Selection criteria for rehabilitation services

In an era of inadequate resources for all health services, rehabilitation services providers are frequently asked to produce criteria defining the patients they will accept. In principle rationing of services by ability to benefit is fair. In practice there are many difficulties. The evidence to allow selection of patients for rehabilitation does not exist and probably the best criterion of ability to benefit from rehabilitation (not 'likely to have a good outcome') is demonstration of benefit within a rehabilitation programme. Basic considerations of epidemiological statistical facts also show that criteria are likely to select too many inappropriate patients into services or exclude too many appropriate patients from services. The solution is for purchasers and providers to develop mutual trust and, in the UK at least, to ensure that patients who do not need rehabilitation can be discharged quickly into appropriate support services.