A comparison and synthesis of rehabilitation definitions used by consumers (Google), major Stakeholders (survey) and researchers (Cochrane Systematic Reviews): a terminological analysis.

BACKGROUND: The term "rehabilitation" is heterogeneously used in the health context. Different interpretations can lead to disagreements, misunderstandings and different interpretations of what rehabilitation is between who provides it, who receives it and who studies it. The aim of this study was to conduct a terminological analysis of the different rehabilitation definitions used by different audiences: consumers, rehabilitation stakeholders and researchers. METHODS: We performed a terminological analysis with comparison of three different collections of rehabilitation definitions in English language. We performed: systematic reviews of databases representing consumers and lay persons (Google) and researchers (Cochrane Systematic Reviews [CSRs]), and a survey of rehabilitation stakeholders (Cochrane Rehabilitation Advisory Board). To aggregate words that had the same underlying concepts, their roots were extracted, and their occurrences counted. The 30 most frequent roots of each search were included. The 3 obtained collections were compared and similarities calculated. An overall collection of the most important 30 roots was obtained weighting those obtained in each single collection. All analyses have been performed using Excel. RESULTS: One hundred and eighty-seven rehabilitation definitions were identified: 23 from CSRs, 36 from the survey and 128 from Google. The most frequent roots were "function*" (92%), followed by "proces*" (69‰), "health*" (59‰), "disab*" (53‰), and "person*" (50‰). The most common relevant roots related to rehabilitation concept were "proces*" (73‰) in Google, "function*" (109‰) in the survey and "disab*" (41‰) in CSRs. The noun "function" prevailed in Google and "functioning" in the survey. CONCLUSIONS: According to our findings, any definition of rehabilitation for research purposes should include the identified terms, focusing on the concept of process and considering the main elements of functioning (and function), disability, person, health, optimization and environment.

Toward a new definition of rehabilitation for research purposes: a comparative analysis of current definitions.

There is a need for a common, shared definition of rehabilitation to conduct systematic reviews and identify relevant systematic reviews for knowledge translation purposes, which is an important task of Cochrane Rehabilitation. The present paper aimed to introduce and compare existing health-related definitions of rehabilitation and to propose core aspects that should characterize a new and workable definition of rehabilitation that is able to serve both as the basis for internal communication and identity work and for external communication. We have conducted a PubMed literature search on current definitions that have been published since the launch of WHO's ICF in 2001. Definitions were analyzed by framing questions to which the definitions provide answers. Nine definitions were included in the analysis. Rehabilitation has been defined as a process, as a set or bundle of interventions, and as a health strategy. The main beneficiaries were mainly related to the presence of disability, however, no specific means or interventions in rehabilitation could be identified. The definitions provided varying answers to the questions "by whom…," "where…," and "when…" and additionally identified certain conditions for rehabilitation. The present analysis can serve as a valuable source of information for developing a Cochrane Rehabilitation definition of rehabilitation.

Expert opinions leave space for uncertainty when defining rehabilitation interventions: analysis of difficult decisions regarding categorization of rehabilitation reviews in the Cochrane library.

BACKGROUND: In 2017, Cochrane Rehabilitation created an online relational database to crowd-source the identification and categorization of Cochrane publications for relevance to rehabilitation. One of the challenges of this work has been the lack of an operational definition to determine what is or is not a rehabilitation intervention. As such, categorization decisions have been largely based on expert opinion, with two health professionals screening each review, and with disagreements in categorization decisions being adjudicated by the Cochrane Rehabilitation Review Committee. AIM: To analyze the rationale for resolving conflicts in the identification of rehabilitation reviews from all Cochrane reviews to contribute to future work on the scope and definition of rehabilitation interventions. METHODS: We extracted data on decisions made about all Cochrane titles (both protocols and reviews) published between 1 January, 1996, and 31 August, 2019, and identified all titles where there had been disagreement between any people categorizing the reviews. We used thematic analysis methods to classify the reasons for including or excluding reviews from a collection of reviews on rehabilitation interventions. We compared across groups to identify areas of conflict and errors in the initial categorization. RESULTS: Of the 9756 Cochrane titles screened, we identified 894 (9.2%) where some disagreement existed about whether a review was about rehabilitation interventions or not. Of these, 333 (37.2%) had met our original pragmatic criteria for being a "rehabilitation" review, while 561 (52.8%) had not. Seven hundred and nineteen of these reviews (80.4%) could be grouped by inductively created, reportable criteria to justify the initial categorization decisions. Fifty-seven reviews (6.4%) were on topics that were too idiosyncratic to easily group with others for the purposes of categorization. Conflicts in the rationale for categorization decisions were identified in 90 reviews (10.1%) and errors in the initial categorization for 28 reviews (3.1%). CONCLUSIONS: The challenges and conflicts identified in this study clearly indicate the need for better operational definition of rehabilitation interventions. This study provides a foundation for future work to check the utility of any new definition of rehabilitation interventions and to improve the trustworthiness of categorization decisions regarding the Cochrane Rehabilitation database.

