Literature Review: Introduction to Rehabilitation

Introduction

Rehabilitation can be defined as a process that aims at the restoration, enhancement and maximisation of the mental, functional and physical health of an individual after they have suffered an accident or been through surgery or illness. It involves a variety of interventions that take into account the unique needs and concerns of the patient. Rehabilitation, at its core, focuses on recovery and improvement in the quality of life of the individual, making them competent to again engage in their day-to-day activities (Khalid et al., 2015). The phases three to five, also known as the final phases of rehabilitation, play a critical role in the process of recovery with a significant contribution in enabling an individual to return to normal and healthy functionality (Chen et al., 2016).

Phase 3 deals with strength and conditioning which involves individuals progressing from simple exercises to more complex and rigorous activities. The focus of this phase lies in working towards enhancing cardiovascular endurance and rebuilding muscle strength (Verschuren et al., 2016). Exercise physiologists play an essential part in this phase as they are responsible for creating regimes for exercise. These regimes take into account the health status, health goals and medical history of the patient. These professionals ensure the safety and effectiveness of the exercises by using their expertise and understanding they have with respect to the area of exercise physiology (Gabriel & Zierath, 2017).

The next phase, i.e. phase 4, involves the return or transition to normal day-to-day activities and responsibilities (Wagstaff & Leach, 2015). In this phase, rehabilitation coaches play a crucial role as they provide support and motivation along with guidance that suits the goals and needs of the patient They help individuals by collaborating with them and making them competent to achieve goals that are achievable and realistic. They are also responsible for making strategies, monitoring progress and addressing any challenges that may arise. Lastly, this phase is also based on building confidence and emotional capability apart from just physical competency (Lin et al., 2022).

The fifth and final phase of rehabilitation encompasses injury prevention or pre-habilitation and focuses on reducing the risk of possible injuries in the future (Banugo & Amoako, 2017). Return-to-sport strength and conditioning coaches play a more significant role in this phase. They are responsible for designing training programs that prioritise agility and flexibility and focus on lessening the possibility of re-injury. This phase places emphasis on the shift from rehabilitation to proactive measures leading to the overall well-being of the individual in the long run (Peña et al., 2021).

Rehabilitation services in different countries 

Firstly, the rehabilitation system in New Zealand focuses on patient-centred care and comprises both private and public entities. The public rehabilitation services receive funding from the government for different types of therapy, helping individuals to deal with physical and mental health problems along with support regarding substance use (Keene et al., 2016). The Accident Compensation Corporation (ACC) is the primary organisation functioning in the country for the facilitation of care and rehabilitation services for people suffering from injuries due to accidents (Live and Work New Zealand, 2023). In addition to this, the Ministry of Health (New Zealand) is responsible for publishing guidelines and policies for rehabilitation. These include embracing new models of care, equity, literacy and safety related to health, along with the promotion of a flexible workforce (Ministry of Health NZ, 2017). Additionally, a professional association known as Physiotherapy New Zealand provides guidelines for exercise physiologists and physiotherapists (Physiotherapy Board, 2023). 

Secondly, the rehabilitation system in Canada draws from the universal system of healthcare that it has. Canada too offers rehabilitation with respect to issues related to addiction, physical and mental health issues (Pincus et al., 2016). The core medical services are usually covered by the Canadian healthcare system through organisations like Health Canada. However, the accessibility associated with rehabilitation services can get affected due to resource limitations (Government of Canada, 2023). In addition to this, organisations like the Canadian Physiotherapy Association (CPA) and Canadian Medical Association (CMA) provide guidelines for services related to physiotherapy and Clinical Practice Guidelines (CPG) development, respectively. They provide recommendations that are evidence-based and optimal practices for interventions focusing on providing patient-centred care (Reyes Ayllon, 2021). 

Thirdly, the services related to public rehabilitation in Australia can be accessed through the Medicare system, which is funded by the government and provide rehabilitation for addiction treatment along with mental and physical health (Department of Health and Aged Care, 2023). In addition to this, the National Disability Insurance Scheme (NDIS) plays a significant role in funding individuals living with permanent disabilities and enabling them to access appropriate support and rehabilitation services (NDIS, 2022). Another organisation, called the Australian Rehabilitation Providers Association (ARPA), is a presenting body providing occupational and workplace rehabilitation (ARPA, 2023). Furthermore, the Department of Health under the Australian government is responsible for providing guidelines for services related to rehabilitation and healthcare. The guidelines include specifications related to the eligibility criteria and standards for service (Australian Institute of Health and Welfare, 2018). 

