needs and preferences of the individual, but be capable of adjusting these plans should initial strategies prove ineffective or as different goals for rehabilitation arise.

The development of the World Health Organisation Package of Rehabilitation hopes to further support this and strengthen rehabilitation in health systems by providing further information that contributes to the implementation of rehabilitation interventions that are relevant to people with health conditions, supported by evidence of acceptable quality, and most importantly are applicable in any income setting.[22]

Resources[edit | edit source]

World Health Organisation[edit | edit source]

Package of Rehabilitation Interventions

References [edit | edit source]

  1. 1.0 1.1 World Health Organization. World Report on Disability 2011. Geneva: World Health Organization, 2011. Rehabilitation.
  2. NHS England. Commissioning Guidance for Rehabilitation. March 2016.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Levack, W and Dean, SG, Chapter 4 Processes in Rehabilitation. In: Interprofessional Rehabilitation: A Person-Centred Approach, First Edition. Edited by Sarah G. Dean, Richard J. Siegert and William J. Taylor. John Wiley, 2012. p97-103
  4. Rapolienė, J., Endzelytė, E., Jasevičienė, I. and Savickas, R., 2018. Stroke Patients Motivation Influence on the Effectiveness of Occupational Therapy. Rehabilitation Research and Practice, 2018, pp.1-7.
  5. Nair SP, Panhale VP, Nair N. Perceived barriers to evidence-based practice among Physiotherapy students. J Edu Health Promot 2021;10:17.
  6. Maclean, N. and Pound, P. (2000). A critical review of the concept of patient motivation in the literature on physical rehabilitation. Social Science and Medicine, 50(4), 495–506.
  7. 7.0 7.1 7.2 Maclean, N., Pound, P., Wolfe, C. and Rudd, A. (2002). The concept of patient motivation: a qualitative analysis of stroke professionals’ attitudes. Stroke, 33(2), 444–450.
  8. Schut, H. A. and Stam, H. J. (1994). Goals in rehabilitation teamwork. Disability and Rehabilitation, 16(4), 223–226.
  9. Tripp, S. (1999). Providing psychological support. In: M. Smith (Editor). Rehabilitation in Adult Nursing Practice. Edinburgh: Churchill Livingstone, pp. 105–112.
  10. 10.0 10.1 Nair, K. P. S. (2003). Life goals: the concept and its relevance to rehabilitation. Clinical Rehabilitation, 17, 192–202.
  11. Wade, D. T. (1999). Goal planning in stroke rehabilitation: why? Topics in Stroke Rehabilitation, 6(2), 1–7.
  12. Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation: A 35-year odyssey. American psychologist. 2002 Sep;57(9):705.
  13. 13.0 13.1 Baird J, Unit ML, Petticrew M, White M. Developing and evaluating complex interventions. Swindon, UK: Medical Research Council. 2006.
  14. WHO (World Health Organization). 2001. International Classification of Functioning, Disability and Health: ICF. Geneva: WHO
  15. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2
  16. WHO (World Health Organization). 2001. International Classification of Functioning, Disability and Health: ICF. Geneva: WHO
  17. Albarqouni L, Hoffmann T, Straus S, Olsen NR, Young T, Ilic D et al. Core Competencies in Evidence-Based Practice for Health Professionals: Consensus Statement Based on a Systematic Review and Delphi Survey. JAMA Netw Open. 2018;1(2):e180281.
  18. NHS England. Commissioning Guidance for Rehabilitation. March 2016
  19. 19.0 19.1 19.2 Mills T., Marks E, Reynolds T, et al. Rehabilitation: Essential along the Continuum of Care. In: Jamison DT, Gelband H, Horton S, et al., editors. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27. Chapter 15. Available from: doi: 10.1596/978-1-4648-0527-1_ch15
  20. WHO (World Health Organization). 2001. International Classification of Functioning, Disability and Health: ICF. Geneva: WHO
  21. WHO (World Health Organization). 2016c. International Classification of Health Interventions. Geneva: WHO.​/ichi/en/.
  22. 22.0 22.1 22.2 Rauch A, Negrini S, Cieza A. Toward strengthening rehabilitation in health systems: methods used to develop a WHO package of rehabilitation interventions. Archives of physical medicine and rehabilitation. 2019 Nov 1;100(11):2205-11.
  23. Kirby RL. WHO Package of Rehabilitation Interventions: Some Concerns About Methodology. Archives of physical medicine and rehabilitation. 2020 Jun 1;101(6):1095.
  24. Alexandra Rauch, Stefano Negrini, Alarcos Cieza, Author Response to “WHO Package of Rehabilitation Interventions: Some Concerns About Methodology”, Archives of Physical Medicine and Rehabilitation, Volume 101, Issue 6, 2020.
  25. American Physical Therapy Association APTA, Evidence Based Practice & Research, (accessed 6 August 2019)