Current rehabilitation definitions do not allow correct classification of Cochrane systematic reviews: an overview of Cochrane reviews.

BACKGROUND: During the first three years of its work, Cochrane Rehabilitation was faced with the challenge of defining the inclusion and exclusion criteria of what is rehabilitation on four different occasions: when we worked on classifying all Cochrane systematic reviews (CSRs) for relevance to rehabilitation, when we checked for newly published CSRs, when we started the process to set up the reporting guidelines for the Randomized Controlled Trials Rehabilitation Checklist (RCTRACK) project, and during our collaboration with the World Health Organization for the Package of Rehabilitation Interventions. The aim of this paper was to check how the word "rehabilitation" gets used by researchers in the health field. METHODS: This overview of reviews included all CSRs that used the term "rehabilitation" in the title. They were compared with the authors' judgement (AJ) and with the contents of two main sources: CSRs identified by Cochrane Rehabilitation as relevant to rehabilitation (CRDB), and PubMed MeSH term "rehabilitation." We also performed a content analysis classifying all CSRs by field and type of intervention and checked the internal coherence of the two databases in order to verify whether all CSRs on interventions in a specific rehabilitation field were included in the databases or not. RESULTS: Out of 14,816 PubMed entries, we analyzed 89 CSRs. We found four reviews that were judged by all classifications as not rehabilitation: they were related to mouth, nutritional, penile and schizophrenia rehabilitation. While CRDB and AJ included 94% and 91% of CSRs respectively, PubMed included only 50%. One CSR about cardiac rehabilitation was excluded only by CRDB and four by AJ. In the 50% CSRs excluded by PubMed, we found that all CSRs on cancer and vestibular rehabilitation, and those on cognitive and neuropsychological interventions, were always omitted, even if all other CSRs on neurological rehabilitation were included. CONCLUSIONS: Our results clearly highlight the need for a comprehensive rehabilitation definition that is able to point out what should be included and excluded from rehabilitation interventions. This will consequently inform all of Cochrane Rehabilitation's work and will serve the wider community of research and rehabilitation.

Zika Virus After Emergency Response: Can the ICF Guide Rehabilitation of Children With Microcephaly?

The outbreak of Zika in Brazil almost 3 years ago had harmful medical, financial, and social consequences for children and their families. It also significantly increased the statistics of Brazilian children with disabilities being followed up in rehabilitation centers. Actions promoting the use of the International Classification of Functioning, Disability and Health (ICF) framework are encouraged in view of the complex health needs identified in this population, which cover all areas of functioning, and gain special relevance when it comes to a vulnerable context. This perspective article discusses the challenges related to the implementation of the ICF in rehabilitation services for children with congenital syndrome.

Classifying and Measuring Human Resources for Health and Rehabilitation: Concept Design of a Practices- and Competency-Based International Classification.

The burden of physical impairments and disabilities is growing across high-, middle-, and low-income countries, but populations across the globe continue to lack access to basic physical rehabilitation. Global shortages, uneven distributions, and insufficient skill mix of human resources for health and rehabilitation (HRH&R) contribute to such inequitable access. However, there are no international standards to classify HRH&R and to promote their global monitoring and development. In this article, we conceptually develop an international classification of HRH&R based on the concept of monitoring HRH&R through their stock of practices and competencies, and not simply counting rehabilitation professionals such as physical or occupational therapists. This concept accounts for the varying HRH&R configurations as well as the different training, competencies, or practice regulations across locations, even within the same profession. Our perspective specifically develops the concept of a proposed classification, its structure, and possible applications. Among the benefits, stakeholders using the classification would be able to: (1) collect locally valid and internationally comparable data on HRH&R; (2) account for the rehabilitation practices and competencies among nonspecialized rehabilitation workers (eg, in less resourced/specialized contexts); (3) track competency upgrades or practice extensions over time; (4) implement competency-based human resources management practices, such as linking remuneration to competency levels rather than to professional categories; and (5) inform the development of (inter-)professional education, practice regulation, or even task-shifting processes for the whole of HRH&R. The proposed classification standard, still in a concept-development stage, could help drive policies to achieve the "right" stock of HRH&R, in terms of practices and competencies.

Rehab Concepts and Discharge Dispositions: Workshop for Medical Students.

