Cross-Cutting

Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)

Rehabilitation Treatment Specification System

IC28: Rehabilitation Treatment Specification System (RTSS): Principles and Application in Rehabilitation Education, Research, and Clinical Practice

Presenter(s)

• 

  Susan Fasoli, ScD, OTR/L

  Professor, Occupational Therapy
  MGH Institute of Health Professions
  Boston, Massachusetts
• 

  Mary Ferraro, PhD, OTR/L

  Education Coordinator
  Moss Rehabilitation Research Institute
  Elkins Park, Pennsylvania
• 

  Andrew Packel, PT, NCS

  Locomotor Coordinator
  MossRehab
  Cheltenham, Pennsylvania
• 

  Sue Ann Sisto, PT, MA, PhD, FACRM

  Professor and Chair, Dept. of Rehabilitation Science
  University at Buffalo
  Buffalo, New York
• 

  Jarrad Van Stan, PhD, CCC-SLP

  Assistant Professor, Speech Language Pathologist, Adjunct Professor
  Harvard Medical School, Massachusetts General Hospital, MGH Institute of Health Professions
  Boston, Massachusetts
• 

  John Whyte, MD, PhD

  Institute Scientist Emeritus
  Moss Rehabilitation Research Institute
  Elkins Park, Pennsylvania

  Presentation Slides Handouts
• 

  Jeanne Zanca, PhD, MPT, FACRM

  Senior Research Scientist
  Kessler Foundation
  West Orange, New Jersey

  Presentation Slides Handouts

Body of Abstract: The ultimate goal of rehabilitation research and clinical education is to enable rehabilitation clinicians to provide effective care that optimizes patient outcomes. A barrier to this ideal is the lack of a universal system for describing, or specifying, rehabilitation interventions. Current methods of description vary across disciplines and settings, creating barriers to collaboration. In addition, the tendency to characterize treatments mostly in terms of functional deficits and anticipated outcomes obscures connections between clinician behaviors (e.g. words, actions, use of devices and substances, etc.) and patient changes in functioning. A systematic, well-organized and theory-driven system for specifying the essential elements of rehabilitation interventions is needed.

The Rehabilitation Treatment Specification System (RTSS) is the result of more than a decade of effort by a multidisciplinary group of rehabilitation clinicians and researchers to develop a theory-based framework to specify rehabilitation interventions. Support for RTSS development has been provided by the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) and the Patient-Centered Outcomes Research Institute (PCORI).

The RTSS describes clinical treatments in terms of “treatment components,” with each component defined based on its underlying treatment theory—a statement that links clinician actions with expected changes in functioning. Treatment theories are considered to have three parts:

• active ingredient(s) (words, actions, devices, substances, or forms of energy delivered or selected by a clinician),


• target (a measurable aspect of functioning that is to be changed),


• mechanism of action (the known or hypothesized process by which the active ingredient(s) bring about change in the target)

The RTSS distinguishes targets of treatment (those aspects of functioning that are directly changed by the selected treatment ingredients) from treatment aims (which are distal functional changes that may result from the individual or combined effect of one or more treatments). All rehabilitation treatments can be clustered into three broad groupings: those that influence the functioning of organs or organ systems, those that lead to the development of skills and habits, and those that affect cognitive and emotional states. The RTSS also recognizes the importance of volition, broadly defined as patient effort, in the implementation of rehabilitation interventions, and provides methods to specify ingredients selected by the clinician to motivate active engagement of patients in treatment activities.

Use of a systematic approach for defining and (ultimately) measuring the nature, quality and quantity (dose) of specific treatments will enhance research, practice, and training in rehabilitation. The RTSS has begun to be applied in the academic instruction of new therapists, and provides a framework to teach therapists about the essential ingredients necessary for treatment fidelity, and to transfer knowledge from expert to novice clinicians. The RTSS can support clinical reasoning by highlighting the relationship between the treatment ingredients selected by the clinician and the functional changes that are desired. In the context of research, the RTSS provides a foundation to support the design of experimental and comparator intervention protocols, selection of outcome measures, and translation of experimental findings to clinical practice. Finally, the RTSS may strengthen communications between treatment team members and other stakeholders regarding rehabilitation interventions. Each of these efforts is expected to improve the quality of rehabilitation practice. Through efforts centered around the ACRM Rehabilitation Treatment Specification Networking Group (RTS NG), materials related to teaching and dissemination of the RTSS are being developed and will be introduced to attendees.

This presentation will: (1) explain the need for and advantages of treatment theory-based system for rehabilitation treatment specification, (2) describe the key concepts of the RTSS as currently developed, (3) discuss potential applications in clinical education, research, and practice, (4) provide participants with hands-on opportunities to apply the RTSS to treatments used in their clinical practice or research efforts, and (5) inform workshop participants of resources available to assist them in applying the RTSS in their efforts.


Abbreviated Description: This symposium will orient learners to the NIDILRR- and PCORI-funded Rehabilitation Treatment Specification System (RTSS), an interprofessional standardized system for defining and specifying rehabilitation treatments. Examples of clinical treatments and case scenarios will be discussed to: (1) elucidate the structure, principles, and terminology of the RTSS; (2) facilitate reflection on active ingredients and targets of rehabilitation interventions; and (3) demonstrate how the RTSS can stimulate critical thinking and strengthen clinical reasoning underlying the planning and delivery of interventions. Learners will be provided opportunities to practice applying the RTSS to treatments used in their clinical, academic, and/or research work.

Learning Objectives:

• Define key concepts that are part of the Rehabilitation Treatment Specification System (RTSS, a formally developed procedure for specifying treatments), such as treatment theory, target, aim, ingredient, treatment component.
• Gain experience using the RTSS to specify treatments used in one’s own clinical practice or research.
• Identify ways in which the basic concepts of the RTSS may be integrated into rehabilitation-related curricula.
• Discuss how RTSS concepts can be used to support research design and reporting.
• Describe strategies for using RTSS concepts to promote clinical reasoning.

Presentations:

• 8:30 AM – 9:40 AM EST

  IC28: Introductions, RTSS Principles, Specification Process & Activity 1 Setup (Rehabilitation Treatment Specification System (RTSS): Principles and Application in Rehabilitation Education, Research, and Clinical Practice)
• 9:40 AM – 10:10 AM EST

  IC28: Activity 1 Review - Pre-Recorded (Rehabilitation Treatment Specification System (RTSS): Principles and Application in Rehabilitation Education, Research, and Clinical Practice)
• 10:10 AM – 11:00 AM EST

  IC28: Volition and Specification & Activity 2 Setup (Rehabilitation Treatment Specification System (RTSS): Principles and Application in Rehabilitation Education, Research, and Clinical Practice)
• 11:00 AM – 11:30 AM EST

  IC28: Activity 2 Review - Pre-Recorded (Rehabilitation Treatment Specification System (RTSS): Principles and Application in Rehabilitation Education, Research, and Clinical Practice)
• 11:30 AM – 12:20 PM EST

  IC28: RTSS Benefits, Applications & Resources (Rehabilitation Treatment Specification System (RTSS): Principles and Application in Rehabilitation Education, Research, and Clinical Practice)