Yet another example is the treatment that patients often get after they suffer a heart attack. Patients in such situations participate in cardiac rehab, in which they learn healthy lifestyle changes, such as exercise, smoking cessation, dietary changes, weight loss, and stress management. Similarly, a traditional form of chronic pain management is a treatment called chronic pain rehabilitation. Chronic pain rehabilitation programs are an interdisciplinary treatment that involves learning healthy lifestyle changes that reduce pain over time and learning improved ways of coping with the pain that remains chronic.
Why are all these different types of therapies called rehabilitation? What do they have in common?
Rehabilitation model of care
These questions imply that we should step back a bit, away from the particulars of these different treatments, and understand that all these treatments share an underlying model of care. It’s called the rehabilitation model of care. Let’s explain what it is and, in doing so, it will be helpful to differentiate it from another model of healthcare, the acute medical model.
The rehabilitation model of healthcare focuses on what the patient can do to get better. Patients learn healthy lifestyle changes and ways o
f coping that lead to improved health when done over time. Self-management is the term that refers to these health-improving changes. The rehabilitation model of care is typically best suited for persistent conditions, conditions for which there are no immediate cures. Rehabilitation helps patients to get better by reducing the impact that a persistent condition has on their lives. That is to say, by learning how to successfully self-manage a persistent condition, patients can keep the condition in check and move on with the rest of their lives.
The rehabilitation model of healthcare differs from the acute medical model of care. The latter is the model of care that underlies the delivery of many medications and surgical procedures. Its emphasis is on what the healthcare provider can do for the patient. Its goal is to alleviate symptoms and, ideally, bring about a cure. It tends to be best suited for acute conditions, such as injuries and infectious illness.
Both models of care have their time and place. It’s safe to assume that no one is going to attempt to self-manage an acute appendicitis or try to find the right specialist to cure alcoholism. Rather, we focus on acute care procedures when having appendicitis and other curable conditions; we focus on rehabilitation and self-management when having persistent conditions, such as alcohol dependence.
Persistent health conditions
The lynch pin that determines the type of care to pursue is whether the condition is persistent or not. If the condition is long-lasting, then there are no immediate cures for it. So, rehabilitation is the preferred treatment approach. Sometimes, there are medications that can help to manage a long-lasting or chronic condition. Some examples are insulin for diabetes, or high blood pressure and high cholesterol medications for heart disease, and antidepressants and anti-epileptics for chronic pain. Sometimes, too, certain surgical procedures can keep a person with heart disease alive, but ultimately it still does not cure the underlying disease. So, when having a persistent health condition, most patients are referred to some type of rehabilitation care where the focus is on what patients can do to minimize the condition and minimize its impact on them.
The rehabilitation model of care is used with some of the most significant health problems of our day: diabetes, heart disease, chronic pain, among others. With diabetes, it tends to be called diabetes education or diabetic self-management. The focus is on accepting the long-lasting nature of the condition, dietary changes, weight loss, exercise, and stress and mood management. With heart disease, the approach is called cardiac rehabilitation. The focus is on accepting the long-lasting nature of the condition, dietary changes, weight loss, smoking cessation, exercise, stress and mood management. With regard to persistent pain, the rehabilitation model of care is used in chronic pain rehabilitation programs. The focus of such programs is on accepting the pain, exercise, relaxation therapies, and cognitive behavioral strategies that reduce pain, insomnia, stress, anxiety, and depression. The goals for any of these types of programs are for the patient to successfully self-manage their chronic condition and be able to live well despite having it.
Key differences between the acute medical and the rehabilitation models of care
The following table highlights the key differences between the acute medical model and the rehabilitation model of care.
|
Acute Medical Model of Care Rehabilitation Model of Care |
|
| Ideal of care is to provide a cure or ‘quick fix’ | Ideal of care is to assist patients in making healthy changes (accept, adapt, compensate, cope, ‘move on’) and live well despite having the condition |
| Goal is to return to premorbid functioning (how the patient was prior to onset of the condition) | Goal is to get better than how ever the patient is today |
| Hope lies in what the healthcare provider can do for the patient | Hope lies in the patient taking back control |
| Power lies in the expertise of the provider (relies on an ‘external locus of control’) | Patient becomes empowered (relies on an 'internal locus of control') |
| The therapeutic relationship tends to be hierarchical; the provider is the expert, active agent; the patient is a passive recipient of care | The therapeutic relationship is less hierarchical; provider is like a coach who educates and motivates the patient; the patient is like an athlete who practices and implements the changes |
| Progress is qualitative: cured yes/no | Progress is incremental: by degrees |
| Can have spectacular results, but may also have potential for iatrogenic results (i.e make one worse) | Progress is slow; rehabilitation is relatively benign |
| Has a point of diminishing returns (i.e., the more procedures patients get for the same condition, the less likely they tend to be beneficial) | The longer you do the therapies and the more you do them, the better you get |
| Well-suited for acute injuries and illnesses | Well-suited for persistent health conditions |
Date of publication: January 11, 2013
Date of last modification: August 27, 2022
About the author: Murray J. McAllister, PsyD, is a pain psychologist and consults to clinics and health systems on improving pain care. He is the founder and editor of the Institute for Chronic Pain.
