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Importance

A great number of pathological conditions affect mobility and/or communication, many are chronic and may be progressive. The underlying pathologies include those with a very high incidence, such as arthritic and neuromuscular conditions. The burden of the consequent disabilities is enormous in terms of the effect on the quality of life of affected individuals and their carers, and the cost to the NHS.

A wide range of interventions are used by remedial and other therapists to assist disabled people maintain independence. Many interventions aim to improve symptoms, provide alternative coping strategies or remedy the underlying pathology. The therapies used envelop the whole range of services provided within the health service. They include physical, psychosocial and pharmaceutical methods, involving health care professionals from many disciplines as well as carers and families.

Although the paramedical professions make a significant contribution to rehabilitation, service provision is variable. Decisions on the level of service provided are influenced by factors other than patient need or demand, and the methods used are often poorly described and inadequately evaluated. Currently the specific therapeutic approaches used tend to be chosen on an ad hoc basis (Wilson, 1993). An inevitable consequence is that considerable resources, time and effort are devoted to providing interventions which are not effective or are sub-optimal in terms of outcome or cost-effectiveness.

Efforts made to evaluate different therapeutic interventions have been sporadic. The work carried out has tended to be small scale and insufficiently detailed to allow replication, and sometimes limited by methodological problems. The findings of such studies have tended to be reported in specialist journals and not made widely available.

Most efficacy studies have not attempted to capture the impact of the whole therapeutic programme. Most effort has concentrated on treatments that minimise impairment rather than change the disability or improve the well being of client or carer. The majority of interventions provided by therapists have not been evaluated either when used in isolation or as part of an integrated approach to treatment.

There is an urgent need to review existing information and make it more accessible, to develop appropriate methodologies, and to undertake larger scale studies of the effectiveness and cost effectiveness of the whole therapeutic programme.

Virtually all existing interventions are open to rigorous evaluation, either through randomised controlled trials, or through studies using qualitative research methods. (Siegel, 1993; Wertz, 1993). The benefit of such research would be considerable. The time and resources currently devoted to interventions that are not effective could be used for evaluating interventions with unproven benefit and to develop effective treatments.

Examples of Research and Development Objectives

References

Wilson BA. 1993. How do we know rehabilitation works? Neurophysiological Rehabilitation, 3: 1-4.

Siegel GM. 1993. Research: Issues in treatment efficacy; a natural bridge. ASHA 35: 36-38.

Wertz RT. 1993. Issues in treatment efficacy: Adult onset disorders. ASHA 35: 38-40.