Rehabilitation Definition for Research Purposes: A Global Stakeholders’ Initiative by Cochrane Rehabilitation

Stefano Negrini; Melissa Selb; Carlotte Kiekens; Alex Todhunter-Brown; Chiara Arienti; Gerold Stucki; Thorsten Meyer

doi:10.1097/PHM.0000000000002031

TABLE 3

The final version of the rehabilitation definition with the meaning of each term

PICO Definition What Does This Mean?
In a healthcare context (see note 1)
Intervention rehabilitation is a

Multimodal Application of more than one intervention or of one intervention with more than one component

Person-centered Interventions are selected and tailored to an individual’s needs and engagement, building on and strengthening the resources of the person, taking into account the person’s values, preferences and contextual factors

Collaborative Participation of the person(s) providing the interventions and the person(s) engaged in rehabilitation. The degree of participation and the participants vary according to the health condition(s), the rehabilitation phase (acute, postacute, chronic), and the contextual factors, including setting(s) (inpatient, outpatient, home, community). Participation of the person(s) engaged in rehabilitation can be absent at early stages but must gradually develop during the individual continuum of care (rehabilitation process).

Process The process includes one or more consecutive rehabilitation cycles (assessment including goal setting, assignment, interventions, evaluation and repetition if needed) until the optimization of functioning—commonly referred to as the Rehab-Cycle.

including interventions targeting a person’s
Capacity What a person can do with limited or no influence of environmental factors

(By addressing body structures, functions, and activities/participation) Capacity is addressing body structures (body parts and organs), body functions (physiological functions of body systems, including psychological functions), activities (capacity to execute a task or action by an individual), participation (capacity to be involved in individual life situations)

and/or
Contextual factors related to performance Contextual factors include personal (that influence how the individual experiences disability) and environmental (the physical, social and attitudinal environment in which people live and conduct their lives) factors that influence performance (what a person with a health condition does in their usual environment)

Outcome with the goal of
Optimizing Improving or maintaining or limiting decline (changing trajectory in terms of deceleration and/or duration) in comparison to the expected (natural) course

Functioning Functioning is an umbrella term for body structures and functions, activities and participation
Population of
Persons with health conditions Health conditions include illnesses, injuries and also physiological changes (for example, associated with aging or pregnancy) that affect health and functioning
Currently experiencing disability Persons with an impairment(s), activity limitation(s) or participation restriction(s) with potential for resolution of the condition or improvement of functioning
or
Likely to experience disability Probability of disability due to worsening of the health condition or contextual factors, and with a potential for prevention or reduction
or
Persons with disability Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others (United Nations Convention on the Rights of Persons with Disabilities—UNCRPD), with a potential to avoid or limit decline or optimize functioning
Notes 1. This definition focuses on services aimed at addressing the healthcare needs of individuals. Health care includes services related to health needs. “General health needs include health promotion, preventive care, treatment of acute and chronic illness, and appropriate referral for more specialized needs where required. These needs should all be met through primary health care in addition to secondary and tertiary as relevant” (WHO). Rehabilitation professionals, other health professionals, or appropriately trained community-based workers deliver the services. This definition does not include reintegration into the society of a convicted person.
2. This definition follows the PICO framework in this order: Intervention, Outcome and Population.
3. According to this definition, rehabilitation is defined when all the definition elements are respected.
4. The expression “rehabilitation intervention” is commonly used to describe a single intervention. However, this abbreviation can be a source of confusion. According to this rehabilitation definition, the expression “rehabilitation intervention” is acceptable as an abbreviation of “an intervention within the rehabilitation process.” Conversely, it is not acceptable as an abbreviation of “intervention applied by a rehabilitation professional.” According to this rehabilitation definition, the expression “rehabilitation interventions” does not include single interventions provided by rehabilitation professionals out of the rehabilitation process.

PICO	Definition	What Does This Mean?
	In a healthcare context (see note 1)
Intervention	rehabilitation is a

	Multimodal	Application of more than one intervention or of one intervention with more than one component

	Person-centered	Interventions are selected and tailored to an individual’s needs and engagement, building on and strengthening the resources of the person, taking into account the person’s values, preferences and contextual factors

	Collaborative	Participation of the person(s) providing the interventions and the person(s) engaged in rehabilitation. The degree of participation and the participants vary according to the health condition(s), the rehabilitation phase (acute, postacute, chronic), and the contextual factors, including setting(s) (inpatient, outpatient, home, community). Participation of the person(s) engaged in rehabilitation can be absent at early stages but must gradually develop during the individual continuum of care (rehabilitation process).

	Process	The process includes one or more consecutive rehabilitation cycles (assessment including goal setting, assignment, interventions, evaluation and repetition if needed) until the optimization of functioning—commonly referred to as the Rehab-Cycle.

including interventions targeting a person’s
Capacity	What a person can do with limited or no influence of environmental factors

(By addressing body structures, functions, and activities/participation)	Capacity is addressing body structures (body parts and organs), body functions (physiological functions of body systems, including psychological functions), activities (capacity to execute a task or action by an individual), participation (capacity to be involved in individual life situations)

and/or
Contextual factors related to performance	Contextual factors include personal (that influence how the individual experiences disability) and environmental (the physical, social and attitudinal environment in which people live and conduct their lives) factors that influence performance (what a person with a health condition does in their usual environment)

Outcome	with the goal of
	Optimizing	Improving or maintaining or limiting decline (changing trajectory in terms of deceleration and/or duration) in comparison to the expected (natural) course

Functioning	Functioning is an umbrella term for body structures and functions, activities and participation
Population	of
	Persons with health conditions	Health conditions include illnesses, injuries and also physiological changes (for example, associated with aging or pregnancy) that affect health and functioning
	Currently experiencing disability	Persons with an impairment(s), activity limitation(s) or participation restriction(s) with potential for resolution of the condition or improvement of functioning
	or
	Likely to experience disability	Probability of disability due to worsening of the health condition or contextual factors, and with a potential for prevention or reduction
	or
	Persons with disability	Persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others (United Nations Convention on the Rights of Persons with Disabilities—UNCRPD), with a potential to avoid or limit decline or optimize functioning
Notes	1. This definition focuses on services aimed at addressing the healthcare needs of individuals. Health care includes services related to health needs. “General health needs include health promotion, preventive care, treatment of acute and chronic illness, and appropriate referral for more specialized needs where required. These needs should all be met through primary health care in addition to secondary and tertiary as relevant” (WHO). Rehabilitation professionals, other health professionals, or appropriately trained community-based workers deliver the services. This definition does not include reintegration into the society of a convicted person. 2. This definition follows the PICO framework in this order: Intervention, Outcome and Population. 3. According to this definition, rehabilitation is defined when all the definition elements are respected. 4. The expression “rehabilitation intervention” is commonly used to describe a single intervention. However, this abbreviation can be a source of confusion. According to this rehabilitation definition, the expression “rehabilitation intervention” is acceptable as an abbreviation of “an intervention within the rehabilitation process.” Conversely, it is not acceptable as an abbreviation of “intervention applied by a rehabilitation professional.” According to this rehabilitation definition, the expression “rehabilitation interventions” does not include single interventions provided by rehabilitation professionals out of the rehabilitation process.