Background
Objective
Methods
Development of the framework
Domains and competencies
Rehabilitation | A “set of interventions designed to reduce disability and optimize functioning in individuals with health conditions in interaction with their environment” [1]. Health conditions may refer to disease, disorder, injury or trauma, but may also include conditions such as pregnancy, ageing, stress, congenital anomalies or genetic predisposition [1]. Rehabilitation services may be accessed by people living with all types of health conditions, and is not limited to those who experience a disability [1]. |
Disability | The World Health Organization (WHO) follows the International Classification of Functioning, Disability and Health framework in defining disability as an “umbrella term for impairments, activity limitations and participation restrictions” [7]. Disability is the interaction of body function and structure, activity and participation in the context of environmental and personal factors upon an existing health condition [8]. Disability is a human rights issue encompassing stigmatization, discrimination and inequalities [7]. Individuals with disabilities continue to experience separation and/or segregation and exclusion in many communities around the world despite the work to shift towards community, educational and work inclusion. Persons with disability include people who are traditionally understood as disabled, such as persons who are wheelchair users, those who are blind or deaf, people with intellectual impairments or mental health conditions. It also includes the wider group of persons who experience difficulties in functioning due to a wide range of conditions such as non-communicable diseases, infectious diseases, neurological disorders, injuries and conditions that result from the aging process [7]. |
People-centered care | People-centered health services consciously consider perspectives of individuals, families and communities, and recognizes each as participants and beneficiaries of such services, while respecting their needs and preferences in a humane way. In so doing, people are educated and informed in order to be active participants in their care. People-centered care focuses on the holistic health needs and expectations of people rather than their disease [9]. (http://www.who.int/servicedeliverysafety/areas/people-centred-care/global-strategy/en/). |
Domains | Competencies | ||
---|---|---|---|
Domain 1. | Basic concepts of rehabilitation and disability | Competency 1.1 | Demonstrate an understanding of the contemporary frameworks of rehabilitation and disability |
Competency 1.2 | Effectively communicate with patients and all/key stakeholders involved in the rehabilitation process | ||
Domain 2. | Legal, regulatory and ethical components | Competency 2.1 | Apply in clinical practice the laws, regulations and policies that impact delivery of rehabilitation services |
Competency 2.2 | Apply in clinical practice the ethical delivery of services | ||
Competency 2.3 | Deliver rehabilitation services in line with regulatory standards | ||
Competency 2.4 | Advocate for rehabilitation services as a means of achieving optimal outcomes, including return to work | ||
Domain 3. | Rehabilitation management of disability and other health conditions | Competency 3.1 | Clinical assessment—evaluates patients’ health status and related circumstances to develop a working diagnosis |
Competency 3.2 | Formulate a clinical plan of management | ||
Competency 3.3 | Monitor and evaluate progress of care and health outcomes | ||
Competency 3.4 | Participate in implementing the rehabilitation plan within the unique cultural and environmental context |
Domain 1 | Basic concepts of disability and rehabilitation |
Competency 1.1 Demonstrate an understanding of the contemporary frameworks of rehabilitation and disability | Knowledge |
• Describe the concept of rehabilitation | |
• Describe the concept of disability (e.g. International Classification of Functioning, Disability and Health (ICF)) | |
• Identify the determinants of health within populations served | |
• Explain the epidemiology of neuromusculoskeletal diseases and the factors that might prevent or delay their onset, and prognosis | |
Skills | |
• Diagnose and care for patients within a biopsychosocial model | |
• Apply contemporary concepts of rehabilitation and disability in the implementation of services | |
Competency 1.2 Effective communication with patients and all/key stakeholders involved in rehabilitation services | Knowledge |
• Recognize good communication is a core skill that fosters relationships and improves outcomes | |
• Understand that disability encompasses physical, mental and sensory components | |
• Understand the power of words in communication | |
Skills | |
• Develop knowledge, attitudes and skills of effective communication | |
• Recognize and interpret verbal and non-verbal communication | |
• Utilize available information and communication technologies | |
