Rehabilitation - a new approach. Part four: a new paradigm, and its implications.

This editorial proposes changes in healthcare services that should greatly improve the health status of all patients with disability. The main premises are that: rehabilitation usually involves many actions delivered by many people from different organisations over a prolonged period; specific rehabilitation actions cover a wide range of professional activities, with face to face therapy only being one; and the primary patient activity that improves function is practice of personally relevant activities in a safe environment. This editorial argues that: rehabilitation should occur at all times and in all settings, in parallel with medical care in order to maximise recovery and to avoid loss of fitness, skills and confidence associated with rest and being cared for; hospitals and other healthcare settings should adapt the environment to encourage practice of activities at all times; and that measuring rehabilitation, whether in research or for re-imbursement, should not simply consider face-to-face 'therapy time' but must include: all the other important activities undertaken by the team; 'structures' such as the appropriateness of the environment; and a process measure of the time spent by patients undertaking activities.

Wade D 《-》

Rehabilitation - a new approach. Part two: the underlying theories.

This editorial considers how healthcare systems should approach the problems associated with ongoing, persistent symptoms and limitations on a person's ability to undertake activities. It starts from the premise, established in the first editorial, that the current reliance on the biomedical model of health and illness is no longer 'fit for purpose', and is one major cause of current difficulties within the health service. Among other problems, it may lead to the marginalisation of rehabilitation services, especially when resources are limited. This editorial describes and then highlights the implications of the holistic, biopsychosocial model of illness. It also outlines the rehabilitation process, demonstrating its similarity to the process used by medical services, with the primary difference being the centre of attention: disease for medical service, disability for rehabilitation services. The model of rehabilitation emphasises: the importance of being patient-centred and goal-directed in rehabilitation; the need for liaison by the team and learning by the patient; and that the patient needs to be encouraged and enabled to practice wanted activities.

Wade D 《-》

Rehabilitation - a new approach. Part three: the implications of the theories.

The last editorial suggested that rehabilitation needed to involve the patient in learning, and depended upon a group of professionals to identify what actions might help the patient, and to undertake or arrange the necessary actions. In many cases there will be both a wide variety of actions needed from a reasonably large number of people and organisations, and the process is likely to be extended over weeks, months or occasionally years. This editorial shows that these features characterise the rehabilitation process as complex and therefore it needs to be managed by a trans-disciplinary team. Some of the characteristics of teamwork are discussed. This leads to a discussion of teams in rehabilitation, showing that there are currently many different types of teams organised around different areas of interest and that a patient might need access to several specialised teams. It is then argued that the complexity of team coordination is best resolved by formal rehabilitation planning meetings, held early in a patient's involvement with rehabilitation; this should increase effectiveness and efficiency. Finally the editorial argues that rehabilitation would be improved by having rehabilitation teams that mirror the existing medical specialities, ensuring that all patients thereby have easy and early access to rehabilitation planning.

Wade D 《-》

Is public health ready to participate in the transformation of the healthcare system?

The healthcare system in Canada is undergoing significant transformation in response to three major interrelated pressures: the overall burden of illness is rising, patients are getting poor quality of care and healthcare costs are inexorably rising. One idea to guide this change is to transform the primary care system into a community-based primary healthcare (CBPH) system. This paper discusses, in particular, the readiness of public health to participate in the transformation to a CBPH system.

Millar J ，Bruce T ，Cheng SM ，Masse R ，McKeown D ... -  《-》

Determining the competences of community based workers for disability-inclusive development in rural areas of South Africa, Botswana and Malawi.

Lorenzo T ，van Pletzen E ，Booyens M 《Rural and Remote Health》