Box 1.

An evidence-based description of effective rehabilitation13 based on the framework of Donabedian14

Patients and places
Rehabilitation may benefit anyone with a longer-term disabling illness at any stage of that illness and be delivered in any setting.
The structure
The necessary resource is a multidisciplinary team with the range of knowledge and skills needed to manage, from within their own team, 80% of patients seen without additional help. This team should be based within a single organisation and have its own geographic base, and financial arrangements should be managed in consultation with the team.15
The goal (outcome)
To optimise a patient's self-rated quality of life and degree of social integration through optimising independence in activities, minimising pain and distress, and optimising the ability to adapt and respond to changes in circumstances.
The process
Rehabilitation is a problem-solving process, framed in the context of the holistic biopsychosocial model of illness, delivered in a person-centred way,11 and requiring:
  • an expert, multidisciplinary team, setting collaborative team-based goals

  • a formulation of the situation, covering all domains of the biopsychosocial model

  • close, collaborative working across all boundaries, professional, organisational and geographic

  • ongoing monitoring of change and effects of interventions.

Interventions fall into five categories:8
  • General exercise that increases cardio-respiratory work

  • Repeated practice of functional activities

  • Psycho-social therapies

  • Education with an emphasis upon self-management

  • A set of specific actions tailored to the patient's priorities, needs and goals, covering (if necessary) all domains of the biopsychosocial model of illness, and being evaluated regularly for their benefits and harms, to determine whether they should be continued, changed or abandoned.