• Share resources and knowledge | |
• Facilitate a structured, evidence-based rehabilitation encounter | |
Domain 2 | Legal, regulatory and ethical components |
Competency 2.1 Apply in clinical practice the laws, regulations and policies that impact delivery of rehabilitation services | Knowledge |
• Comprehend legal duties and responsibilities relating to rehabilitation and disability | |
• Describe the basic regulations and policies of stakeholder organizations relating to rehabilitation, disability and return to regular activities | |
• Explain the application of the professional duty of candour | |
• Distinguish the professional and ethical boundaries expected of the chiropractor-patient relationship | |
• Summarize the principles of risk management, safe practice and duty of care | |
• Explain medico-legal processes and procedures, including vicarious liability | |
• Describe the model of health care service provision across the different levels and sites of care at the local, regional and national level | |
Skills | |
• Competent acquisition of informed consent from the patient or substitute decision maker | |
• Integrate and respect the diversity of patients’ cultural and religious values and belief systems | |
• Demonstrate respect for individual preferences and expressed needs | |
• Recognize and manage threats to safety of people requiring rehabilitation | |
• Operate a safe and accessible practice environment | |
• Manage health risks and public health issues, including reporting | |
• Practice in accordance with laws and principles of confidentiality | |
• Work with a community or population to identify the determinants of health that affect them | |
• Enable and support integration of chiropractic services within the health care system context | |
Competency 2.2 Apply in clinical practice the ethical delivery of services | Knowledge |
• Recognize persons entitlement to enjoyment of universal and indivisible rights and freedoms | |
• Describe, promote and protect human rights and freedoms of persons | |
• Recognize individual involvement in decision-making | |
Skills | |
• Engage persons full participation in community, work and home environments | |
• Engage persons active involvement in decision-making | |
• Provide an accessible environment for rehabilitation services | |
• Communicate clinical information with equipoise | |
• Refer patients in need of accessible information about mobility aids, devices and assistive technology to appropriate providers | |
• Evaluate and work within provider’s individual capacity of knowledge and skills | |
• Develop rapport and trust with patients, and other stakeholders, colleagues and professionals, in compliance with privacy legislation | |
• Apply ethical principles of autonomy, beneficence, non-malfeasance and justice | |
Competency 2.3 Deliver rehabilitation services in line with regulatory standards | Knowledge |
• Describe and apply evidence-based clinical guidelines and protocols required for clinical practice | |
• Recognize and respect scope of practice of other health care professionals | |
• Recognize and respect the policies and regulations governing key stakeholders | |
• Acquire and incorporate advances in knowledge into clinical practice | |
• Comprehend duties and responsibilities arising from statutory regulation | |
• Describe the structure of the chiropractic profession and the purpose of representative bodies (including trade unions, chiropractic associations, colleges, societies and patients’ associations) | |
Skills | |
• Complies with professional standards and legal requirements for creation, maintenance, storage and disposal of patient records and business documents | |
• Allocate finite healthcare resources appropriately | |
• Apply evidence-based and management processes to achieve cost-appropriate care | |
• Work collaboratively to provide an interdisciplinary approach to care | |
• Collaborate with community organizations, families, employers, and other stakeholders as required | |
• Critically evaluate quantitative and qualitative research to inform evidence-based practice | |
• Recuse self from practice when personal health and well-being makes it unsafe to do so | |
Competency 2.4 Advocate for rehabilitation services as a means of achieving optimal outcomes, including return to work | Knowledge |
• Define available rehabilitation services in individualized care plans. | |
• Define key stakeholders that would facilitate return to activity and work | |
Skills | |
• Communicate with stakeholders to facilitate return to activity and work | |
• Engage stakeholders to improve rehabilitation services | |
• Employ people centered care to support equitable and accessible rehabilitation services | |
Domain 3 | Rehabilitation management of disability and other health conditions |
Competency 3.1 Clinical assessment—evaluate patients’ health status and related circumstances to develop a working diagnosis | Knowledge |
• Describe normal structure and function of the human body | |
