In the light of the recent financial crisis, which has resulted in economic policies that severely limit the public health service, an integrated approach to rehabilitation can be proposed, which combines standard methods of diagnosis and treatment with the most up to date therapy and assistance models.
According to work carried out at the international level, incorporating other therapeutic models alongside orthodox methods of diagnosis and therapy would not require new funding. On the contrary, it could lead to cost reductions, as a result of increased patient compliance [
Rehabilitation includes a variety of measures which are physical, functional, psychological and psycho-social. It is precise, because of this multi-faceted nature, that a form of rehabilitation may exist that can be conceived of as a combination of a variety of clinical, treatment and care models, which can be integrated with each other, creating a “framework” of reference for the evaluation of, and activities involving, the patient.
In recent years, rehabilitation has seen a gradual advancement in research, in both purely technical terms and in terms of knowledge. More than 10,000 randomized clinical trials have been held, and the quality of the proposed studies is progressively developing [
It is precisely this integration between clinical experience and knowledge that was officially confirmed in 2005, when, with the “Sicily Statement on Evidence-based Practice”, an international research team affirmed that health professionals should possess a critical spirit both in relation to their professional practice and scientific evidence, be able to research, evaluate and apply the best evidence, and be willing to implement guidelines and care approaches. The absence of these qualities will make it impossible for healthcare organizations to provide “the best care, based on evidence” [
It should be pointed out that research in the field of rehabilitation presents some particularities that distinguish it from other disciplines. The outcomes of rehabilitation, for example, are difficult to measure, as they aim to assess behaviours and not a single biological parameter. Indeed, EBR does not focus on organ damage alone, but recovery from disability and participation, placing the person at the center of the activity.
In this regard, we have aimed to consider those branches of medicine, such as Narrative-Based Medicine (NBM), Psycho-Neuro-Immuno-Endocrinology (PNEI) and the connection with Empathy, which put into practice the centrality of the patient and have a positive correlation with EBM.
Today more than ever, the term “to treat” refers to not only the implementation of the best therapeutic practices, but also returning to its original meaning. It must also involve caring for and accommodating the person who is experiencing the painful condition [
Narrative-Based Medicine (NBM) is part of this context. In fact, it is the form of medicine that makes reference to not only the patient’s experience, but also the experience of the healthcare professional, and above all the “narrative” relationship that develops between them. What the founder of Narrative-Based Medicine, Rita Char on, has called the “marriage” between Evidence and Narrative has proved even more effective [
Another new medical discipline that can be added is Psycho-Neuro-Endocrine-Immunology. PNEI became a clinically recognised science at the beginning of this century, thanks to intensive research and experimentation, which has established a connection between the brain, stress and immunity [
With regard to the connection with empathy, it has been established that rehabilitative practice has always given great importance to the therapist-patient relationship. The therapeutic relationship that develops between the two parties is commonly considered to be essential to the outcome of the rehabilitation process. A good therapeutic relationship requires the establishment of a high level of empathy, and the ability of the operator to see the situation through the patient’s eyes, to enter into their thoughts and their meanings, even if they are different from our own, and get in touch with what the patient feels and see things from their perspective. Also in this case, as with narrative medicine and PNEI, several studies have been conducted, and the results obtained demonstrate not only an advantage for the patient who, quite naturally, prefers to work with a health care professional who is not only well trained, but also empathetic and willing to listen and understand their state of mind, but also greater satisfaction for the operator, resulting in a more successful outcome of the disease. Being empathetic has been correlated with better therapeutic results (outcomes) and less medico-legal litigation [
All of this proposes the inclusion in rehabilitation of therapeutic models that are moving towards an integrated management of the patient, along with better patient compliance, which could result in a reduction of costs.
This is especially true, as economic policy, with limited healthcare costs, must increasingly provide for an aging population. The aging demography is one of the most significant phenomena in the 21st century, and entails an increase in chronic and degenerative diseases. Thus, to maintain the current level of “health and well- being”, it is necessary to identify economically compatible and sustainable alternatives in the near future.
The European framework of health spending is significantly burdened by the management of chronic pain, which affects 1 out of 5 persons [
In this regard, it is clear how the health care is moving towards the centrality of the patient. Indeed, the World Health Organization (WHO) has indicated among the priority objectives of “Health 2020” (
The combination of the various therapeutic models described could represent a reduction in health care costs, moving from a system that treats pathologies to a set of integrated interventions that take care of the actual needs of people, and could therefore be productive in a correct allocation of resources.
In conclusion, it will take time, organizational skills and specific experiments to radically change the understanding of health care and rehabilitation, and limit the gap between research and clinical experience [
sents the ideal path towards a better response for the patient and an improvement in well-being and healthcare, with a higher healthy life expectancy and better use of reduced economic resources.