Editorial on the Research Topic
Highlights in medical and surgical rehabilitation 2021/22
Rehabilitation is a crucial component of universal health coverage, which encompasses
promoting good health, preventing disease, treatment, and palliative care. It helps
individuals of all ages, from children to older people, to engage in everyday activities
independently and participate in education, work, and recreation. Worldwide, approximately
2.4 billion people live with a health condition that could benefit from rehabilitation,
and the demand for rehabilitation is predicted to rise due to changes in the population’s
health and characteristics. Rehabilitation is essential in achieving Sustainable Development
Goal 3: “Ensure healthy lives and promote well-being for all at all ages.” (1) Rehabilitation
is personalized, with interventions that are targeted at individuals’ goals and preferences,
such as speech and language therapy for those with brain lesions or exercise training
for those with Parkinson’s disease. Rehabilitation can be provided in various settings,
such as outpatient clinics, hospitals, and community settings. Rehabilitation’s benefits
include reducing the impact of a wide range of health conditions, such as chronic
diseases, cancers, and diabetes, and preventing complications associated with conditions
such as spinal cord injury, stroke, or fractures. It also helps to minimize or slow
down the disabling effects of chronic health conditions by equipping people with self-management
strategies and assistive products. Rehabilitation is an investment with benefits for
both individuals and society. It is essential to have timely, high-quality, and affordable
rehabilitation interventions available to all, starting as early as possible. However,
in some low- and middle-income countries, more than 50% of people do not receive the
rehabilitation services they require. Rehabilitation is not only for people with disabilities
or long-term or physical impairments; it is an essential health service for anyone
with an acute or chronic health condition, impairment, or injury that limits functioning
and, as such, should be guaranteed for anyone who needs it. Improving access to rehabilitation
for all people is a constant challenge. It necessitates a multifaceted approach, including
research into new techniques, rehabilitation methods, and care organization. By conducting
research in these areas, healthcare providers and policymakers can identify effective
strategies to improve rehabilitation service accessibility.
Recently, it is evident that scientific research in physical and rehabilitation medicine
(PRM) requires careful consideration of study design and methodology. The research
question guides the entire research process and helps in selecting an appropriate
study design (2). There are three main study designs commonly used in PRM research:
descriptive, exploratory/analytic, and experimental. Descriptive designs are used
to describe a particular population; exploratory designs aim to explore relationships
between variables; and experimental designs investigate the effect of interventions.
Epidemiological studies using descriptive or exploratory designs are classified as
observational or non-experimental studies. Clinical trials, a type of experimental
study, can be classified into different types, such as parallel, crossover, and factorial
designs. They can also be categorized based on their purpose, including superiority
trials, equivalence trials, and non-inferiority trials. Studies with a higher level
of evidence are considered to have a lower risk of methodological bias. Randomized
controlled trials (RCTs) are considered the gold standard of design but may not always
be feasible in PRM research, especially for non-pharmacological interventions. Difficulties
in implementing RCTs lead to the exploration of alternative designs, such as pre-posttest
studies and pragmatic trials. Pragmatic trials are designed to evaluate the effectiveness
of interventions in real-life clinical settings, while benchmarking controlled trials
(BCTs) aim to assess the efficacy of interventions or clinical pathways in observational,
real-world settings. These designs are gaining popularity in PRM research due to their
better alignment with the complexities of rehabilitation. Proper reporting of study
details is essential for transparency and the replication of research. Reporting guidelines,
such as STROBE for observational studies and CONSORT for clinical trials, provide
frameworks to ensure comprehensive reporting. Efforts, such as the Cochrane Rehabilitation
Methodology Meetings and the RCTRACK project, are being made to improve the methodology
and generate effective and translational evidence in PRM research (3, 4).
In addition to quantitative research methods, qualitative research methodologies can
provide important insights into how interventions work and how patients react to new
techniques and methods. In the field of rehabilitation science, the number of qualitative
studies published in journals of rehabilitation has increased significantly over the
past two decades. There are many areas of opportunity and difficulty include paradigm
shifts, advances in methodology, emerging technology, advances in quality evaluation,
the growing popularity of mixed-methods approaches, and evolving approaches to knowledge
translation. Qualitative research should play an important role in the development
of rehabilitation science, and it is crucial that qualitative researchers and methods
continue to evolve. The objective of qualitative research in medical rehabilitation
is to comprehend the experiences and perspectives of patients and healthcare professionals
in relation to medical rehabilitation. It entails collecting data using techniques
such as interviews, focus groups, and observation, and analyzing the data to identify
themes and patterns (2). Qualitative research can provide valuable insights into the
patient experience, including the patient’s beliefs, attitudes, and rehabilitation-related
behaviors. It can also assist healthcare professionals in gaining a better understanding
of the obstacles and challenges patients face during the rehabilitation process, which
can aid in the development of more effective interventions.In qualitative research
on medical rehabilitation, frequent topics include patient satisfaction, quality of
life, communication between patients and healthcare providers, and barriers to care
access (5).
The field of medical and surgical rehabilitation aims to assist individuals in recovering
from illness or injury, enhancing their physical function and overall quality of life.
