Authors: Tiago S. Jesus, Felicity A. Bright, Cátia S. Pinho, Christina Papadimitriou, Nicola M. Kayes & Cheryl A. Cott
AIM
Person-centred rehabilitation is widely discussed, but the rehabilitation literature addressing it had not previously been systematically mapped. This scoping review aimed to describe how much literature existed, what kinds of questions researchers were studying, which methods they used, and which populations, professions and settings were represented.
This is therefore primarily a mapping study. It describes the landscape of person-centred rehabilitation research in adults with physical impairments rather than defining precisely what person-centred rehabilitation should involve.
METHODS
The authors followed a previously published protocol and established scoping-review methods. They searched PubMed, Scopus and CINAHL, supplemented by reference and citation searching and consultation with experts. Searches were updated through May 2019.
The review deliberately included a broad range of English-language literature concerning adults with physical impairments. Papers could address six overlapping areas: conceptual perspectives; design of person-centred interventions; implementation and effects of person-centred approaches; clients’ qualitative perspectives; providers’ qualitative perspectives; and quantitative measurement of patient experiences.
Screening involved independent reviewers, pilot testing and procedures for resolving disagreements. Two reviewers also extracted information including study aims, participants, setting, professional disciplines, topics and methods.
The authors used descriptive statistics and content analysis to map the literature, alongside regression to examine publication trends over time. Consistent with the purpose of this scoping review, they did not formally appraise the methodological quality of included studies or synthesise their clinical results.
RESULTS / FINDINGS
The review identified a substantial and increasingly empirical research field. From 5,912 unique records screened, 170 papers were included. Of these, 136 were empirical, including 13 systematic or scoping reviews, while 34 were non-empirical or conceptual. Across the empirical literature, data had been collected from 15,264 rehabilitation clients and 4,098 providers.
Research activity had also increased considerably. Between 2009 and 2018, publications increased by approximately two papers per year, and just over half of all included papers had been published since 2015.
The literature was methodologically diverse. The largest category concerned implementation of person-centred rehabilitation approaches and their effects, containing 67 papers. These included randomised trials and other experimental designs, qualitative studies, process evaluations, mixed-methods research, surveys, case studies and systematic reviews.
Qualitative research was also prominent. Forty-two papers explored clients’ perspectives and 33 explored providers’ perspectives, addressing subjects such as goal setting, participation, communication, relationships, power and control, involvement of relatives and experiences of rehabilitation. Forty papers contributed conceptual perspectives, while 26 described the design of new person-centred approaches. Only 13 addressed quantitative measurement of patient experiences and person-centred rehabilitation.
This diversity is meaningful. Person-centred rehabilitation had not developed as a single intervention or research tradition. Researchers were approaching it through questions about experiences, relationships, implementation, outcomes, measurement, ethics and service organisation, using different methodologies suited to those different questions.
The literature also crossed many conventional rehabilitation boundaries. Most papers were not focused on a single profession, setting or health condition. Where one profession was specifically examined, occupational therapy was most frequently represented, followed by physiotherapy. Most papers were relevant across settings, and 60% applied to more than one health condition or did not specify a single condition.
There were nevertheless clear imbalances. Neurological rehabilitation, particularly stroke, was strongly represented, whereas musculoskeletal rehabilitation received comparatively little specific attention. Research was also geographically concentrated: New Zealand, Sweden, Denmark and Canada were prominent after adjustment for population, while low- and middle-income countries were barely represented.
Taken together, the review maps person-centred rehabilitation as a broad, multidisciplinary and methodologically diverse field, with increasing attention to how person-centred principles can be implemented in actual rehabilitation practice.
LIMITATIONS & INTERPRETIVE CAUTIONS
The review has several methodological strengths. It followed a published protocol, combined database searching with snowballing and expert consultation, used independent reviewers, and established procedures to improve agreement when applying its broad inclusion criteria. Its inclusive approach also allowed conceptual, qualitative and quantitative traditions to be represented within the same map of the field.
Its scope is important when interpreting the findings. The authors intentionally mapped the literature rather than synthesising its findings or assessing its quality. Consequently, the presence of 67 papers concerning implementation or effects tells us that these questions have received substantial research attention. Similarly, participant numbers describe the size of the accumulated literature rather than the strength of evidence supporting person-centred rehabilitation.
Some literature may also have been missed. Only English-language papers were included, three major databases were searched, and relevant papers that did not explicitly identify themselves with person-centred terminology in their title, abstract or keywords could have escaped detection.
The geographical analysis also used the first author’s affiliation as the paper’s country of origin, providing a pragmatic indicator of research location rather than a complete representation of international collaboration. English-language restrictions and the absence of experts from low- and middle-income countries may have contributed to their very limited representation.
Finally, the review’s breadth produces substantial heterogeneity. The included literature encompasses different meanings of person-centredness, research questions and methodologies. That diversity is itself an important finding, but means that the 170 papers should not be interpreted as a single coherent body of evidence supporting one defined model or intervention.
IN PRACTICE
For physiotherapy, this review is useful partly because it shows just how broad the idea of person-centred rehabilitation has become.
The literature extends beyond familiar practices such as asking about goals or involving patients in decisions. Researchers have explored communication, relationships, patient and clinician experiences, power, involvement of families, teamwork, service organisation, implementation and clinical outcomes. Clinically, this may encourage us to think of person-centredness less as one consultation technique and more as something operating across several dimensions of rehabilitation.
The diversity of methods is equally informative. If we want to understand whether an intervention improves an outcome, an experimental design may help. If we want to understand how someone experiences goal setting, why clinicians struggle to implement collaborative practice, or how power operates within rehabilitation relationships, different methods can contribute different forms of knowledge. Person-centred rehabilitation appears to require multiple ways of investigating practice because the questions themselves are different.
The review also raises an interesting issue for musculoskeletal physiotherapy. Despite the large burden of musculoskeletal conditions, condition-specific person-centred rehabilitation research in this review was much more heavily concentrated in neurological populations. This does not prevent broader rehabilitation principles from being relevant to MSK practice, but it highlights an area where more directly contextualised research may be valuable.
Perhaps most importantly, this paper provides a map rather than an answer. It shows that by 2019 there was already a substantial and growing body of work concerned with person-centred rehabilitation, while revealing considerable diversity in how the concept had been studied and operationalised.
For a clinician interested in becoming more person-centred, that creates a useful next question: which aspect of person-centred practice are we trying to understand, for whom, in what context, and what kind of evidence could help us understand it?
Reference
Jesus, T. S., Bright, F. A., Pinho, C. S., Papadimitriou, C., Kayes, N. M., & Cott, C. A. (2021). Scoping review of the person-centered literature in adult physical rehabilitation. Disability and Rehabilitation, 43(11), 1626–1636. https://doi.org/10.1080/09638288.2019.1668483