Directions in brain injury research: From concept to clinical implementation

Development of rehabilitation treatments and services that are effective and supported by rigorous evidence is a long and multi-step process. Although there are similarities between this process and that used in pharmaceutical development, the sequence involved in developing this evidence in rehabilitation is more complex and less linear. The specific steps involved depend on a variety of factors including the location of the target of treatment within the International Classification of Functioning, Disability, and Health (ICF; World Health Organisation, 2006), the degree to which the treatment is guided by an underlying theory, the availability of animal models, and the plausibility of safety concerns. Similarly, the research designs chosen and the setting of the research vary both by treatment target and by maturity of the programme of evidence development. A full picture of the appropriate role and anticipated impact of specific rehabilitation treatments can benefit from a marriage between rehabilitation research (which seeks to understand how to change specific aspects of function), and enablement/disablement research (which seeks to understand how changes in one part of the ICF framework affect functioning elsewhere). Although the specific steps involved in a programmatic approach to rehabilitation treatment research vary, development of evidence about all treatments can benefit from a systematic programmatic approach in which each step seeks to answer specific questions and set the stage for subsequent investigation.