Scientists and Clinicians at Jefferson Moss Rehabilitation Research Institute and Jefferson Moss-Magee Rehabilitation, particularly John Whyte, MD, PhD, Tessa Hart, PhD, Andy Packel, PT, NCS, and Mary Ferraro, PhD, OTR/L, have been leading the field in the development, implementation, and dissemination of the Rehabilitation Treatment Specification System (RTSS). The RTSS seeks to open the “black box” of rehabilitation treatments by providing a standard framework for defining the targets of rehabilitation treatments and the known or hypothesized active ingredients that address them.
Since 2019, when the RTSS was described and the Manual for Rehabilitation Treatment Specification was released, numerous projects have begun to explore the potential impact of implementing RTSS-based concepts in rehabilitation education, research, and clinical practice. In the intervening years, more than 1,600 manuals have been downloaded, and 57 articles have been published with RTSS as a key word.
Multiple Rehabilitation Science training programs, including Boston University, McMaster University, Mass General Hospital Institute of Health Professions, Texas Tech, and University of Buffalo, have redesigned their curricula around RTSS concepts of targets, active ingredients, and treatment theory, and support for this kind of curriculum development is provided through the American Congress of Rehabilitation’s (ACRM) Rehabilitation Treatment Specification Networking Group. The RTSS framework is also central to the recently published book, Transforming Cognitive Rehabilitation by McKay Moore Sohlberg, Justine Hamilton, and Lyn S. Turkstra (a Scientist in Residence at the Institute). Educators report that this framework supports clinical reasoning and, particularly, interprofessional education.
Researchers have used the RTSS to define and measure active ingredients in real world treatments.1 They have shown that this can be done reliably from videotaped records of therapy sessions, with good inter-rater agreement, and that the pattern of ingredient delivery is more similar within different sessions of the same therapist than across therapists, suggesting the potential to measure meaningful differences in practice patterns. The RTSS has also been used post-hoc to analyze potential ingredient overlap between the experimental and comparison conditions in a cancer rehabilitation trial, helping to interpret positive and null results.2 Most recently, Cochrane Rehab developed a new reporting guideline for rehabilitation treatment studies, called GUIDE-Rehab, which largely follows the RTSS specification structure.3
An exciting pilot project at Shirley Ryan AbilityLab is exploring the feasibility and impact of redesigning the electronic medical record (EMR) along RTSS lines. They selected a single functional area for Speech/Language Therapy (dysphagia treatment), Physical Therapy (gait training), and Occupational Therapy (ADL training), and engaged members of each discipline in developing RTSS-defined sets of targets they treat and ingredients that are used in treatment. They then redesigned the EMR with drop down menus that allowed selection of those targets and ingredients. Though the process of developing the target and ingredient lists was complex and costly, once developed, it was relatively easily adopted. New clinicians who had not participated in its development were “trained” by the EMR structure itself. This has already allowed Shirley Ryan leadership to examine practice variation across their many outpatient sites, and the degree to which treatment ingredients selected match research evidence on efficacy. Perhaps most exciting, clinicians report a high degree of satisfaction with the system and are asking when the entire EMR can be converted.
These advances in applying the RTSS in education, research, and clinical practice represent important steps in the evolution of the field of rehabilitation, improving clarity in how treatments are selected and described, replicability in clinical trials, and communication and synthesis across research studies and disciplines.
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