Current trends in medical and surgical rehabilitation include the followings: (1)
Provide patient-centered care that is tailored to the patient’s specific needs, goals,
and preferences. This requires collaborating with patients and their families to develop
individualized treatment plans that are geared toward achieving specific outcomes.
(2) Utilizing devices and technologies such as virtual reality, robotics, and wearable
sensors to aid in recovery and rehabilitation, medical and surgical rehabilitation
has become increasingly technologically advanced. These innovations can provide patients
with more effective care. (3) Integration of medical and surgical rehabilitation with
other healthcare services, such as primary care, mental health care, and social services.
This integrated approach aims to improve outcomes by addressing all aspects of a patient’s
health and well-being. (4) Professionals from diverse fields, such as physical therapy,
occupational therapy, speech therapy, nursing, psychology, and social work, are increasingly
collaborating to provide comprehensive care for patients on medical and surgical rehabilitation
teams. (5) Prevention by providing patients and their families with information and
resources to assist them in maintaining optimal health and avoiding future health
problems.
The following are some trends in medical and surgical rehabilitation research:
Personalized Rehabilitation: Personalized rehabilitation is gaining popularity, with
an emphasis on individualizing rehabilitation programs based on patient characteristics
such as age, gender, climate, environment, and nation. This strategy allows for improved
patient outcomes and satisfaction (6).
There is a growing interest in developing less invasive techniques for managing pain,
such as the unique technique of mechanical needling with sterile water injection for
calcification and fibrosis removal treatment by Areerat Suputtitada (7, 8). This approach
can result in less pain, faster recovery times, and a reduced risk of complications.
Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation
(tDCS) are two of the most notable noninvasive brain stimulation techniques that have
gained significant attention and have shown promise in treating various neurological
and psychiatric conditions. TMS and tDCS are both noninvasive methods that can modulate
brain activity without the need for invasive procedures. TMS uses magnetic fields
to stimulate neurons in the brain, while tDCS uses a low-intensity electrical current.
Both methods have shown efficacy in treating conditions such as depression, anxiety,
and chronic pain, and ongoing research is exploring their potential in other areas
such as swallowing, balance, and gait ability in stroke rehabilitation (9, 10).
Long-term COVID management in post-acute sequelae of SARS-CoV-2 infection (PASC),
refers to ongoing symptoms experienced after recovering from acute COVID-19. Rehabilitation
is vital in managing this condition, and emerging trends include a multidisciplinary
approach, individualized treatment programs, gradual and graded exercise, tele-rehabilitation,
and long-term follow-up. It’s essential for healthcare professionals to stay updated
as research on post COVID-19 continues to evolve (11, 12).
Tele-rehabilitation is a new trend that uses technology to remotely provide patients
with rehabilitation services. Telemedicine may involve virtual consultations, remote
monitoring, and teleexercises. This strategy has gained popularity as a result of
the COVID-19 pandemic (13, 14).
Virtual Reality: Virtual reality is being used to create simulated environments in
which patients can practice real-world activities such as walking, reaching, and grasping.
It has been demonstrated that this method increases patient motivation and participation
in rehabilitation (13–15).
Robotics: Robotics is used to assist with rehabilitation exercises, such as upper
limb exercises following a stroke. Robotic devices can provide a training regimen
that is more intensive and repetitive than conventional therapy (13, 14, 16).
Wearable Technology: Smart watches and fitness trackers are being used to monitor
and track rehabilitation progress. This method can assist patients and healthcare
professionals in identifying improvement areas and monitoring progress (13, 14, 17).
Mind-Body Approaches, such as mindfulness and yoga, are used to supplement conventional
rehabilitation programs. These methods can aid in reducing stress and enhancing well-being,
which can have a positive effect on rehabilitation outcomes (18).
Intensity of Exercise: Research is increasingly focusing on the optimal intensity
of exercise for various populations and conditions. This strategy aims to maximize
rehabilitation outcomes while minimizing injury and overexertion risks (19).
Regenerative Medicine: Stem cell therapy and tissue engineering are being studied
as potential treatments for conditions that impair the body’s ability to heal, such
as spinal cord injuries and osteoarthritis (20).
Conclusion
In conclusion, rehabilitation plays a crucial role in universal health coverage and
the achievement of Sustainable Development Goal 3. It helps individuals of all ages
regain independence and improve their quality of life. Qualitative research is essential
to understanding the complex experiences and perspectives of patients and healthcare
professionals in the field of rehabilitation. Current trends in medical and surgical
rehabilitation include personalized care, integration with other healthcare services,
technological advancements, interdisciplinary collaboration, prevention, and innovative
research areas such as the unique technique of mechanical needling with sterile water
injection for calcification and fibrosis removal treatment, noninvasive brain stimulation,
long-term COVID management, tele-rehabilitation, virtual reality, robotics, wearable
technology, mind-body approaches, optimal exercise intensity, and regenerative medicine.
By staying informed and embracing these trends, healthcare professionals can contribute
to the advancement of rehabilitation science and provide more effective and patient-centered
care.