Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 19

Strengthening health-related rehabilitation services at the national level
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Table I. Matrix of health-related rehabilitation services (from Gutenbrunner et al. (8); modified)
A. Acute care
Types of service
Tertiary level
of healthcare
Secondary
level of
healthcare
Primary level
of healthcare
B. Post-acute care
Types of service
A.1: Acute rehabilitation wards B.1: Inpatient post-acute
A.2: Mobile acute rehabilitation rehabilitation unit
teams
A.2: Mobile acute rehabilitation
teams
B.1: Inpatient post-acute
rehabilitation unit
C. Long-term-care
Type of service
–
C.1: Intermittent inpatient rehabilitation
service
B.2: Outpatient post-acute
rehabilitation unit
–
B.3: Mono-professional post-
acute services
B.2: Outpatient post-acute
rehabilitation unit
B.3: Mono-professional
post-acute services
C.2: Primary care rehabilitation centres
C.3: Mono-professional long-term
services
C.4: Community-based rehabilitation
service
Bold: most important types of rehabilitation services.
guidance based on scientific principles for which
types of rehabilitation services are needed and
how they should be organized. This also applies
to the description of the field of competence of
rehabilitation professionals. Such a framework or
matrix is a precondition to the analysis of existing
rehabilitation services and the available rehabi-
litation workforce. The matrix of health-related
rehabilitation services developed by the authors
is described in Table I.
One of the most challenging issues for rehabi-
litation service implementation advisory missions
is to systematically describe existing rehabilitation
services and recommend service implementation.
Due to the lack of an internationally accepted clas-
sification of rehabilitation services, Meyer et al. (10)
developed a conceptual description of rehabilitation
services, and Gutenbrunner et al. (11) proposed
dimensions (service organization, financing and
service delivery) for describing rehabilitation
services. This distinction has been shown to be
useful and can be used for describing or designing
prototype services (12). Nonetheless, this tool can-
not replace a “normative” description or classifica-
tion of services. For this, some international and
interdisciplinary consensus projects are necessary.
For the country mission, RAT experts chose a
pragmatic approach and used a matrix in terms of
primary, secondary and tertiary levels of healthcare
and for all phases of care (acute, post-acute and
long-term) (13). In addition, narrative descrip-
tions of the most important types of rehabilitation
services were provided (Box 1). This pragmatic
approach was applicable for the development of
NHDRPs. A more consensus-based service des-
cription is needed for the future (12).
A similar issue arose when describing the field
of competence of rehabilitation professionals. The
Box 1. Short narrative descriptions of the most relevant
types of health-related rehabilitation services (11)
• Acute rehabilitation services delivered in hospitals at the
secondary and tertiary levels. The target group are patients
with severe disease or injury who are likely to develop
long-term disability. Acute rehabilitation services should
start even during intensive care and should be performed in
multi-professional teams (including, physical rehabilitation
medicine (PRM) doctor, physiotherapist (PT), occupational
therapist (OT), and other rehabilitation professionals). Acute
rehabilitation services may be delivered in specialized acute
rehabilitation wards or in mobile acute rehabilitation teams.
• Post-acute rehabilitation services delivered immediately
or shortly after discharge from acute care hospitals. The
target groups are patients with persisting impairment
activity limitations and participation restrictions after acute
care or trauma. Post-acute rehabilitation services improve
functioning (including participation) and can contribute to
earlier discharge from hospital. For more severe cases (with
limitations in mobility and activities of daily living) post-acute
rehabilitation should be carried out in inpatient post-acute
rehabilitation units. Patients with fewer restrictions can be
referred to outpatient post-acute rehabilitation units. For
patients with minor deficits mono-professional services may
be sufficient. Post-acute rehabilitation services should be
specialized for the specific disease or trauma and be delivered
by a multi-professional rehabilitation team.
• Long-term rehabilitation services, which aim to improve
functioning for persons with long-term disability, including
congenital disability, acquired disability and chronic diseases.
These services are also the main entrance point for more
specialized rehabilitation if needed. Long-term rehabilitation
can be performed by rehabilitation professionals (e.g. PRM
doctors, PTs, OTs). In many cases, primary healthcare
professionals (e.g. family doctors, primary healthcare
rehabilitation workers) may take an important role in
long-term rehabilitation. Long term rehabilitation can be
delivered in primary care rehabilitation centres and as mono-
professional long-term rehabilitation services. If no specialized
rehabilitation exists, community-based rehabilitation
(CBR) is a m