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In order to rethink rehabilitation — it is vital that we think about current rehabilitation — what it looks like and why. The dominant models that have emerged to guide development and practice, the frameworks that underpin compensation policies, funding for services, and indeed research, all have historical and political roots. If we better understand these models, their basis or foundation, their strengths and also their weaknesses, then perhaps we can better understand how to contribute to progress in the future. Our aim in this paper, therefore, is to discuss issues concerning how past, present, and future understandings of disability and related conceptual models might best inform rehabilitation strategies. The paper is composed of two main parts: Part 1 revisits the history of “conceptions of disability”. We broadly retrace how disabled people have been described and progressively identified as a specific population within society throughout modern Western history. We mainly focus on the changing social and political perspectives on poverty and assistance, out of which disability has been emerged as a social and medical issue. In the twentieth century, the social and political approach to disability, supported by the social movements of disabled people, challenged this medical approach, bringing about an ongoing debate on conceptual models of disability. Part 2 considers the merits of key contemporary disability and disablement models by challenging assumptions and “common” knowledge. We particularly focus on contemporary evolutions of disability models, from the 1960s to today, because in many ways, they reflect or react against prior approaches and underpin much of what is thought of as “modern rehabilitation”. Understanding these approaches, and their evolution, may help us better structure and plan future rehabilitation schemes, services, or evaluations. We conclude the paper by discussing and suggesting some future lines of reflection. [ABSTRACT FROM AUTHOR]

The International Classification of Functioning, Disability and Health (ICF) published in 2001 describes the consequences of health conditions with three components of impairments in body structures or functions, activity limitations and participation restrictions. Two of the new features of the conceptual model were the possibility of feedback effects between each ICF component and the introduction of contextual factors conceptualized as moderators of the relationship between the components. The aim of this longitudinal study is to provide empirical evidence of these two kinds of effect. Structural equation modeling was used to analyze data from a French population–based cohort of 548 patients with knee osteoarthritis recruited between April 2007 and March 2009 and followed for three years. Indicators of the body structure and function, activity and participation components of the ICF were derived from self-administered standardized instruments. The measurement model revealed four separate factors for body structures impairments, body functions impairments, activity limitations and participation restrictions. The classic sequence from body impairments to participation restrictions through activity limitations was found at each assessment time. Longitudinal study of the ICF component relationships showed a feedback pathway indicating that the level of participation restrictions at baseline was predictive of activity limitations three years later. Finally, the moderating role of personal (age, sex, mental health, etc.) and environmental factors (family relationships, mobility device use, etc.) was investigated. Three contextual factors (sex, family relationships and walking stick use) were found to be moderators for the relationship between the body impairments and the activity limitations components. Mental health was found to be a mediating factor of the effect of activity limitations on participation restrictions. [ABSTRACT FROM AUTHOR]

The International Classification of Functioning, Disability and Health (ICF) published in 2001 describes the consequences of health conditions with three components of impairments in body structures or functions, activity limitations and participation restrictions. Two of the new features of the conceptual model were the possibility of feedback effects between each ICF component and the introduction of contextual factors conceptualized as moderators of the relationship between the components. The aim of this longitudinal study is to provide empirical evidence of these two kinds of effect. Structural equation modeling was used to analyze data from a French population–based cohort of 548 patients with knee osteoarthritis recruited between April 2007 and March 2009 and followed for three years. Indicators of the body structure and function, activity and participation components of the ICF were derived from self-administered standardized instruments. The measurement model revealed four separate factors for body structures impairments, body functions impairments, activity limitations and participation restrictions. The classic sequence from body impairments to participation restrictions through activity limitations was found at each assessment time. Longitudinal study of the ICF component relationships showed a feedback pathway indicating that the level of participation restrictions at baseline was predictive of activity limitations three years later. Finally, the moderating role of personal (age, sex, mental health, etc.) and environmental factors (family relationships, mobility device use, etc.) was investigated. Three contextual factors (sex, family relationships and walking stick use) were found to be moderators for the relationship between the body impairments and the activity limitations components. Mental health was found to be a mediating factor of the effect of activity limitations on participation restrictions. [ABSTRACT FROM AUTHOR]

The PROMIS Preference score (PROPr) is a new generic, societal, and preference-based health-related quality of life (HrQoL) score for Quality-adjusted life years (QALY) in cost-effectiveness analyses, promising to overcome limitations of existing legacy measures such as ceiling effects. The mean PROPr (UK 0.48, France 0.54, Germany 0.48; p<0.01) and the mean EQ-5D-5L index value (UK 0.79, France 0.82, Germany 0.88, p<0.01) show significant difference (UK d=0.31; France d=0.29; Germany d=0.39; p<0.01). [Extracted from the article]