It’s More Than a Black Box; It’s a Russian Doll

Abstract

Research on treatment efficacy and effectiveness requires that the treatments of interest be objectively defined. Such definitions are relatively straightforward for pharmacologic and surgical treatments, in which the active ingredients can be specified in terms of chemical structure or anatomic result. Definitions of treatment are more difficult for the many experience-based interventions employed in rehabilitation. This has led to the criticism that much clinical rehabilitation research has characterized the treatments of interest as a "black box," allowing little insight into the active ingredients contained therein. Moreover, rehabilitation care may involve the simultaneous application of multiple different treatments, raising the question of whether to define the individual components or the service delivery system. In this article, we consider how the levels of analysis considered in rehabilitation (disease, impairment, activity, and participation) and the role of theory shape the definition of treatment, and we address the need to develop protocol-based treatments and tools to objectively verify their contents. Rigorous definition of rehabilitation treatments, supported by theory, will facilitate needed efficacy research, will allow replication of that research, and will ultimately foster dissemination of effective treatments into clinical practice.

Relative Importance of Rehabilitation Therapy Characteristics on Functional Outcomes for Persons With Stroke

“…That is, it provides evidence of a dose-response effect in that more therapy is related to greater than expected gains. Using this approach along with theorybased definitions of rehabilitation treatments, 20 the role ther-apy plays in specific types of improvement can be examined more rigorously in future research.…”

Characteristics of occupational therapy and physiotherapy within the context of reablement in Swedish municipalities: A national survey

“…Given that reablement is implemented for heterogeneous target groups, the focus and content of the intervention, and the role of different professionals may differ, for example, in relation to supporting clients after a hip fracture or clients diagnosed with neuropsychiatric limitations. To enhance evidence-based practice and to unravel the 'Russian doll' (Whyte & Hart, 2003), detailed descriptions of reablement practices are needed rather than viewing reablement as a 'one-size fits all intervention'.…”

A scoping review to explore how universal design for learning is described and implemented by rehabilitation health professionals in school settings

“…It is critical that RHPs record and describe the complex UDL interventions they have provided in a more explicit way. Rehabilitation research has faced criticism about the “black box” of clinical rehabilitation research and a general lack of description for what these interventions entail (Whyte & Hart, ). Clear descriptions of interventions are required for clinicians to implement these strategies into practice and for researchers to determine the efficacy of these interventions (Whyte & Hart, ).…”