The rehabilitation system in South Africa functions independently but faces challenges due to social and economic disparities and historical background. The public rehabilitation services are provided by clinics and government hospitals (Wegner & Rhoda, 2015). In addition to this, non-profit organisations also make conscious efforts to bridge the gap existing with respect to access to rehabilitation services and provide necessary support and services to underprivileged and disabled individuals and communities (Botha, 2021). The National Department of Health (NDoH) outlines the guidelines and policies related to rehabilitation in the country (Louw et al., 2023). Also the South African Society of Physiotherapy (SASP) also provides clinical guidelines for physiotherapists along with resources and promoting standards (SASP, 2014). Furthermore, the National Rehabilitation Policy of South Africa (NRP) was introduced in 2000, placing an emphasis on the need for services related to healthcare and the appropriate allocation and availability of resources concerning rehabilitation and disability (Louw et al., 2023).

Lastly, the rehabilitation system in the USA is very diverse due to the broad and robust healthcare landscape in the country. It encompasses a wide range of counselling, therapies and other rehabilitation services. These services can be accessed through clinics, hospitals, private practices and centres for rehabilitation (Anderson et al., 2023). For instance, the Affordable Care Act (ACA) enables expanded access to rehabilitation services through insurance coverage (U.S. Deaprtment of Health and Human Services, 2023). In addition to this, government-regulated programs like Medicare and Medicaid are significantly responsible for providing access to rehabilitation services to elderly and financially unstable individuals (HHS, 2023). In the USA, the Centers for Medicare & Medicaid Services (CMS) is in charge of providing guidelines for services associated with rehabilitation included under the Medicaid and Medicare programs (Centers for Medicare & Medicaid Services, 2023). Furthermore, the American Physical Therapy Association (APTA) is accountable for the development of guidelines related to physical therapy and other interventions and recommendations in rehabilitation (APTA, 2020).

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Role of exercise physiologists in different countries

Firstly, in New Zealand, exercise physiologists have made a collaborative effort along with the government organisations like the Ministry of Health. They have made a significant contribution to public health campaigns for the promotion of activities related to physical health (Dekhoda et al., 2023). For instance, till 2020, the Exercise Association of New Zealand (ExerciseNZ) reported the registration of over 650 professionals and 3,500 exercise physiologists (Exercise NZ, 2020). Secondly, in Canada, The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO), has developed the 24 hour movement for children and youth (Ross et al., 2020). Thirdly, in the case of Australia, exercise physiologists have been found to provide care in collaboration with various organisations such as the Clinical Oncology Society of Australia (COSA) (Cormie et al., 2018). In addition to this, exercise physiologists in South Africa have collaborated with the National Department of Health (NDoH) for the prevention and management of chronic diseases and the promotion of physical activity (Useh & Akindele, 2018). Lastly, in the case of the US, exercise physiologists have exhibited a collaborative effort with organisations like the American Heart Association (AHA) and the Centers for Disease Control and Prevention (CDC) for the development and implementation of programs based on exercise focusing on management and prevention of chronic diseases like diabetes, obesity and cardiovascular diseases (Members, 2023).

Scope

On the one hand, where exercise physiologists are majorly involved in the designing of exercise interventions that aim at the improvement of fitness levels, the scope of practice in this profession is focused on exercise regimes and physiological assessments. On the other hand, other professions like occupational and physical therapists have a broader spectrum due to the implementation of a wide variety of techniques, therapies and targeted exercises. Therefore collaboration between these professions can lead to a care approach that is integrative and comprehensive in nature. This can also lead to patients getting their emotional and cognitive needs addressed along with their physical considerations (Albert, 2022). 

Emerging trends in final phases of rehabilitation

Firstly, wearable devices and rehabilitation through telemedicine and telehealth services can help exercise physiologists keep a check on the progress of patients from remote areas and receive real-time data. This enables them to design specific exercise programs irrespective of the patient’s location (Senbekov et al., 2020). Secondly, the incorporation of concepts like virtual reality and gamified exercises in the regime has motivated patients and made exercise regimes more engaging for them. Thirdly, utilising technologies such as in-depth analysis of movement and brain-computer interfaces and robotic therapies can help in the improvement of motor recovery (Jin et al., 2020). In addition to this, hybrid models for rehabilitation and other techniques, such as meditation and cognitive approaches, have also been used to enhance psychological health. Lastly, developing care models in collaboration with physical therapists and psychologists would also lead to holistic rehabilitation care (Balcombe & De Leo, 2020).

Similarities and differences

The approaches for rehabilitation have both similarities and differences across various nations. However, the principal similarity that is present in every approach is dedication towards providing care that is patient-centred and adherence to evidence-based practices. Irrespective of the country, professionals involved in the field of rehabilitation focus on providing care that is specific to the goals, needs and concerns of the patient. The majority of the time, it includes a collaborative and multidisciplinary approach (Triliva et al., 2020). In spite of this, the rehabilitation approaches existing in different countries differ from one another due to healthcare systems and other cultural and social norms. For instance, in the US, there is a close collaboration between exercise physiologists and medical teams for the development of exercise programs suiting the needs and goals of patients along with their medical history (Berry et al., 2020). In addition to this, exercise physiologists also play a significant role in initiatives associated with research and the well-being of the community, apart from direct patient care in countries like Canada. Furthermore, in the case of Australia, chronic disease management through rehabilitation and improvement of conditions like diabetes and cardiovascular diseases is being focused on by the Australia Accredited Exercise Physiologists (AAEP) (Ehrman et al., 2022). 

