Special communicationA Theory-Driven System for the Specification of Rehabilitation Treatments
Section snippets
Scope and structure of the RTSS
The RTSS is intended to apply to all rehabilitation treatments administered by clinicians, that is, rehabilitation professionals, from any discipline in any setting or format. The focus of the RTSS is on treatment of the individual patient or another recipient∗ who will interact with an individual patient, such as a family member learning how to administer care, or an employer learning how to adjust his or her behavior to help the patient adapt to his or her work environment. As in the RTT
The rationale for a theoretical structure underlying treatment specification
What do we mean when we say that the RTSS is based on treatment theory, and why do we emphasize theory at all? Rehabilitation is notoriously lacking in theory,14 tending to follow instead a pragmatic, whatever it takes approach. The multiple disciplines collaborating in rehabilitation, each with its own theories focused on specific aspects of care (eg, motor learning, behavior management), have also contributed to the lack of overarching theories for the specialty as a whole. And as discussed
Three groups of treatment components
Because key treatment ingredients (and associated mechanisms of action) do tend to vary systematically among broad classes of targets, we have found it useful to retain the concept of treatment groups,∗ containing mutually exclusive targets, that was introduced in the RTT.7 However, we have collapsed 2 of the previous groups into 1, resulting in the 3 groups depicted in table 2. We have also further elaborated some of the groups and the distinctions among them, as described below.
The Organ
Special considerations for treatment specification
In addition to the increased emphasis on volitional behavior as a target of treatment, the RTSS includes some topics relevant to the distinction between targets and aims of treatment, in several domains often encountered in rehabilitation. One example is societal participation, which is a key concept in the ICF and the ultimate goal of many rehabilitation endeavors. However, many participation goals—employment, parenting, establishing a social network—are so broad that it is very unlikely that
The treatment specification process
In the RTSS we have developed an algorithm for treatment specification, summarized in fig 2. The first step in specification is to determine the number of treatment targets (and corresponding treatment components) to be specified; the process shown in the figure is then applied to each treatment component. Although the details of this process cannot be captured in an article of this length, interested readers may download the entire Manual for Rehabilitation Treatment Specification from //mrri.org/innovations/manual-for-rehabilitation-treatment-specification/
Conclusions
The ultimate worth of the RTSS will be borne out in its uptake by rehabilitation clinicians, researchers, and clinical educators. What could be its major benefits to these users, and to the field as a whole?
This article began by reiterating the problem of the black box. If the contents of rehabilitation are opaque, or if they are enumerated and described in different ways by each practitioner, there can be no meaningful examination of their specific effects on specific aspects of patient
Acknowledgment
We thank the members of our Advisory Board, who provided valuable feedback on the concepts presented here. Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (contract number ME-1403-14083). The views, statements, and opinions presented in this publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors
References (28)
- et al.
Toward a taxonomy of rehabilitation interventions: using an inductive approach to examine the “black box” of rehabilitation
Arch Phys Med Rehabil
(2004) A grand unified theory of rehabilitation (we wish!). The 57th John Stanley Coulter Memorial Lecture
Arch Phys Med Rehabil
(2008)Mental models in cognitive science
Cogn Sci
(1980)- et al.
Representation, pattern information, and brain signatures: from neurons to neuroimaging
Neuron
(2018) - et al.
The importance of voluntary behavior in rehabilitation treatment and outcomes
Arch Phys Med Rehabil
(2019) - et al.
Traumatic brain injury patient, injury, therapy, and ancillary treatments associated with outcomes at discharge and 9 months postdischarge
Arch Phys Med Rehabil
(2015) - et al.
Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors
Arch Phys Med Rehabil
(2009) - et al.
Advancing rehabilitation practice through improved specification of interventions
Arch Phys Med Rehabil
(2019) - et al.
The Rehabilitation Treatment Specification System: implications for improvements in research design, reporting, replication, and synthesis
Arch Phys Med Rehabil
(2019) - et al.
Toward a rehabilitation treatment taxonomy: summary of work in progress
Phys Ther
(2014)
Characterizing rehabilitation interventions
Treatment definition in complex rehabilitation interventions
Neuropsychol Rehabil
International classification of functioning, disability and health (ICF)
Describing rehabilitation interventions
Clin Rehabil
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Supported by Patient Centered Outcomes Research Institute (contract number ME-1403-14083).
Disclosures: none.