What is rehabilitation?
Rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”.
Put simply, rehabilitation helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family. It does so by addressing underlying conditions (such as pain) and improving the way an individual functions in everyday life, supporting them to overcome difficulties with thinking, seeing, hearing, communicating, eating or moving around.
Anybody may need rehabilitation at some point in their lives, following an injury, surgery, disease or illness, or because their functioning has declined with age.
Some examples of rehabilitation include:
- Exercises to improve a person’s speech, language and communication after a brain injury.
- Modifying an older person’s home environment to improve their safety and independence at home and to reduce their risk of falls.
- Exercise training and education on healthy living for a person with a heart disease.
- Making, fitting and educating an individual to use a prosthesis after a leg amputation.
- Positioning and splinting techniques to assist with skin healing, reduce swelling, and to regain movement after burn surgery.
- Prescribing medicine to reduce muscle stiffness for a child with cerebral palsy.
- Psychological support for a person with depression.
- Training in the use of a white cane, for a person with vision loss.
Rehabilitation is highly person-centered, meaning that the interventions and approach selected for each individual depends on their goals and preferences. Rehabilitation can be provided in many different settings, from inpatient or outpatient hospital settings, to private clinics, or community settings such as an individual’s home.
The rehabilitation workforce is made up of different health professionals, including physiotherapists, occupational therapists, speech and language therapists, orthotists and prosthetists, and physical medicine and rehabilitation doctors.
The benefits of rehabilitation
Rehabilitation can reduce the impact of a broad range of health conditions, including diseases (acute or chronic), illnesses or injuries. It can also complement other health interventions, such as medical and surgical interventions, helping to achieve the best outcome possible. For example, rehabilitation can help to reduce, manage or prevent complications associated with many health conditions, such as spinal cord injury, stroke, or a fracture.
Rehabilitation helps to minimize or slow down the disabling effects of chronic health conditions, such as cardiovascular disease, cancer and diabetes by equipping people with self-management strategies and the assistive products they require, or by addressing pain or other complications.
Rehabilitation is an investment, with cost benefits for both the individuals and society. It can help to avoid costly hospitalization, reduce hospital length of stay, and prevent re-admissions. Rehabilitation also enables individuals to participate in education and gainful employment, remain independent at home, and minimize the need for financial or caregiver support.
Rehabilitation is an important part of universal health coverage and is a key strategy for achieving Sustainable Development Goal 3 – “Ensure healthy lives and promote well-being for all at all ages”.
Misconceptions about rehabilitation
Rehabilitation is not only for people with long-term or physical impairments. Rather, rehabilitation is a core health service for anyone with an acute or chronic health condition, impairment or injury that limits functioning, and as such should be available for anyone who needs it.
Rehabilitation is not a luxury health service that is available only for those who can afford it. Nor is it an optional service to try only when other interventions to prevent or cure a health condition fail.
For the full extent of the social, economic and health benefits of rehabilitation to be realized, timely, high quality and affordable rehabilitation interventions should be available to all. In many cases, this means starting rehabilitation as soon as a health condition is noted and continuing to deliver rehabilitation alongside other health interventions.
Unmet global need for rehabilitation
Globally, about 2.4 billion people are currently living with a health condition that benefits from rehabilitation. With changes taking place in the health and characteristics of the population worldwide, this estimated need for rehabilitation is only going to increase in the coming years.
People are living longer, with the number of people over 60 years of age predicted to double by 2050, and more people are living with chronic diseases such as diabetes, stroke and cancer. At the same time, the ongoing incidence of injury (such as a burn) and child developmental conditions (such as cerebral palsy) persist. These health conditions can impact an individual’s functioning and are linked to increased levels of disability, for which rehabilitation can be beneficial.
In many parts of the world, this increasing need for rehabilitation is going largely unmet. More than half of people living in some low- and middle-income countries who require rehabilitation services do not receive them. The COVID-19 pandemic has led to a new increase in rehabilitation needs as well as causing severe disruption to existing rehabilitation services in 60-70% of countries worldwide.
Global rehabilitation needs continue to be unmet due to multiple factors, including:
- Lack of prioritization, funding, policies and plans for rehabilitation at a national level.
- Lack of available rehabilitation services outside urban areas, and long waiting times.
- High out-of-pocket expenses and non-existent or inadequate means of funding.
- Lack of trained rehabilitation professionals, with less than 10 skilled practitioners per 1 million population in many low- and middle-income settings.
- Lack of resources, including assistive technology, equipment and consumables.
- The need for more research and data on rehabilitation.
- Ineffective and under-utilized referral pathways to rehabilitation.
Rehabilitation in emergencies
Natural hazards such as earthquakes or disease outbreaks and human induced hazards including conflict, terrorism or industrial accidents can generate overwhelming rehabilitation needs as a result of injury or illness. They also simultaneously disrupt existing services and have the greatest impact on the most vulnerable populations and the weakest health systems.
While the important role of rehabilitation in emergencies is recognized in clinical and humanitarian guidelines, it is rarely considered as part of health system preparedness and early response. The result is that pre-existing limitations in rehabilitation services are magnified, health service delivery is less efficient, and people directly affected are at risk of increased impairment and disability.
For rehabilitation to reach its full potential, efforts should be directed towards strengthening the health system as a whole and making rehabilitation part of health care at all levels of the health system, and as part of universal health coverage.
In 2017, WHO launched the Rehabilitation 2030 initiative, which emphasizes the need for health system strengthening, and calls for all stakeholders worldwide to come together to work on different priority areas, including: improving leadership and governance; developing a strong multidisciplinary rehabilitation workforce; expanding financing for rehabilitation; and improving data collection and research on rehabilitation.
WHO is responding to the identified challenges and promoting health system strengthening for rehabilitation through:
- Providing technical support and building capacity at country level
- Increasing leadership, prioritization and resource mobilization
- Developing norms, standards and technical guidance
- Shaping the research agenda and monitoring progress