The more avid followers of The Disabilities Trust might have heard a thing or two about our rehab mantras initiative Rehab Mantras at the Trust. This consists of sharing mantras, short statements which summarise key principles of our approach to rehabilitation. This month’s Research Digest is looking more deeply into the research behind this initiative, from three angles: lack of consensus on what the active “ingredients” of rehabilitation are [1], the evidence base behind the principles we have identified, and how an initiative like this could become a useful method for reducing the lag between research generated knowledge and practice [2].

What are the “active” ingredients of rehabilitation?

The short, but probably most accurate, answer to this question at this point in time is “depends”. In the words of Hart and Ehde [1] “rehabilitation is a complex field incorporating many disciplines, settings, interventions, and populations”, yet little progress has been made into specifying and measuring the rehabilitation process itself. There is also heterogeneity regarding how terminology is used. For example, “neurobehavioural” has been used to describe various interventions ranging from those based on cognitive-behavior therapy, to comprehensive-holistic rehabilitation programs [3]. The rehab mantras initiative is helping us reach consensus on what the active ingredients of our approach are.

What is the evidence base behind the rehab mantras?

Each mantra we develop is grounded on research evidence. For example, “every interaction is rehab” reminds us that social and behavioural training procedures, initially acquired in the rehabilitation centre, are consolidated through exposure to real-life events in the community [4], while “it’s never too late to rehab” highlights the chronic nature of acquired brain injury [5], and the fact that despite this long-term impact, there is evidence to suggest that people can benefit from rehabilitation even many years after injury [6].

Tackling the lag between research and practice

No one working in health and social care can be “too aware” of the challenges of implementing research knowledge into practice. Michie and colleagues [7] have even proposed a model that helps us understand how some of these challenges could be tackled, which resembles what detectives use to solve a crime, where means, opportunity and motive must be shown. In the Capability, Opportunity, and Motivation Model of Behaviour (COB-M), the necessary conditions for a “volitional behaviour to occur” - in other words, changes to practice - are capability, defined as the individual’s psychological and physical capacity to engage in the practice in question; motivation, defined as all those brain processes that energize and direct behaviour and opportunity, defined as all the factors that lie outside the individual that make the behaviour possible or prompt it. We are hoping that the rehab mantras initiative will help increase capability and opportunity, if not motivation, by supporting our staff to consolidate their knowledge, and prompting its application, and in this way represent a small but significant step in bridging this gap.

Last but not least, we will engage with all stakeholders to look into how the initiative went, which could add to our general understanding of rehabilitation, and in that way is a form of research in itself.

References

[1] Hart, T., & Ehde, D. M. (2015). Defining the treatment targets and active ingredients of rehabilitation: Implications for rehabilitation psychology. Rehabilitation Psychology, 60(2), 126.

[2] Davis, D., Davis, M. E., Jadad, A., Perrier, L., Rath, D., Ryan, D., ... & Zwarenstein, M. (2003). The case for knowledge translation: shortening the journey from evidence to effect. BMJ, 327(7405), 33-35.

[3] Cattelani, R., Zettin, M., & Zoccolotti, P. (2010). Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: A systematic review. Neuropsychology Review, 20(1), 52-85.

[4] Wood RL, Worthington AD. (2001) Neurobehavioural rehabilitation: a conceptual paradigm. In R. Ll. Wood & T. M. McMillan (Eds.) Neurobehavioural Disability and Social Handicap Following Traumatic Brain Injury. Hove: Psychology Press.

[5] Masel, B. E., & DeWitt, D. S. (2010). Traumatic brain injury: a disease process, not an event. Journal of Neurotrauma, 27(8), 1529-1540.

[6] Parish, L., & Oddy, M. (2007). Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury. Neuropsychological Rehabilitation, 17(2), 230-243.

[7] Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6(1), 1-12.