Figure 1: Framework of Rehabilitation
The framework is arranged in rows by level of one's experience or interaction that is affected by the disability, and in columns by stage of condition, services delivered, and context for service delivery, as follows.
- Level of interaction or experience affected by the disabling condition, including (1) the disabling condition's physical effects on an individual, (2) the individual's interaction with the physical environment, and (3) the social interaction of the individual).
- Stage of the disabling condition targeted for intervention, including (1) disease, (2) impairment, and (3) disability/handicap.
- Services provided to target the disabling condition, including (1) medical/surgical treatment, (2) therapeutic/assistive devices, and (3) environmental/social services.
- Context for service provision, including (1) inpatient acute setting, (2) inpatient rehabilitative setting, skilled nursing facility, or outpatient therapeutic setting, and (3) home or community-based care.
The entries along each row and column are not necessarily distinct or exclusive, but represent ranges of attributes that can be used to describe the need for, delivery of, and other aspects of rehabilitation services. For example, the sites of service do not necessarily align one-to-one with the stages of condition.
An advantage to this framework is that it can help direct and organize the findings of a literature synthesis on rehabilitation in a way that reflects how care for particular types of impairment is delivered and by what means it is paid, since these tend to be defined by service type and delivery setting. As such, this is more of an empirical, rather than a normative, framework. The utility of this framework could be evaluated by how well it helps to identify gaps in care or lack of continuity of care for patients, including particular policies and practices (e.g., payment policies or professional jurisdictions) that act as barriers or disincentives to optimal care.