Conceptual changes needed to improve outcomes in rehabilitation medicine: A clinical commentary.

Rehabilitation medicine has expanded the horizon of all medicine and brought about new human achievements. To facilitate continued advances in achievement, several changes are suggested in customary rehabilitation strategic goals, concepts, and practices. The main rehabilitation goals should focus on prolonged survival, contrary to the opinions of most authors on rehabilitation, and on achievement of maximum ability realization, rather than of independence or any given (including previous) level of functioning. Setting rehabilitation goals should benefit the patient, rather than the caregiver or the insurer. Training should focus on tasks that contribute to the patients' interests and desires, rather than on any task that reduces the burden of care. The main criterion for admission to a rehabilitation ward should be based on expected advantage in prolonging patient survival and maximizing ability realization.