Opinion Is rehabilitation's unifying expertise its holistic scope and cognitive approach to the patient's problems? An exploration 2025 Wade

[Andy]

Abstract​

Objective​

To propose three areas of cognitive expertise as the foundation of rehabilitation, uniting the many varieties of rehabilitation.

Five issues​

The following matters require an explanation:
(i)  Does only providing assistive technology constitute rehabilitation?
(ii)  What explains the dramatic success of spinal cord injury rehabilitation?
(iii)  How did stroke rehabilitation units reduce mortality and morbidity?
(iv)  How does rehabilitation improve outcomes in progressive conditions?
(v)  How does rehabilitation benefit people born with a disabling condition?

Foundations​

People naturally adapt to illness, and rehabilitation facilitates this adaptation within the holistic biopsychosocial framework.

Three features​

Three cognitive characteristics of rehabilitation practice are identified:
(i)  Recognising that the person's adaptation to any limitations imposed by a health condition is the fundamental process underlying change, and that rehabilitation expertise enhances and facilitates it.
(ii)  Being person-centred, considering the patient's situation using the holistic biopsychosocial model of illness, paying particular attention to the potential long-term social outcomes, including living arrangements.
(iii)  Using systematic and evidence-based clinical reasoning to achieve a holistic formulation focused on functional problems, collaborating with other professions and services in the interventions.

Healthcare​

Rehabilitation is one of many specialities using a biopsychosocial healthcare approach, focused on these principles, which contrasts with a biomedical approach focused on disease.

Conclusion​

Rehabilitation expertise has a broader scope than biomedical practice, emerging from rehabilitation thinking, which combines three key features: enhancing the person's adaptation, being person-centred, and employing a systematic approach to clinical reasoning. These differences resolve the five issues.

Open access

 

[Trish]

Being person-centred, considering the patient's situation using the holistic biopsychosocial model of illness, paying particular attention to the potential long-term social outcomes, including living arrangements.

The buzz-words 'person-centred', 'holistic' and 'biopsychosocial' are completely redundant.
The point is better made as:
Considering the patient's situation, paying particular attention to the potential long-term social outcomes, including living arrangements.

 

[Trish]

Similarly the title is ridiculous. All they seem to be saying is that rehab should be adapted to each patient's needs, including their home and social environments.

 

[Chandelier]

The author is also coauthor of:

Thread 'Anomalies in the review process and interpretation of the evidence in the NICE guideline for (CFS & ME), 2023, White et al'
https://www.s4me.info/threads/anoma...-guideline-for-cfs-me-2023-white-et-al.34097/

 

[Jonathan Edwards]

He also wrote to the BMJ along with Lynne Turner Stokes.
It is when you see essays (I wouldn't call it a paper) as bad as this that you come to realise who these people really are. The benefit of the doubt can be filed away in the attic.

 

[rvallee]

 

[Yann04]

I had to reread the title like 4 times before the grammar made sense.

 

[Utsikt]

This model wouldn’t even pass at undergrad level in business management.

The second attempt isn’t much better.


Then there’s whatever this is:

Clinical messages

• The core skill underpinning rehabilitation is a cognitive approach, which requires the clinician to:
  • Be person-centred.
  • Recognise that rehabilitation facilitates and enhances adaptation to the condition.
  • Use a systematic approach, based on the holistic biopsychosocial model and evidence-based clinical reasoning.

And lastly:

Acknowledgements
I thank the reviewers of my first draft for their criticisms and comments that have substantially improved the paper by forcing me to think more clearly and write more logically.

I don’t even want to think about what the firsr draft looked like!

 

[Sean]

It is when you see essays (I wouldn't call it a paper) as bad as this that you come to realise who these people really are. The benefit of the doubt can be filed away in the attic.

Yep. They long ago forfeited any right to the benefit of the doubt.

 

[bobbler]

Similarly the title is ridiculous. All they seem to be saying is that rehab should be adapted to each patient's needs, including their home and social environments.

it seems to be asking the question of whether rehabs expertise are the two things that all of their staff weren't trained in or qualified in?

why not get some good scientific cognitive psychologists in as the main qualification for training route if that is what they are planning to do instead?

and errm .. oh yeah I guess 'holistic scope' is only something you can blag and anyone in the job can 'make it their own' as to what it entails and what they fancy meddling with.

Imagine having a stroke and needing your house adapted to what you are likely to be capable of when you finally get home. And wanting to make sure that whilst you were at your illest someone was on top of any paperwork you needed to submit or would have a nightmare trying to unpick after wards etc.

and being landed with someone who because of the 'systemic approach' and holistic allowing for cherry-picking of the person doign the job, you end up with someone nosying into how you don't get on with your sister and asking about trauma you don't have other than how it was horrific enough waking up disabled and having to rely/hope on staff sorting out what you practically need done if you have a long time suddenly out of work or other situation and might lose your house if the right things aren't done etc and someone not listening to you on that then assuming you are a 'stress-head' for saying noone answering you on whether you can get help on it is 'causing stress'.

I hope it doesn't leave room for that sort of thing.

But is about preserving agency, dignity and autonomy properly ie having respect that they need help with certain things but should be in control of making decisions on others where they can even if someone else is having to do the hand-writing etc. Like keeping them in their own home when they wish to stay and so on.

I'm slightly open-minded to the possibility some might do this. I'm not confident it ensures all of these

bps really is the nightmare dystopian good intentions cover/excuse model for liquorice all sorts of people to go in all sorts of directions and places that might be done well but without the right permission and person getting it right could be grim and logically seems to be barely tangentally justified as being anything to do with 'healthcare' or 'allied' other than the Sharpe type 'any illness can be psych' unproven sophist truism, that particularly something like the nhs really doesn't need ? particularly when it's example by speaking in tongues rather than tight, relevant case studies that make the intention explicit.

 

[bobbler]

This model wouldn’t even pass at undergrad level in business management.
View attachment 28967
The second attempt isn’t much better.
View attachment 28968

Then there’s whatever this is:

And lastly:

I don’t even want to think about what the firsr draft looked like!

Do he not realise he has literally put the person at the very bottom of both of those diagrams like a ps afterthought to ask them what their shared decision is?

whilst using buzz-word of person-centred for it

yeah right it all starts with understanding the person. I have great doubts from looking at this that this began with any deep listening to or understanding of any patient from their perspective rather than stuck-on assumptions of who they are and what's best for them nevermind them thinking of things like you know co-creation.