Factors impacting trends in rehabilitation

There are numerous factors that have an impact on the evolving trends associated with rehabilitation practices. For instance, the implementation of technological advancements and innovations such as virtual reality and telerehabilitation in the management of stroke rehabilitation can result in beneficial outcomes in countries like the USA (Varela-Aldás et al., 2021). Secondly, another significant factor is the aging population which makes it necessary for countries like Australia to invest in the implementation of rehabilitation programs and services for the elderly, promoting independence and social inclusion (Maxwell et al., 2021). Thirdly, countries like South Africa have prioritised the development of focused rehabilitation services for diseases like diabetes due to the increasing burden of chronic diseases. These programs lay emphasis on exercise, adjustments in diet and modifications in lifestyle (Carpenter et al., 2022). Lastly, there has been the incorporation of findings from research into clinical procedures in countries like Canada has led to evidence-based interventions (Kislov et al., 2019). 

Recommendation to be implemented among practice in New Zealand

Firstly, New Zealand can incorporate telemedicine and telerehabilitation initiatives used in the US to improve the engagement of patients in their care plan and making sure that the rehabilitation regime is in alignment with the needs, goals and preferences of the patient. It can also help New Zealand in providing comprehensive care irrespective of geographical location. Secondly, following an approach of collaboration existing in Canada between exercise physiologists and other professionals for programs focusing on community welfare can also be helpful. Thirdly, the successful involvement of exercise physiologists in Medicare in Australia can serve as a model for New Zealand to broaden access to rehabilitation services and chronic disease management. Lastly, adopting community-based rehabilitation projects like the ones in South Africa can help New Zealand in addressing socioeconomic and cultural factors and promote cultural sensitivity in rehabilitation. Incorporating the following strategies into the rehabilitation services existing in New Zealand, would help the country to provide better care and improved patient outcome in the last phases of rehabilitation resulting in an overall enhanced health and well-being of the individual.

Conclusion: 

Rehabilitation, at its core, focuses on recovery and improvement in the quality of life of the individual, making them competent to again engage in their day-to-day activities. Take home message will involves exercise physiologists play an essential part in this phase as they are responsible for creating regimes for exercise. These regimes take into account the health status, health goals and medical history of the patient.
 

References

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American Physical Therapy Association (APTA). (2020). Standards of practice for physical therapy. https://www.apta.org/apta-and-you/leadership-and-governance/policies/standards-of-practice-pt

Anderson, E., Wiener, R. S., Molloy-Paolillo, B., McCullough, M., Kim, B., Harris, J. I., & Bokhour, B. G. (2023). Using a person-centered approach in clinical care for patients with complex chronic conditions: Perspectives from healthcare professionals caring for Veterans with COPD in the US Veterans Health Administration’s Whole Health System of Care. Plos One, 18(6), e0286326. https://doi.org/10.1371/journal.pone.0286326

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Balcombe, L., & De Leo, D. (2020). Psychological screening and tracking of athletes and digital mental health solutions in a hybrid model of care: mini review. JMIR Formative Research, 4(12), e22755. https://doi.org/10.2196/22755

Banugo, P., & Amoako, D. (2017). Prehabilitation. BJA Education, 17(12), 401-405. https://watermark.silverchair.com/mkx032.pdf

Berry, R. B., Neric, F., & Dwyer, G. B. (2020). The state of clinical exercise physiology in the United States. Journal of Clinical Exercise Physiology, 9(4), 148-154. https://doi.org/10.31189/2165-7629-9.4.148

Botha, M. (2021). Blindness, rehabilitation and identity: a critical investigation of discourses of rehabilitation in South African non-profit organisations for visually impaired persons. http://hdl.handle.net/11427/33440

Carpenter, B., Nyirenda, M., & Hanass-Hancock, J. (2022). Disability, a priority area for health research in South Africa: an analysis of the burden of disease study 2017. Disability and Rehabilitation, 44(25), 7839-7847. https://doi.org/10.1080/09638288.2021.2000047

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Cormie, P., Atkinson, M., Bucci, L., Cust, A., Eakin, E., Hayes, S., & Adams, D. (2018). Clinical Oncology Society of Australia position statement on exercise in cancer care. Medical Journal of Australia, 209(4), 184-187.  https://doi.org/10.5694/mja18.00199

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Useh, U., & Akindele, M. O. (2018). Interprofessional Care for Chronic Diseases of Lifestyle. African Journal of Biomedical Research, 21(2), 101-105. https://www.ajol.info/index.php/ajbr/article/view/178851

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