title: Development of a theory-driven rehabilitation treatment taxonomy: conceptual issues.
abstract: Many rehabilitation treatment interventions, unlike pharmacologic treatments, are not operationally defined, and the labels given to such treatments do not specify the active ingredients that produce the intended treatment effects. This, in turn, limits the ability to study and disseminate treatments, to communicate about them clearly, or to train new clinicians to administer them appropriately. We sought to begin the development of a system of classification of rehabilitation treatments and services that is based on their active ingredients. To do this, we reviewed a range of published descriptions of rehabilitation treatments and treatments that were familiar to the authors from their clinical and research experience. These treatment examples were used to develop preliminary rules for defining discrete treatments, identifying the area of function they directly treat, and identifying their active ingredients. These preliminary rules were then tested against additional treatment examples, and problems in their application were used to revise the rules in an iterative fashion. The following concepts, which emerged from this process, are defined and discussed in relation with the development of a rehabilitation treatment taxonomy: rehabilitation treatment taxonomy; treatment and enablement theory; recipient (of treatment); essential, active, and inactive ingredients; mechanism of action; targets and aims of treatment; session; progression; dosing parameters; and social and physical environment. It is hoped that articulation of the conceptual issues encountered during this project will be useful to others attempting to promote theory-based discussion of rehabilitation effects and that multidisciplinary discussion and research will further refine these rules and definitions to advance rehabilitation treatment classification.
authors.affiliation: Moss Rehabilitation Research Institute, Elkins Park, PA. Electronic address: jwhyte@einstein.edu.
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Dijkers
authors.affiliation: Moss Rehabilitation Research Institute, Elkins Park, PA.
authors.forename: Tessa
authors.initials: T
authors.lastname: Hart
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Zanca
authors.affiliation: Moss Rehabilitation Research Institute, Elkins Park, PA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Packel
authors.affiliation: Moss Rehabilitation Research Institute, Elkins Park, PA.
authors.forename: Mary
authors.initials: M
authors.lastname: Ferraro
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Theodore
authors.initials: T
authors.lastname: Tsaousides
mesh_terms: D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D004777:Environment; D006040:Goals; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D008962:Models, Theoretical; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D026761:Physical Therapy Specialty / Q000145:classification* / Q000458:organization & administration*
keywords: Behavior and behavior mechanisms; Classification; Environment; ICF; International Classification of Functioning, Disability and Health; Patient education as topic; RTT; Rehabilitation; Social environment; Therapeutics; rehabilitation treatment taxonomy