Creating a manual to better define rehabilitation treatments / John Whyte [and eight others].

Format:

Book

Author/Creator:

Whyte, John, author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Language:

English

Subjects (All):

Outcome assessment (Medical care).

Physical Description:

1 online resource (140 pages) : illustrations.

Place of Publication:

Washington, D.C. : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: Stakeholders in the health care enterprise are interested in the comparative effectiveness of treatment alternatives. Rehabilitation is a key component of the health care system that is expected to grow as the population ages and increasing numbers of patients survive with chronic illnesses and disabilities. At present, however, rehabilitation lacks sufficient rigorous research to guide clinicians and consumers toward effective treatments. The field has a plethora of measures of case mix and outcome, but the treatment process itself is a "black box" specified only crudely with metrics such as length of stay, sessions of physical therapy, and course of vocational rehabilitation. The rehabilitation treatments that must be compared in effectiveness research are not specified in sufficient detail to be measured and studied with respect to their differential impact on outcomes important to consumers. In 2008, we embarked on a NIDRR (National Institute on Disability and Rehabilitation Research)-funded 5-year effort to improve classification and measurement of rehabilitation interventions. This culminated in a conceptual framework for a rehabilitation treatment taxonomy (RTT), described in a January 2014 supplement to Archives of Physical Medicine and Rehabilitation. This work in progress has received enthusiastic support, commentary, and dissemination from many rehabilitation disciplines. We included representatives of these disciplines in periodic discussions and workshops to help shape the effort described in this report. OBJECTIVES: The objective of this project was to incorporate the conceptual framework of the RTT into standardized operational procedures so that clinicians, educators, and researchers across all rehabilitation disciplines could define and specify rehabilitation treatments according to their immediate effects, mechanisms of action, and hypothesized active ingredients. Thus, 1 tangible objective was the development, initial testing, and dissemination of a Manual for Rehabilitation Treatment Specification (see Methods). A further objective, using the results of that testing, was to continue developing the RTT toward the goal of achieving a common language and classification system for all rehabilitation interventions (now renamed the Rehabilitation Treatment Specification System--RTSS), thus allowing meaningful grouping of similar treatments and meaningful comparisons across distinct treatment approaches. The ultimate goals of the RTSS, once adopted, are to1. enhance the ability of clinical educators and supervisors to ensure that treatments are delivered as intended;2. improve the ability to replicate and disseminate effective treatment research;3. improve the ability to synthesize treatment evidence across replications of the same or similar treatments;4. support cross-cutting research on treatment principles that apply to larger categories of treatment;5. enhance communication among members of different disciplines coordinating care; and6. increase the value of administrative data sets in treatment research by increasing the information value of treatment documentation. METHODS: Directed by the principal investigator and 2 senior co-investigators, a multidisciplinary core team and 5 work groups compiled a sample of 51 treatments that a multidisciplinary sample of rehabilitation clinicians was most interested in evaluating and comparing. We built vignettes, which contained brief clinical summaries, around these treatments and used them as the basis for treatment specification. The vignettes focused on a range of treatments delivered in both inpatient and outpatient settings to adults as well as children in the following disciplines: occupational therapy (13), physical therapy (13), speech-language pathology (12), nursing (7), and psychology (6). Core team members attempted specification of these treatment vignettes, identified ambiguities and gaps in the set of rules and procedures that were drafted to guide them, and recommended refinements to those procedures in an iterative manner. The core team discussed the challenges encountered in these attempted specifications in weekly meetings, and 1 team member was assigned to draft written resolutions or revisions to existing manual rules. After multiple cycles of attempted specification, rule revision, and respecification, the core team arrived at a full draft of the Manual for Rehabilitation Treatment Specification, which described the key concepts of treatment specification and provided a reproducible procedure for such specification, along with a set of 5 fully specified vignettes as teaching illustrations. We provided a group of 40 rehabilitation clinicians from mixed disciplines with web-based training in using the manual. We used feedback from trainees about the manual's clarity and utility to shape a final version. The project advisory board met by teleconference and in 2 face-to-face meetings to provide feedback on the evolving manual, suggestions for design of the RTSS clinician training cycle, and final input on next steps toward implementing the specification system. RESULTS: Despite the previous period of NIDRR funding, a number of challenging conceptual obstacles emerged during the process. Developing and revising rules to guide the specification of volitional treatments--treatments that require effort and engagement on the part of the patient--were among the most challenging tasks. In addition, we developed procedures and rules for (1) determining the number of treatment components, (2) defining the target of treatment for each treatment component, (3) determining the treatment group to which each treatment component belongs, and (4) specifying the treatment component's active ingredients and their dosing parameters. Feedback obtained from the advisory board, from participants in the RTSS clinician training cycle, and from attendees at multiple professional presentations confirmed that the concepts contained in the manual were valuable and useful in supporting clinical education and supervision, clinical reasoning, and research reporting and synthesis. Advisory board members and training participants also agreed that repeated practice with feedback and discussion would be necessary to allow development of independent skills in treatment specification. Thus, the advisory board recommended continued efforts to implement these concepts into curricula for rehabilitation clinicians and researchers as well as a series of focused implementation projects that could document the positive impact of the RTSS and encourage its broader adoption. CONCLUSIONS: We developed and summarized the conceptual framework for the RTSS in the Manual for Rehabilitation Treatment Specification. Those who have engaged with the concepts have found them valuable for both clinical reasoning and research reporting, but the rules and procedures needed for independent treatment specification require practice and skill development. We will need to take additional steps to train relevant stakeholders to implement this system. Note: In this report, technical terms are in bold when first used and are defined in the Glossary in the Appendix.

Contents:

Background

Stakeholder Engagement

Methods

Results

Discussion

Conclusions

References

Publications

Acknowledgments

Appendix.

Notes:

Description based on publisher supplied metadata and other sources.