Abstract
The field of rehabilitation remains captive to the black-box problem: our inability
to characterize treatments in a systematic fashion across diagnoses, settings, and
disciplines, so as to identify and disseminate the active ingredients of those treatments.
In this article, we describe the Rehabilitation Treatment Specification System (RTSS),
by which any treatment employed in rehabilitation may be characterized, and ultimately
classified according to shared properties, via the 3 elements of treatment theory:
targets, ingredients, and (hypothesized) mechanisms of action. We discuss important
concepts in the RTSS such as the distinction between treatments and treatment components,
which consist of 1 target and its associated ingredients; and the distinction between
targets, which are the direct effects of treatment, and aims, which are downstream
or distal effects. The RTSS includes 3 groups of mutually exclusive treatment components:
Organ Functions, Skills and Habits, and Representations. The last of these comprises
not only thoughts and feelings, but also internal representations underlying volitional
action; the RTSS addresses the concept of volition (effort) as a critical element
for many rehabilitation treatments. We have developed an algorithm for treatment specification
which is illustrated and described in brief. The RTSS stands to benefit the field
in numerous ways by supplying a coherent, theory-based framework encompassing all
rehabilitation treatments. Using a common framework, researchers will be able to test
systematically the effects of specific ingredients on specific targets; and their
work will be more readily replicated and translated into clinical practice.
Keywords
List of abbreviations:
ICF (International Classification of Functioning, Disability and Health), RTSS (Rehabilitation Treatment Specification System), RTT (rehabilitation treatment taxonomy)To read this article in full you will need to make a payment
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References
- Toward a rehabilitation treatment taxonomy: summary of work in progress.Phys Ther. 2014; 94: 319-321
- Characterizing rehabilitation interventions.in: Fuhrer M.J. Assessing medical rehabilitation practices: the promise of outcomes research. Paul H. Brookes, Baltimore1997: 307-317
- Treatment definition in complex rehabilitation interventions.Neuropsychol Rehabil. 2009; 19: 824-840
- International classification of functioning, disability and health (ICF). World Health Organization, Geneva, Switzerland2001
- Describing rehabilitation interventions.Clin Rehabil. 2005; 19: 811-818
- It’s more than a black box, it’s a Russian doll: defining rehabilitation treatments.Am J Phys Med Rehabil. 2003; 82: 639-652
- Toward a theory-driven classification of rehabilitation treatments.Arch Phys Med Rehabil. 2014; 95: S33-S44.e32
- Development of a theory-driven rehabilitation treatment taxonomy: conceptual issues.Arch Phys Med Rehabil. 2014; 95: S24-S32.e22
- Toward a taxonomy of rehabilitation interventions: using an inductive approach to examine the “black box” of rehabilitation.Arch Phys Med Rehabil. 2004; 85: 678-686
- Traumatic brain injury–practice based evidence study: design and patients, centers, treatments, and outcomes.Arch Phys Med Rehabil. 2015; 96: S178-S196.e115
- Practice based evidence: incorporating clinical heterogeneity and patient-reported outcomes for comparative effectiveness research.Med Care. 2010; 48: S17-S22
- The role of theory in rehabilitation assessment, treatment, and outcomes.in: Glueckauf R. Sechrest L. Bond G. McDonel E. Improving assessment in rehabilitation and health. Sage Publications, Newbury Park1993: 33-58
- Contributions of treatment theory and enablement theory to rehabilitation research and practice.Arch Phys Med Rehabil. 2014; 95: S17-S23.e12
- A grand unified theory of rehabilitation (we wish!). The 57th John Stanley Coulter Memorial Lecture.Arch Phys Med Rehabil. 2008; 89: 203-209
- A review and analysis of the use of ‘habit’in understanding, predicting and influencing health-related behaviour.Health Psychol Rev. 2015; 9: 277-295
- Increasing physical activity through principles of habit formation in new gym members: a randomized controlled trial.Ann Behav Med. 2017; 51: 578-586
- Mental models in cognitive science.Cogn Sci. 1980; 4: 71-115
- Representation, pattern information, and brain signatures: from neurons to neuroimaging.Neuron. 2018; 99: 257-273
- Information processing in illness representation: implications from an associative-learning framework.Health Psychol. 2017; 36: 280
- The importance of voluntary behavior in rehabilitation treatment and outcomes.Arch Phys Med Rehabil. 2019; 100: 156-163
- The behaviour change wheel: a new method for characterising and designing behaviour change interventions.Implement Sci. 2011; 6: 42
- A conceptual review of engagement in healthcare and rehabilitation.Disabil Rehabil. 2015; 37: 643-654
- Traumatic brain injury patient, injury, therapy, and ancillary treatments associated with outcomes at discharge and 9 months postdischarge.Arch Phys Med Rehabil. 2015; 96: S304-S329
- Communication skills training for practitioners to increase patient adherence to home-based rehabilitation for chronic low back pain: results of a cluster randomized controlled trial.Arch Phys Med Rehabil. 2017; 98: 1732-1743.e1737
- Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.Arch Phys Med Rehabil. 2009; 90: S22-S35
- Motivational interviewing to enhance treatment attendance in mental health settings: a systematic review and meta-analysis.J Psychiatr Ment Health Nurs. 2017; 24: 699-718
- Advancing rehabilitation practice through improved specification of interventions.Arch Phys Med Rehabil. 2019; 100: 164-171
- The Rehabilitation Treatment Specification System: implications for improvements in research design, reporting, replication, and synthesis.Arch Phys Med Rehabil. 2019; 100: 146-155
Article info
Publication history
Published online: September 26, 2018
Footnotes
Supported by Patient Centered Outcomes Research Institute (contract number ME-1403-14083).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine