National Institutes of Health Medical Rehabilitation Coordinating Committee; National Institutes of Health Research Plan on Rehabilitation. Am J Occup Ther 2017;71(3):7103320020p1-7103320020p5. doi: 10.5014/ajot.2017.713004.
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© 2019 American Occupational Therapy Association
One in 5 Americans experiences disability that affects daily function because of impairments in mobility, impairments in cognitive function, sensory impairment, or communication impairment. The need for rehabilitation strategies to optimize function and reduce disability is a clear priority for research to address this public health challenge. The National Institutes of Health (NIH) recently published a Research Plan on Rehabilitation that provides a set of priorities to guide the field over the next 5 years. The plan was developed with input from multiple institutes and centers within the NIH, the National Advisory Board for Medical Rehabilitation Research, and the public. This article provides an overview of the need for this research plan, an outline of its development, and a listing of six priority areas for research.
Increase the quality of evidence for rehabilitation interventions in populations of people with disabilities across the lifespan (pediatric, adult, and geriatric) through increased focus on the design, dose, intensity, timing, mechanisms, and specified targets and outcomes of these interventions.
Through basic, translational, and clinical research, determine the methods by which lifestyle and wellness interventions can promote health and prevent and treat comorbidities in individuals with disabilities.
Address symptoms and secondary conditions associated with disability through the development, adaptation, or evaluation of interventions (e.g., pain, cognitive impairment, depression). Determine methods to address symptom burden and improve health-related quality of life.
Investigate the nature of health disparities and their impact on the implementation and effectiveness of rehabilitation interventions.
Identify and test care delivery models during periods of lifespan transition (e.g., from home to school, from childhood to adolescence, from adolescence to adulthood, from adulthood to late life) that enable the highest level of benefit from health interventions.
Through longitudinal and population-based cohort studies, determine the natural history of conditions that cause disability and common secondary conditions that develop over the life course.
Develop self-management strategies that can be implemented in community settings to promote quality of life by helping individuals better understand and manage disabilities and achieve and maintain independence.
Examine the stressors, challenges, and benefits experienced by caregivers of individuals with disabilities, and examine the impact of these on the health of the caregiver and the care recipient.
Develop and test interventions that address stress and burden and maximize benefits and resilience in caregivers.
Examine the impact of sociodemographic influences on the outcomes of rehabilitation interventions.
Determine the ways in which individuals with disabilities can partner with caregivers and care providers as active members of the rehabilitation team, either in promotion adherence and assistance with in-facility or home-based care or in setting treatment goals to optimize outcomes.
Advance the use of telehealth in rehabilitation assessment, delivery, and adherence monitoring.
Advance the use of assistive technologies, noninvasive sensors, and mobile health (mHealth) approaches in rehabilitation science.
Provide an evidence base for device development, manufacturing, and implementation for individuals with disabilities, including methods to incorporate needs and preferences of users.
Support research to better define new and innovative metrics and outcomes of interest in the use of various technologies in rehabilitation.
Encourage the use of computational models for designing and developing new rehabilitation technologies and for evaluating their functional outcomes.
Support technology development that incorporates monitoring and remote access in the acquisition, analysis, and monitoring of data from individuals who are receiving care or continued support in their homes.
Expand the evidence base for specific treatment interventions and approaches with an emphasis on validated protocols associated with improved outcomes for conditions that cut across populations of individuals with disabilities (e.g., spasticity, bowel and bladder control, sexual function, gait disturbance).
Conduct both efficacy and effectiveness trials, including not only randomized clinical trials but also adaptive and pragmatic trials and trials using other innovative designs.
Examine the use of existing databases and registries as mechanisms for discovery.
Encourage clinical translational research and dissemination and implementation research to enhance reach and application of evidence-based approaches.
Improve characterization of environmental barriers and biological comorbidities that might impede rehabilitation adherence or efficacy of a rehabilitation intervention.
Identify and test models of rehabilitation that increase participation by older adults, women, ethnic minorities, and people of low socioeconomic status.
Identify, measure, and compare the costs and consequences of rehabilitation assessment, delivery, and monitoring approaches, interventions, devices, and technologies using health economics methods, including cost analysis, economic evaluation, decision and transmission modeling, and regulatory impact analysis.
Integrate cell-, tissue-, and model organism–based research to identify the principal physiological mechanisms and key interventional targets in the adaptive and maladaptive changes associated with disabling conditions.
Encourage approaches that exploit the biological and physiological adaptations associated with rehabilitation strategies in the clinical setting.
Advance the understanding of precision medicine approaches relevant to rehabilitation medicine.
Characterize biomarkers associated with specific injuries, illnesses, or disorders that are prognostic or guide prescription of rehabilitation interventions.
Determine the effectiveness of integrative, multimodal interventions that focus on defining the optimal combination and “dosing” of individual interventions to improve and possibly accelerate recovery after injury or disease.
Increase the use of and coordination among the centers that make up the Medical Rehabilitation Research Network (NICHD, 2015).
Enhance the rehabilitation research community’s use of and contribution to training programs, including predoctoral, postdoctoral, and continuing education for researchers with unique training needs or partnerships.
Review the current model for training in rehabilitation research, and develop a strategy to increase the availability of training and partnerships between programs to provide it.
Evaluate the availability of funding opportunity announcements both from extramural sources and from the NIH Common Fund that include disability or rehabilitation targets, and determine gap areas or areas for enhancement that could spur cooperative funding strategies.
Identify methods to encourage knowledge translation to promote clinical competence based on evidence-informed treatment.
Promote interdisciplinary collaboration in rehabilitation research. Develop metrics that can be used to evaluate and encourage interdisciplinary science and that accurately reflect the contributions of scientists who work to drive rehabilitation research.
Provide a strategy for recruiting individuals with disabilities into the field of rehabilitation research; consider enhanced diversity supplements and partnerships with other federal agencies (e.g., National Science Foundation; National Institute on Disability, Independent Living, and Rehabilitation Research).
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