LAUSR

Professor Derick Wade, in his valedictory editorial for Clinical Rehabilitation after 27 years in the editor’s chair, makes many important observations about the changing understanding of rehabilitation during his professional life and reflects on his phenomenal contribution to the field. Most importantly, he states that ‘rehabilitation is much broader than traditional medical practice’ and that ‘psychology, sociology and other behavioural sciences’ are relevant to its practice. He champions the Biopsychosocial model of wellness and despairs of the ‘biomedical approach’ to much of non-rehabilitation medicine. He concludes that he has ‘developed a reasonably cohesive model of what rehabilitation is’. We think he could go further and, in this article, using a much broader time horizon and evidence from large, randomised trials, we propose a cohesive model for rehabilitation with the evidence mainly from the field of stroke, arguing that successful rehabilitation depends most on the person, not the health professionals who may be involved. This key idea requires us to rethink current rehabilitation dogma, including the pre-eminence of the health professional team, the belief that success is fundamentally about rehabilitation ‘dose’ and the use of ‘SMART’ (Specific Measurable Achievable Realistic Timed) and similar goal-setting strategies. In 1972, Dr Howard Rusk, often credited as the ‘father’ of modern comprehensive rehabilitation, proposed two principles for successful rehabilitation outcomes. The first was that ‘the whole person needed rehabilitation, not just the part of him that had been damaged’ and the second that ‘Ultimately, the success of all rehabilitation depends on the patient himself’. Even earlier, Abraham Maslow, one of the great pioneers of