Rehabilitation potential: A critical review of its meaning and validity

Abstract

Background The concept of rehabilitation potential emerged in 1950 as a way to select people for rehabilitation; it is also used to limit access to services. Objective To elucidate the meaning(s) of rehabilitation potential and whether it is valid in selecting patients for rehabilitation, whether as an inpatient, outpatient, or in the community. Method A non-systematic review of how it has been used, a structured discussion of its potential meanings, an exploration of the evidence in support of selecting people who might benefit from rehabilitation, and a discussion of the concept of rehabilitation potential. Findings It has been used in several ways with two primary meanings: predicting a person's function at some later time; predicting who will gain additional improvement in outcome from being seen by a rehabilitation service. The concept is flawed because rehabilitation is a process, not a specific action; the effects anticipated after rehabilitation are not restricted to functional improvement; patient characteristics do not determine many essential outcomes. There is no evidence to guide the selection of patients for an assessment and formulation by a rehabilitation team. Conclusion Rehabilitation potential, defined as data that gives the likelihood of additional benefit from receiving input from an expert rehabilitation service, is an illusion lacking any coherent definition, description, or evidence. Its use to limit access to rehabilitation is invalid. The solution is to offer all people not recently seen by an expert multi-professional rehabilitation team a full rehabilitation assessment and formulation, which will reveal what rehabilitation might achieve.