Rehabilitation for Enhanced Life Participation: A Living Well Program

Rehab@Weiss
A Program of Schwab at Weiss Memorial Hospital
An Affiliate of the University of Chicago Hospitals

Rehab 4NW
4646 N. Marine Drive
Chicago, IL 60640

Rehabilitation for Enhanced Life Participation: A Living Well Program 

Consistent with a current focus on well-being within society, the inpatient rehabilitation team at Weiss Memorial Hospital, Chicago, has developed a "Living Well" program to help attend to patients' goals for resuming meaningful life activity. With short acute rehabilitation stays, clinicians have understandably prioritized improving patients' basic "survival" skills: household mobility, self-care and basic communication. Higher-level functions, including community re-integration, social interaction, and leisure involvement, are often seen as nonessential goal areas during the inpatient rehabilitation stay and left to be addressed at the next level of care. While improved basic function is essential to successful outcomes, we need to concurrently consider what improvements are meaningful to our patients. To an individual recovering from illness, injury or surgery, the extent to which he/she can resume activities of choice will determine the success of rehabilitation. Understanding patients' priorities and expectations for rehabilitation outcomes is essential to developing a treatment plan that addresses both basic functions and higher-level skills.

Chiou and Burnett (1985) found a disconcerting mismatch between patients' and their clinicians' priorities for therapy goals. They suggest that understanding a patient's value system is key to establishing appropriate therapy plans and has the potential to both shorten rehabilitation time and assist with carry-over of gains made in therapy. Our team has explored this concept in developing a "person-centered" philosophy of rehabilitation, which states that patient care starts by " ...understanding the needs, goals, concerns of the person participating in rehabilitation." The International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) has been instrumental in helping our rehabilitation team progress beyond focusing solely on basic functions to considering patients' goals and potential for resumed participation in important life domains. ICF provides a structure for organizing information regarding changes in patients' body structures and/or functions and resulting activity/participation. An extensive classification of possible life domains assists our team with eliciting patients' goals and expectations for resumed life participation. ASHA uses the ICF framework in its revised Scope of Practice for Speech-Language Pathology document and states explicitly that the purpose of speech-language intervention is to improve the quality of life of the persons we serve via facilitating the reduction of body function impairments, and activity/participation and environmental restrictions (ASHA, 2001)

In the ICF construct of Activity/Participation, the ICF differentiates individuals' "capacity" from "performance." Capacity is defined as how the person does on a task in a clinical or research setting; performance is defined as how a person does a task in this same task in his or her actual life. In the inpatient rehabilitation setting, a person is removed from their life setting and the clinical team is necessarily focused on a person's capacity. With our Living Well program, our goal is to provide patients with preparation for their anticipated return to performance within their actual lives.

Life Satisfaction and Life Participation

Discrepancies between patient perceptions of the success of rehabilitation and outcomes measured using standard models indicate the need for better outcome models. Fuhrer (1994) notes that "rehabilitation outcomes must embody concepts outside the disablement model, in particular, the concept of subjective well-being" (p. 358).

Active lifestyles are widely recognized as fundamental to physical and mental well-being and, ultimately, to one's overall life satisfaction. Many researchers have summarized the benefits of physical activity to overall well-being (e.g., Iwaski, Zuzanek and Mannell, 2001; Singh, 2002; Shephard, 1997). Other researchers have found a positive relationship between mental/social activity and overall well-being (Wang et al, 2002; Herzog, Ofstedal and Wheeler, 2002). Several researchers are reporting the health benefits of combined physical and social/mental activity as contributing to life satisfaction (Unger, Johnson and Marks, 1997; Strawbridge et al, 1996; Avlund et al, 1999; Glass et al, 1999).

At Weiss Memorial Hospital, our rehabilitation patients are predominantly aged 65 years or older. For this group, life satisfaction and successful aging are closely related concepts. Discussions regarding components of successful aging consistently report the importance of staying physically active and involved with others (e.g., Fisher, 1995; Horgas et al, 1998; Infeld & Whitelaw, 2002; Harlow and Cantor, 1996; Rowe & Kahn, 1997). Avlund et al (1999) found that both high social participation and good functional ability were associated with quality of life in old age. Strawbridge et al (1996) found evidence that both increased community participation and physical activity was associated with successful aging. Similarly, Unger, Johnson and Marks (1997) concluded that health promotion should include both physical and social activity given their differential effects in counteracting functional decline in the elderly. Glass et al (1999) explored the relationship between mortality and participation in physical fitness, social and/or productive activities in a group of 2761 people aged 65 and older. They found that involvement in social and productive activities resulted in similar survival advantages to physical fitness activities and concluded that "by recognizing the health benefits of social and productive activities as complements to exercise" (p. 482) clinicians have a valuable new intervention at their disposal.