Authors: Tiago S. Jesus, Christina Papadimitriou, Felicity A. Bright, Nicola M. Kayes, Cátia S. Pinho, Cheryl A. Cott
AIM
Person-centred rehabilitation (PCR) is widely advocated, but the concept can remain difficult to translate into everyday practice. This paper aimed to develop a cross-professional model describing what person-centred rehabilitation means and how it can be enacted in adult physical rehabilitation.
The authors were therefore producing conceptual and practice-oriented knowledge. They synthesised how PCR had been conceptualised, experienced and implemented across the rehabilitation literature, then organised this into a model intended to help clinicians and services think about person-centredness.
METHODS
This was a scoping review combined with thematic analysis and conceptual model development.
The authors searched PubMed, Scopus and CINAHL, supplemented by snowballing and consultation with experts. English-language literature published between 2007 and February 2020 was included if it addressed predefined aspects of person-centred rehabilitation in adults with physical impairments.
The evidence base was deliberately broad. It included conceptual papers, intervention designs, implementation research, qualitative accounts from people receiving rehabilitation and providers, and quantitative research examining patient experiences. From 6,527 unique references, 147 articles were included in the thematic analysis, including 26 exclusively conceptual papers.
Two reviewers independently extracted textual material concerning what PCR entails and how it is practised or implemented. They then used an inductive thematic analysis, informed by Braun and Clarke’s approach, to identify patterns and organise them into the Person-Centered Rehabilitation (PCR) Model. Other members of the multidisciplinary research team iteratively reviewed the model, followed by feedback from five external experts, including one person with lived experience of disability.
RESULTS / FINDINGS
The central idea emerging from the synthesis is deceptively simple: person-centred rehabilitation means thinking about and providing rehabilitation “with” the person.
Importantly, the resulting model extends well beyond individual clinicians being empathetic or asking patients about their goals. The authors organise PCR across three interconnected levels: the person-professional relationship, the rehabilitation team and immediate care environment, and the wider organisation.
At the person-professional level, five closely related attributes emerged. Rehabilitation should be respectful of and tailored to the person, including their values, preferences, experiences and circumstances. Interactions should be reflexive and adaptive rather than following a standard script. Relationships should be supportive, compassionate and trusting. Rehabilitation should engage with meaning, hope and strengths alongside problems or impairments. Finally, rehabilitation should be collaboratively constructed, with power, decisions and responsibility shared according to how the person wishes to participate.
This last point adds useful nuance to ideas such as shared decision-making. Person-centredness does not require every person to take maximum control over every decision. The literature instead supported providing opportunities and support for participation to the degree the person desires, while revisiting this over time. Goals and plans similarly emerge as evolving rather than fixed: preferences, circumstances and priorities can change during rehabilitation.
At the microsystem level, person-centredness becomes something produced collectively. Significant others may be involved according to the person’s wishes; different professionals need to work coherently around the person rather than primarily around disciplinary agendas; and the physical and interpersonal environment can either support or constrain person-centred interactions.
At the organisational level, the model becomes broader still. Services can involve people receiving rehabilitation and staff in service design and evaluation, create working conditions that enable person-centred practice, develop staff capability, and organise care around continuity, coordination and individual needs.
This multilevel structure is one of the paper’s most useful contributions. Person-centredness emerges from the synthesis as an interdependent system of relationships and conditions, rather than a collection of isolated clinician behaviours. The model’s attributes intentionally overlap: listening, understanding what matters, building trust, sharing decisions and adapting rehabilitation to the person depend upon one another.
The model is consequently principles- and attributes-based rather than procedure-based. The authors conceptualise PCR as reflexive and responsive to different people, situations and professional-person interactions. A rigid checklist would sit uneasily with the very adaptability the model is trying to describe.
LIMITATIONS & INTERPRETIVE CAUTIONS
The breadth of this review is a strength. It brought together 147 sources spanning conceptual, qualitative, quantitative and implementation literature, used independent selection and extraction, followed a published protocol, involved researchers from different disciplinary backgrounds, and subjected the emerging model to external expert review.
That breadth also defines the kind of knowledge the model provides. The authors did not formally appraise the quality of individual sources, consistent with the mapping and conceptual purpose of their scoping review. The model therefore represents a synthesis of how person-centred rehabilitation has been conceptualised and practised in the literature.
The literature itself was uneven. Person-professional interactions received substantially more attention than team and organisational factors, so the greater detail at the centre of the model may partly reflect where research attention has historically been concentrated.
The thematic synthesis also necessarily involved interpretation by the research team. Their multidisciplinary backgrounds and external expert review provide useful diversity of perspective, but only five external experts contributed and just one was included specifically as a person with lived experience of disability.
Cultural scope is another meaningful boundary. Only English-language literature was included, and the authors recognise that assumptions around autonomy, self-determination and family involvement may differ across cultures, particularly between more individualistic and collectivist perspectives. The model also focuses specifically on adult physical rehabilitation and does not encompass paediatric rehabilitation or broader health-system, policy and legal influences.
The PCR Model is therefore best understood as a well-developed conceptual synthesis that remains open to refinement, particularly through broader lived-experience and cultural perspectives and through implementation in different rehabilitation settings.
IN PRACTICE
For physiotherapy, perhaps the most useful feature of this model is how much it expands the question “Am I practising person-centred care?”
Asking about goals, providing choices or individualising an exercise programme may contribute to person-centredness, but the model invites attention to something deeper: how rehabilitation is actually experienced by this particular person. A technically individualised treatment can still sit within a relationship in which professional assumptions dominate what matters, what counts as progress, or how decisions are made.
Clinically, this may shift attention from performing particular “person-centred behaviours” toward remaining responsive. A patient may want considerable guidance rather than extensive involvement in every decision. Another may prioritise something that does not fit neatly into conventional impairment-based goals. Someone’s priorities may change as they recover. What constitutes appropriate collaboration therefore has to be negotiated and revisited rather than presumed.
The paper also provides a useful way of thinking about goal setting and rehabilitation planning. Goals need not always be highly formalised or measurable to be meaningful to the person. The literature synthesised here suggests a place for both structured and more open-ended approaches, adapted to the individual. Rehabilitation planning consequently becomes an evolving collaborative process rather than simply producing the correct plan at the initial consultation.
More broadly, the model challenges the idea that person-centredness is solely a clinician skill. A physiotherapist can listen carefully and genuinely seek collaboration while working within short appointments, rigid pathways, productivity targets or fragmented services that make those practices difficult. Person-centred rehabilitation therefore becomes partly an organisational responsibility: services create conditions that either enable or constrain what clinicians and patients can construct together.
One reasonable clinical reflection is that person-centredness may be less something we can declare ourselves to be and more something continually negotiated with the person in front of us. The model places reflexivity, adaptation and attention to the person’s experience at its centre. That makes uncertainty and adjustment part of person-centred practice rather than signs that the clinician has failed to apply the correct technique.
For rehabilitation, this is a useful shift: from doing rehabilitation to an individual, toward continually working out how rehabilitation can be constructed with them.
Reference
Jesus, T. S., Papadimitriou, C., Bright, F. A., Kayes, N. M., Pinho, C. S., & Cott, C. A. (2022). Person-centered rehabilitation model: Framing the concept and practice of person-centered adult physical rehabilitation based on a scoping review and thematic analysis of the literature. Archives of Physical Medicine and Rehabilitation, 103(1), 106–120. https://doi.org/10.1016/j.apmr.2021.05.005