Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, Massachusetts; MGH Institute of Health Professions, Charlestown, Massachusetts.
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania.
Arch Phys Med Rehabil. 2021 Mar;102(3):521-531. doi: 10.1016/j.apmr.2020.09.383. Epub 2020 Oct 13.
Although significant advances have been made in measuring the outcomes of rehabilitation interventions, comparably less progress has been made in measuring the treatment processes that lead to improved outcomes. A recently developed framework called the Rehabilitation Treatment Specification System (RTSS) has potential to identify which clinician actions (ie, ingredients) actively improve specific patient functions (ie, targets). However, the RTSS does not provide methodology for standardly identifying specific unique targets or ingredients. Without a method to evaluate the uniqueness of an individual target or ingredient, it is difficult to know whether variations in treatment descriptions are synonymous (ie, different words describing the same treatment) or meaningfully different (eg, different words describing different treatments or variations of the same treatment). A recent project used vocal rehabilitation ingredients and targets to create RTSS-based lists of unique overarching target and ingredient categories with underlying dimensions describing how individual ingredients and targets vary within those categories. The primary purpose of this article is to describe the challenges encountered during the project and the methodology developed to address those challenges. Because the methodology was based on the RTSS's broadly applicable framework, it can be used across all areas of rehabilitation regardless of the discipline (speech-language pathology, physical therapy, occupational therapy, psychology, etc) or impairment domain (language, cognition, ambulation, upper extremity training, etc). The resulting standard operationalized lists of targets and ingredients have high face and content validity. The lists may also facilitate implementation of the RTSS in research, education, interdisciplinary communication, and everyday treatment.
尽管在衡量康复干预措施的结果方面已经取得了重大进展，但在衡量导致结果改善的治疗过程方面进展相对较少。最近开发的一个名为康复治疗规范系统 (RTSS) 的框架有可能确定哪些临床医生的行动（即成分）可以积极改善特定患者的功能（即目标）。然而，RTSS 并没有提供标准识别特定独特目标或成分的方法。如果没有评估单个目标或成分独特性的方法，就很难知道治疗描述中的变化是同义词（即，用不同的词描述相同的治疗）还是有意义的不同（例如，用不同的词描述不同的治疗或相同治疗的变化）。最近的一个项目使用了语音康复成分和目标，为基于 RTSS 的独特总体目标和成分类别列表创建了独特的目标和成分类别，其底层维度描述了各个成分和目标在这些类别中的变化方式。本文的主要目的是描述在项目中遇到的挑战以及为解决这些挑战而开发的方法。由于该方法基于 RTSS 广泛适用的框架，因此无论康复领域（言语病理学、物理治疗、职业治疗、心理学等）或损伤领域（语言、认知、行走、上肢训练等）如何，都可以在所有康复领域中使用。由此产生的目标和成分的标准操作性清单具有较高的表面和内容效度。这些清单还可能促进 RTSS 在研究、教育、跨学科交流和日常治疗中的实施。
