PART 1
The foundation of pulmonary rehabilitation
1A framework for medical rehabilitation: Restoring function and improving quality of life
Julia Warden and Mark Bayley
2Pulmonary rehabilitation: The development of a scientific discipline
Linda Nici and Roger S. Goldstein
3Key concepts in pulmonary rehabilitation
Felipe V.C. Machado, Frits M.E. Franssen and Martijn A. Spruit
4Enhancing use and delivery of pulmonary rehabilitation
Emily Hume, Carolyn L. Rochester and Ioannis Vogiatzis
5Pathophysiological basis, evaluation and rationale of exercise training
Pierantonio Laveneziana and Paolo Palange
6Education: Realizing the potential for learning in pulmonary rehabilitation
Felicity Blackstock and Suzanne C. Lareau
7Self-management
Jean Bourbeau and Tanja W. Effing
8Dual therapy: Pharmacologic management in pulmonary rehabilitation
J. Michael Nicholson and Richard Casaburi
1
A framework for medical rehabilitation: Restoring function and improving quality of life
Julia Warden and Mark Bayley
Introduction
A unifying model for rehabilitation: The International Classification of Functioning, Disability and Health
The approach to rehabilitation assessment
Unpacking the black box of rehabilitation: Important service delivery considerations and questions
Measuring the benefits of rehabilitation
Summary
Conflict of interest
References
Key MESSAGES
•The WHO International Classification of Functioning is a unifying framework for rehabilitation that addresses the impact of the health condition on body structure and function, activities of life and participation in usual roles.
•Rehabilitation treatment is goal oriented, interdisciplinary and is focused on training in remediation or compensation for an impaired function.
•The ideal dose, timing, type, location and delivery model of rehabilitation should be based on the individual patient and address their unique physical, functional and psychological issues.
Introduction
Advances in curative medicine combined with demographic and epidemiological trends of population ageing and the shift to a higher incidence of chronic, non-communicable diseases, require that healthcare systems be able to respond to the increasing needs of people living with chronic conditions and impairments (1). Individuals are living longer, but with more disability, and what affects people more are the limitations in their independence and functioning arising from their health conditions. Rehabilitation is the field of medicine that focuses on improving quality of life and optimizing independence in daily activities.
Based in the WHO International Classification of Functioning, Disability and Health (ICF), rehabilitation can be defined as the health strategy that aims to enable people with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction with the environment (2). It is a strategy that is relevant to all medical specialties and health professions (3), and it complements the other three health strategies, that include prevention, cure and support (2).
To put the four key health strategies in context, the primary goal of the preventive strategy is to prevent health conditions by targeting risk factors, for example controlling tobacco to reduce the incidence of lung cancer. The primary goal of the curative strategy is to cure health conditions, such as achieving remission in cancer, or controlling diseases such rheumatoid arthritis, typically with the use of biologically active medications. The primary goal of the rehabilitative strategy is to restore or optimize function, for example rehabilitating an individual with hemiparesis after stroke so that they are able to manage their basic activities of daily living independently, with or without the use of adaptive aids, and so that they are able to mobilize independently, whether it be with or without a gait aid. The primary goal of the supportive strategy is to optimize quality of life, for example achieving pain control and relieving mental distress in a palliative care patient with terminal cancer (1).
Although conceptually distinct, the four health strategies have many related outcomes. For example, although the rehabilitative strategy focuses on function, similar to the supportive strategy, it is also concerned with quality of life as a closely related outcome. Rehabilitation medicine also aims to optimize disease management, similar to the curative strategy, and it has a focus on minimizing the effects of the initial health problem, which is similar to a preventive strategy.
The objective of this chapter, therefore, is to provide the reader with (a) a unifying model for the discipline of rehabilitation, (b) an overview of the rehabilitation assessment, (c) a peek into the black box of rehabilitation interventions and (d) insights into how rehabilitation outcomes are measured. It concludes with some of the key remaining research questions in the field.
A unifying model for rehabilitation: The International Classification of Functioning, Disability and Health
The ICF is the WHO framework for measuring health and disability of individuals and populations. It has been described as a unifying model for the conceptual description of the rehabilitation strategy (2). The overall purpose of the classification is to provide a framework for the description of health and health-related states, and the unit of classification is categories within health and health-related domains (4).
The classification is based on a model of functioning and disability (Figure 1.1), in which Health condition is defined as a disease (acute or chronic), disorder, injury or trauma. Functioning is an umbrella term for body functions and structures and activities, and Participation signifies the positive aspects of the complex interaction betwe...
