Rehabilitation Treatment Specification System: Methodology to Identify and Describe Unique Targets and Ingredients

• Authors: Jarrad H Van Stan, Harvard Medical School; John Whyte, Moss Rehabilitation Research Institute; Joseph R Duffy, Mayo Clinic, Rochester; Julie M Barkmeier-Kraemer, University of Utah; Patricia B Doyle, University of Connecticut; Shirley Gherson, New York University; Lisa Kelchner, University of Cincinnati; Jason Muise, Harvard Medical School; Brian Petty, Emory University; Nelson Roy, University of Utah; Jospeh Stemple, University of Kentucky; Susan Thibeault, University of Wisconsin, Madison, Wisconsin.; Carol Jorgensen Tolejano, University of Wisconsin, Madison, Wisconsin.
• Journal Title: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
• Volume: Volume 102, Number 3
• Publisher: Elsevier | 2021-03-01, Pages 521-531
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.apmr.2020.09.383
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Methods; Outcome assessment; Health care; Rehabilitation; Therapeutics; Translational medical research

Abstract

Although significant advances have been made in measuring the outcomes of rehabilitation interventions, comparably less progress has been made in measuring the treatment processes that lead to improved outcomes. A recently developed framework called the Rehabilitation Treatment Specification System (RTSS) has potential to identify which clinician actions (ie, ingredients) actively improve specific patient functions (ie, targets). However, the RTSS does not provide methodology for standardly identifying specific unique targets or ingredients. Without a method to evaluate the uniqueness of an individual target or ingredient, it is difficult to know whether variations in treatment descriptions are synonymous (ie, different words describing the same treatment) or meaningfully different (eg, different words describing different treatments or variations of the same treatment). A recent project used vocal rehabilitation ingredients and targets to create RTSS-based lists of unique overarching target and ingredient categories with underlying dimensions describing how individual ingredients and targets vary within those categories. The primary purpose of this article is to describe the challenges encountered during the project and the methodology developed to address those challenges. Because the methodology was based on the RTSS’s broadly applicable framework, it can be used across all areas of rehabilitation regardless of the discipline (speech-language pathology, physical therapy, occupational therapy, psychology, etc) or impairment domain (language, cognition, ambulation, upper extremity training, etc). The resulting standard operationalized lists of targets and ingredients have high face and content validity. The lists may also facilitate implementation of the RTSS in research, education, interdisciplinary communication, and everyday treatment.