• Identify and consider biopsychosocial determinants of health | |
• Describe etiology, pathology, symptomatology, natural history and prognosis of neuromusculoskeletal complaints, pain syndromes and associated disorders | |
• Interpret diagnostic procedures, including reliability, validity, uses and limitations | |
• Identify and consider lifestyle, occupation or external factors that may influence health or well-being and return to activities/work | |
Skills | |
• Conduct a patient history and physical examination using knowledge of pathophysiology, basic and clinical sciences | |
• Identify the need for and availability of external health records | |
• Perform and/or refer for diagnostic studies when indicated, e.g. diagnostic imaging, ultrasound, clinical laboratory tests | |
• Interpret diagnostic study results | |
• Explain outcomes and implications, using an appropriate comprehension level, of assessment, including working diagnosis and plan of management, to the patient, family and/or caregiver | |
• Formulate a differential diagnosis, where appropriate | |
Competency 3.2 Formulate a clinical plan of management | Knowledge |
• Recognize need for emergency care, referral and/or collaborative care | |
• Identify acute, subacute and chronic phases of conditions | |
• Recognize indicators of persons psychosocial, environmental, and health behavioral factors that may be comorbid with neuromusculoskeletal conditions or associated with the risk of developing other physical and/or psychological conditions | |
• Knowledge and understanding of evidence-based people-centered plan of management | |
• Summarizes principles of health promotion and disease prevention | |
• Critical appraisal, translation and application of health care knowledge | |
Skills | |
• Develop therapeutic goals and prognoses based upon individual needs and strengths | |
• Provide advice, explanations and reassurance related to working diagnosis and clinical plan of management | |
• Employ evidence-based rehabilitation interventions for the purpose of optimizing function | |
• Counsel patient, family and/or caregiver on preventive, supportive, concurrent and referral care | |
• Engage and support patient, family, caregiver, employer, union and/or community stakeholders in shared decision-making of a plan of care, including identifying risks, benefits, natural history, alternative care and patient preferences | |
Competency 3.3 Monitors and evaluates progress of care and health outcomes | Knowledge |
• Describe and employ reliable and valid outcome measures | |
• Identify patient expectations, experience and patient-reported outcome measures | |
• Recognize indications for cessation or referral of care based upon patient outcomes | |
Skills | |
• Monitor patient clinical status and modify diagnosis and care plan as indicated | |
• Modify plan of care, including consideration of alternative options, based upon individual’s progress and external factors | |
• Manage potential complications or adverse events arising from plan of care and have procedures in place to manage these circumstances effectively | |
• Discharge from care based upon mutually agreed upon goals | |
Competency 3.4 Participates in implementing the rehabilitation plan within the unique cultural and environmental context | Knowledge |
• Explain the relevance of a history and assessment, taking into account home, school, work and community environments | |
• Describe the environment and culture of the community | |
• Recognize responsibility to protect, promote and advance the health and well-being of individuals, communities and populations | |
• Discuss with stakeholders to facilitate optimal recovery, timely return to work (where appropriate) and restoration of agreed quality of life parameters | |
Skills | |
• Support patient participation and inclusion in all aspects of the home, school, work and community environments | |
• Deliver rehabilitation services that are congruent with the local cultural, sociodemographic, work and environmental context |
• Treat persons with respect for her/his human rights and dignity | |
• Respect person’s autonomy, independence and preferences including their right to consent or refuse assessment and treatment in shared decision-making | |
• Treat persons in a non-judgmental and non-discriminatory manner | |
• Embark upon rehabilitation services as a continuous participatory process, to reach mutually agreed upon outcomes | |
• Demonstrate empathy | |
• Respect and value diversity and differences at individual and cultural levels | |
• Listen to others with respect and use non-authoritarian communication | |
• Respect confidentiality and privacy in the provision of rehabilitation services | |
• Adhere to professional ethical standards | |
• Demonstrate awareness of one’s own attitudes, values and beliefs that may impact the ability to provide confidential, non-discriminatory, non-judgmental and respectful care | |
• Respect accessibility, needs and requirements of persons |