Abstract
Rehabilitation as a concept, and the practice of rehabilitation, have changed remarkably during the preceding years. Modern rehabilitation is multidisciplinary and multi-professional. The development and research of rehabilitation has also grown international. The contents of modern rehabilitation include medical, social and psychological aspects, and in vocational rehabilitation, the working conditions and organisational questions are dealt with as well (Jager 1999).
Traditional methods in vocational rehabilitation and guidance include medical and psychological assessment, and work clinics assessment (which includes practical work assessment in the work place). Presently, the methods, have advanced and rehabilitation is not seen merely as a specific method for handicapped people. Various rehabilitation measures are flexibly applied, and rehabilitation includes elements of adult education, training of working skills, and ideas of on-the-job training and career advancement. The concepts, targets and contexts of rehabilitation and prevention can be described as follows:
Primary Prevention: health education and ergonomic advice for general, non-disabled population.
Secondary Prevention: early rehabilitation for groups at risk with early signs of disability.
Tertiary Prevention: rehabilitation and habilitation of severely disabled to secure social integration.
The outcome of rehabilitation has been studied extensively, but the number of randomised controlled trials (RCT) is not large in any of the major target groups of rehabilitation. Among musculoskeletal disorders, the best evidence for the efficacy of multidisciplinary rehabilitation is for sub-acute and chronic low back pain disorders. Systematic reviews have been performed in various other musculoskeletal disorders as well, e.g. in fibromyalgia and multilocational pain syndromes, where no clear evidence has yet been demonstrated. It should be noted though that RCT’s are not the only way to get information about the outcome, efficacy or effectiveness of rehabilitation, and vocational rehabilitation in particular. The outcome of vocational rehabilitation, i.e. the success of occupational integration, depends a great deal on the general employment outlook. This is generally known but often ignored.
Various forms of supported employments have become more important than earlier. The European Social Fund’s Employment Horizon initiative has launched many projects in Europe. As a result, new training and employment approaches have been developed for disabled persons, including co-operatives, social enterprises and distance work. In practice, supported employment takes the form of individual training at the workplace and consists of finding suitable supported work, redesigning job requirements in co-operation with both employer and employee to fit the employee’s abilities, and ongoing support as long as it is needed.
These programmes reflect the important values of the society. It is a valuable goal to help disabled people to integrate into society, which involves participation into working life. This makes it possible for them to preserve their dignity as well. In fact, how Society deals with its disabled people enables it to discover most clearly its basic values.
The abstracts were prepared by Dr P Dolan. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
