Prioritizing rehabilitation: WFC produces new rehabilitation competency framework

The World Federation of Chiropractic’s Disability and Rehabilitation Committee (WFC-DRC) has produced a new Rehabilitation Competency Framework in response to a call from the World Health Organization (WHO).

The move comes amid increasing recognition of the global unmet need for rehabilitation services.

With low back pain being the largest single cause of years lived with disability, countries are now realizing that it is a major contributor to the global burden of disease and are demanding action. Low back pain is now seen as a lifelong condition featuring episodic exacerbations of varying severity. It affects four out of five adults at some point in their lives and while most episodes are short-lived and relatively benign, chronic back pain can lead to serious disability, affecting activities of daily living, fitness for work, and social activities.

“Our current knowledge means that talk of a cure for back pain is unrealistic. What we need to do as a society is prioritize rehabilitation services and support active care by empowering practitioners and patients,” says WFC DRC Chair, Professor Pierre CÔté.  

The impetus to develop the new framework came after attending a high-level meeting at WHO in February 2017. The meeting, Rehabilitation 2030: A Call For Action, brought together experts and government ministers from around the world to make a global commitment to prioritize rehabilitation, not just related to physical disability but also encompassing mental health and sensory deficits such as blindness and deafness. As a result of the meeting, stakeholders contributed statements of intent and the WFC was subsequently a contributor and founding member organization of the Global Rehabilitation Alliance (GRA).

“Our framework will hopefully be incorporated into the education and training of chiropractors around the world, so that we develop a culture where chiropractors are not simply seen as experts in manual therapy, but also as experts in the prevention of disability and in evidence-based rehabilitation of acute and chronic spinal disorders, ”says CÔté.

The framework is underpinned by a set of six core competences: communication, knowledge, technical skills, clinical reasoning, values and reflection. Produced by a sub-committee under the direction of lead author Professor CÔté, the framework groups these competencies into three domains:

Domain 1: Basic concepts of rehabilitation and disability
The WFC DRC calls on chiropractors to develop a foundational knowledge of rehabilitation and to understand that disability is a term that includes impairments, activity limitations, and participation restrictions. Rehabilitation competencies are based on a basic premise that culturally appropriate people-centred care is at the basis of all provider-patient interactions. Skills in interprofessional communication, communication methods, technologies and rehabilitation are all critical in optimizing outcomes.

Domain 2: Legal, regulatory and ethical components
Knowledge and understanding of human rights, including privacy and confidentiality, ethical considerations of governance and service delivery, and understanding of competing interests are important drivers in this competency domain. Framing the provision of rehabilitation within the context of social, political, and environmental and economic social determinants is also key to optimizing outcomes of care.

Domain 3: Rehabilitation management of disability
Rehabilitation should be seen and delivered through a biopsychosocial lens with a view to considering biophysical elements, psychological components and social influencers. Optimizing function to enable independent living, participation in education and economic productivity are important components. Rehabilitation may be provided in dedicated health care facilities or in the community.

The final published document is the product of consultation by the authors with the other members of the WFC DRC and with the WFC Board. This includes participants from each of the WFC’s seven world regions.

In light of the scale of the need for rehabilitation globally, it is proposed that chiropractors are upskilled and that consideration is given to ensuring rehabilitation competencies are embedded within the education and training of chiropractors around the world.

Richard Brown has been the Secretary-General of the World Federation of Chiropractic since 2015 and is a past-president of the British Chiropractic Association. He is a graduate of AECC University College in the U.K., and was in continuous private practice for 25 years before relocating to Canada.