Leplege Alain, Gzil Fabrice, Cammelli Michele, Lefeve Celine, Pachoud Bernard, Ville Isabelle
REHSEIS (UMR 7596, CNRS-U Paris7) and Université Paris Diderot--Paris7, Paris, France.
Disabil Rehabil. 2007;29(20-21):1555-65. doi: 10.1080/09638280701618661.
The definition and aims of rehabilitation are both topics of frequent debate. Recently several authors have suggested defining rehabilitation and its goals in terms of 'person-centredness'. However such attempts to define rehabilitation in this way have not occurred without running into their own difficulties and criticisms. Consequently, one may question whether person-centredness is a good candidate to characterize and define rehabilitation. The purpose of this article is to reflect upon the historical background and conceptual underpinnings of this term and their relevance for understanding contemporary person-centred rehabilitation.
We conducted a conceptual and historical analysis of the notion of person-centredness in relation to rehabilitation. We ask first whether person-centredness has a consistent and fixed definition and meaning? Secondly, where does person-centredness come from, what is its conceptual history and does an historical approach enable us to identify a unique source for person-centredness?
In the context of rehabilitation, we have identified four main understandings or interpretations of the term person-centredness, each of which denotes several ideas that can be, in turn, interpreted in quite different ways. Thus the concept of person-centredness in rehabilitation has multiple meanings. The conceptual history indicates that person-centredness has diverse meanings and that it has been used in a variety of contexts somewhat unrelated to disability and rehabilitation. Moreover, there does not seem to be any strict relationship between person-centredness as it is used in the context of rehabilitation and these prior uses and meanings.
Person-centredness has an ancient pedigree, but its application in the field of rehabilitation raises both practical and theoretical difficulties. It may be that rehabilitation might get a better sense of what it should be and should do by focusing less on the rhetoric of person-centredness and by putting more emphasis on the investigation and operationalization of its key conceptual components.
康复的定义和目标一直是频繁争论的话题。最近，几位作者建议从“以患者为中心”的角度来定义康复及其目标。然而，以这种方式定义康复的尝试并非没有遇到自身的困难和批评。因此，有人可能会质疑“以患者为中心”是否是描述和定义康复的合适选择。本文的目的是反思这一术语的历史背景和概念基础，以及它们与理解当代以患者为中心的康复的相关性。
我们对与康复相关的“以患者为中心”的概念进行了概念和历史分析。我们首先要问，“以患者为中心”是否有一致且固定的定义和含义？其次，“以患者为中心”源自何处，其概念历史是怎样的，历史方法能否使我们确定“以患者为中心”的独特来源？
在康复的背景下，我们确定了对“以患者为中心”这一术语的四种主要理解或解释，每种解释都包含几个可以反过来以截然不同的方式进行解释的观点。因此，康复中“以患者为中心”的概念具有多种含义。概念历史表明，“以患者为中心”具有不同的含义，并且它已在与残疾和康复有些无关的各种背景中使用。此外，在康复背景下使用的“以患者为中心”与这些先前的使用和含义之间似乎没有任何严格的关系。
“以患者为中心”有着悠久的历史渊源，但其在康复领域的应用引发了实践和理论上的困难。也许康复可以通过减少对以患者为中心的言辞关注，并更多地强调对其关键概念组成部分的研究和操作化，来更好地理解自身应该是什么以及应该做什么。
