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WHO Package of Rehabilitation Interventions: Some Concerns About Methodology

Published:February 27, 2020DOI:https://doi.org/10.1016/j.apmr.2019.12.018
      Rauch et al
      • Rauch A.
      • Negrini S.
      • Cieza A.
      Toward strengthening rehabilitation in health systems: methods used to develop a WHO Package of Rehabilitation Interventions.
      recently published a Special Communication regarding the World Health Organization’s (WHO’s) planned methodology to develop a Package of Rehabilitation Interventions (PRI). Given the early stage of this project and in the hope that the process will be an ongoing one, I would like to express 4 concerns about the proposed methodology. First, the initial step in the planned process is to select health conditions that are prevalent and that cause disability. The authors acknowledge that “(defining) a package of rehabilitation interventions based on health conditions and not on functioning domains…may be controversial”
      • Rauch A.
      • Negrini S.
      • Cieza A.
      Toward strengthening rehabilitation in health systems: methods used to develop a WHO Package of Rehabilitation Interventions.
      (p2209) but suggest that being able to later search the PRI for interventions by functioning domains adequately addresses this limitation. However, if rehabilitation is a process that primarily deals with function,
      World Health Organization
      The International Classification of Functioning, Disability and Health (ICF).
      function should be the starting point, not an afterthought. (Another problem with using health conditions as the starting point is that such an approach reinforces the medical rather than the social model of disability.) At least adding functional domains to the search strategy for rehabilitation interventions would ensure, through a process of triangulation, that important interventions are not missed.
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