Clinical Review Recent advances

Recent advances in rehabilitation

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7246.1385 (Published 20 May 2000) Cite this as: BMJ 2000;320:1385
  1. Derick T Wade, consultant and professor in neurological disability (derick.wade@dial.pipex.com)a,
  2. Bareld A de Jong, consultant in rehabilitation medicineb
  1. a Rivermead Rehabilitation Centre, Oxford OX1 4XD
  2. b Academic Medical Centre, Meibergdreef 9, 1100 DD Amsterdam, Netherlands
  1. Correspondence to: D T Wade

    In Western countries 13-14% of the population have some degree of disability.1 The demand for rehabilitation services will increase as evidence accrues for their effectiveness and as more people survive longer with substantial disability. Current evidence strongly supports the provision of well organised, coordinated, multidisciplinary rehabilitation services based on a problem oriented approach.2 In future, specific interventions will be more evidence based, leading to more appropriate use of interventions and more appropriate referrals to specialist services.

    Rehabilitation has recently seen many practical innovations and new evidence for specific interventions, but the major advances in rehabilitation are conceptual rather than practical. Firstly, the approach to patients has moved from a predominantly medical one to one in which psychological and sociocultural aspects are equally important. Secondly, the need for organised specialist rehabilitation services—for example, for neurological disabilities—is being recognised.

    Methods

    This review concentrates on the conceptual basis of rehabilitation and some emerging principles; the scope of rehabilitation is too large to cover all major advances. We chose topics and papers on the basis of our experience.

    Nature and context of rehabilitation

    Models of illness are important.3 4 They form the basis for all decisions on the allocation of resources. They can help in the analysis and understanding of clinical cases and can form a framework for the research and planning of intervention, the construction of services, and the design of research. For effective disability services, doctors, healthcare professionals, politicians, and the general public need to understand the models.

    The international classification of impairments, disabilities, and handicaps (ICIDH) was developed under the auspices of the World Health Organization and was first published in 1980.5 The development of this classification model and its worldwide acceptance is arguably the greatest single advance in the field of rehabilitation. There are many other models of disability and illness,3 …

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