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Special Article   Open accessopen access

European Journal of Physical and Rehabilitation Medicine 2022 Mar 21

DOI: 10.23736/S1973-9087.22.07509-8

Copyright © 2022 THE AUTHOR(s)

This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.

language: English

Rehabilitation definition for research purposes. A global stakeholders’ initiative by Cochrane Rehabilitation

Stefano NEGRINI 1, 2, Melissa SELB 3, 4, Carlotte KIEKENS 5 , Alex TODHUNTER-BROWN 6, Chiara ARIENTI 7, Gerold STUCKI 3, 4, 8, Thorsten MEYER 9, 3rd Cochrane Rehabilitation Methodology Meeting participants 

1 Department of Biomedical, Surgical and Dental Sciences, University La Statale, Milan, Italy; 2 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; 3 Swiss Paraplegic Research, Nottwil, Switzerland; 4 ICF Research Branch, Nottwil, Switzerland; 5 IRCCS MultiMedica, Milan, Italy; 6 Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK; 7 IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 8 Department of Health Sciences and Medicine, University of Luzern, Luzern, Switzerland; 9 School of Public Health, Bielefeld University, Bielefeld, Germany



Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systematic reviews, and 2) identify relevant systematic reviews for knowledge translation purposes. We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries (LMICs) and consumers. We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that “In a health care context,” rehabilitation is defined as a “multimodal, person-centered, collaborative process” (Intervention-general), including interventions targeting a person’s “capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance” (Intervention-specific) with the goal of “optimizing” the “functioning” (Outcome) of “persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability” (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a “rehabilitation intervention” as “any intervention provided within the rehabilitation process.” We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation.


KEY WORDS: Rehabilitation; Evidence-based medicine; Clinical trial

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