Person-centred rehabilitation: Rhetoric or reality?

Rehabilitation has frequently been at the forefront of conceptual and language development in healthcare. For example, witness the rapid changes in terminology used in the various iterations of the World Health Organization’s classification system since its inception in 1980 [1]. Some might also say we have all too often occupied the forefront of conceptual and linguistic confusion. There is certainly no shortage of variability in definitions of rehabilitation [2 – 7], what actually comprises a good outcome [8 – 10], the nature and impact of rehabilitation interventions [11,12] including core processes as goal setting [13 – 15] and, the best way to work with patients/clients, families and other members of the teams we belong to [16 – 20]. A relatively recent addition to our linguistic armament has been the concept of personcentredness. Despite the intuitive appeal of the term (one tends to think that everything we do in rehabilitation is surely ‘person-centred’) a number of tensions and issues actually exist. Indeed, some might argue that this term only adds to the conceptual and semantic confusion [21 – 23]. The purpose of this special issue of Disability and Rehabilitation is to examine those tensions, make explicit some of the assumptions about personcentredness and, identify or propose ways forward for delivering rehabilitation that truly address the needs and requirements of those who use our services. The gestation of these papers included a meeting of authors in February 2007, in Rotorua, New Zealand, with each presenting a draft of their work in progress to fellow contributors. The resulting debate and questioning over the two-day meeting has contributed to the work you see here. Each author has taken something of a risk in exposing new thoughts and new ideas and these papers are therefore not proposed as definitive or even complete entities. Rather, the intention is that they will facilitate productive consideration of, and engagement with, some key issues facing the future of rehabilitation research and practice. Each of the nine papers identifies a number of tensions and possible ways forward and we hope you find the papers to be challenging, thoughtful, thought-provoking, helpful and even occasionally irritating or inspiring. Leplege et al. [24] tackle the dual histories of rehabilitation and person-centredness, exploring how the concepts have been variably influenced and interpreted over time and in different contexts. They propose at least four distinct interpretations of person-centredness and suggest that not only do these vary significantly, but they may actually be in conflict with one another. Leplege and colleagues urge a move towards further clarity and specificity over the key components of person-centredness in rehabilitation. Given that we are only just emerging from an era where the phrase ‘the black box of rehabilitation’ has been so dominant, this is a timely caution before we end up with ‘the black box of person-centredness’. Cott et al. [25] have published widely in the field of person/client-centred rehabilitation. Their paper in this issue focuses particularly on the consequences of adopting or failing to adopt a person-/clientcentred approach in stroke rehabilitation. The authors highlight a number of well known models such as the International Classification of Health and Functioning [26] and tease out the extent to which any one model fully encapsulates a client-centred focus. Cott and colleagues go on to highlight, using the transition from hospital to community for people with stroke as their clinical touchstone, what they