Introduction: Safe transitions of care are an essential component of safety and quality for the patient community. It is imperative that providers choose appropriate discharge settings to reduce avoidable hospital readmissions. Additionally, providers must also ensure that the multifaceted needs of each patient are met with every discharge recommendation. There is often a lack of formal instruction in medical school on the various discharge dispositions, indications for rehab, and clinical indications for each setting. This is problematic for new interns who are tasked with entering discharge orders and relaying critical information between lead physicians and the interprofessional team. Methods: A 60-minute workshop with both didactic and experiential components provided medical students with opportunities to gain an overview of discharge dispositions while also exercising critical thinking using case examples. The workshop was part of a 2-week Transition to Residency course at a single institution. Results: Twenty-two fourth-year medical students participated in the workshop. Following the workshop, 100% of the participants stated that they had learned something new and that they intended to use the content in practice as interns. Subjective responses indicated that workshop content ought to be incorporated earlier in medical training. Discussion: These results suggest that a 60-minute workshop including didactic instruction as well as experiential and inquiry-based learning can impact medical student knowledge and intent for practice change in regard to providing safe transitions of care for the patient community.

[Use of the ICF in medical rehabilitation in Germany: claims and reality]. / Nutzung der ICF in der medizinischen Rehabilitation in Deutschland: Anspruch und Wirklichkeit.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) is being used in the medical rehabilitation practice in different ways. The World Health Organization (WHO) and many other stakeholders have formulated claims and expectations for its use. OBJECTIVES: A comparative presentation of the claims of various stakeholders for the use of the ICF with examples in current practice. MATERIALS AND METHODS: Database searches (PubMed, REHADAT, and Google Scholar) were conducted for studies concerning claims and the current use of the ICF in practice. RESULTS: There are different requirements regarding the use of the ICF. While lawmakers and social insurance agencies remain very cautious and vague, other stakeholders (research institutions, organizations, stakeholders, service providers) formulate higher expectations and call for greater use of the ICF. In practice, the ICF is used in the form of a bio-psycho-social model, a common language and many different adaptations. CONCLUSIONS: The different requirements for the use of ICF demonstrate the motivations and interests of the stakeholders. Signals must now be sent both by politics and by social insurance agencies that go far beyond non-binding declarations. Furthermore it is necessary to systematize and evaluate the many use adaptations that are primarily being used by service providers. Research is needed on the concrete use of ICF-based instruments and its intended and unintended effects.

[Assessing Social Resources in the Chronically Ill: Development and Initial Psychometric Testing of an Ego-centered Network Generator]. / Erfassung sozialer Ressourcen bei chronisch Kranken: Entwicklung und erste psychometrische Überprüfung eines egozentrierten Netzwerkgenerators.

Background: The social network is one of the most significant resources during the course of the rehabilitation. However, there is a lack of short instruments in questionnaire format for the assessment of social relations in the chronically ill. We therefore developed a network generator (NWG), and tested its performance in patients with different diseases during medical rehabilitation. Methods: We tested its reliability, validity and acceptance in 882 inpatients participating in medical rehabilitation programs (cancer N=290, musculoskeletal diseases N=292, and psychosomatic diseases N=300). Findings: The NWG provides clear information about different aspects of the social network of these subgroups with satisfying psychometric characteristics. Conclusions: The NWG can be applied as short assessment of positive social relationships that, in practice, are important resources during the whole rehabilitation process of the chronically ill.

[The User Survey on the Revision of the Classification of Therapeutic Procedures]. / Die Anwenderbefragung zur Aktualisierung der Klassifikation therapeutischer Leistungen (KTL).

INTRODUCTION: An extensive user survey was conducted in the context of updating the Classification of Therapeutic Procedures (KTL 2015). This paper reflects the results of the user survey and raises critical discussion points. METHODS: The user survey was sent to all rehabilitation centers contracted by the German pension insurance as well as professional associations. The user survey was available both as a paper questionnaire and as an online version. The feedback of the user survey provided an important basis for the revision of the KTL. RESULT: The survey yielded 1,868 suggestions from 360 users. Most of them related to chapters E ("occupational therapy, work therapy, other functional therapy") and C ("information, motivation, training"). The change from German diplomas to the international Bachelor's and Master's degrees, and the inclusion of diagnostic and work-related procedures were the main focus of the user feedback. CONCLUSION: For the revision of the KTL, the user survey provided valuable information. Only by the inclusion of practitioners can the KTL meet the requirements of realistic and comprehensive acquisition of data on therapeutic procedures also in future.

[Rehabilitation based on the bio-psychosocial model concerns health condition, functioning and contextual factors].

This article describes the core themes in modern rehabilitation and how it can be used in practice. The purpose of rehabilitation is an independent and meaningful life with the greatest possible functional ability. Rehabilitation goals will always be what matters most to the patient (not what health professionals think matters). The doctor's role includes clarification of biomedical issues, but also highlighting resources and barriers in relation to rehabilitation (including practical, economic and social barriers and resources).