Rehabilitation

Rating

Category: Allied Health Options

What is it?

Rehabilitation is a general term which encompasses a variety of approaches aimed at restoring or improving physical, psychological and/or social well-being. Rehabilitation may be delivered in in-patient or community settings. For individuals with PTSD, rehabilitation may include the cognitive behavioural therapies or other strategies discussed elsewhere in this document. The use of physical exercise-based rehabilitation programs for PTSD will be discussed in this section. Rehabilitation should always be used in conjunction with other treatments for PTSD.

How does it work?

Rehabilitation studies have shown that exercise regimes aid recovery in patients with widely differing diagnoses such as chronic lung disease, stroke and heart disease. It is believed that individuals with PTSD symptoms which are associated with a severe critical illness may also benefit from a structured rehabilitation program.

Is it effective?

Although there is considerable evidence for rehabilitation programs in other conditions, only one small study explored the effectiveness of physical rehabilitation in combination with other psycho-social strategies, for PTSD symptoms. In intensive care patients recovering from critical illness, those participating in a rehabilitation program had significantly reduced PTSD symptoms (intrusive thoughts and avoidance) compared to those receiving supportive follow-up.
Further research is required to determine the effectiveness of physical rehabilitation for PTSD associated with severe illness.

Are there any disadvantages?

No evidence was found for adverse effects of physical rehabilitation for individuals with PTSD. Restricted activity or a gradual return to exercise may be advisable following severe illness in some individuals, thus advice should be sought from a registered health professional.

Where do you get it?

Physical rehabilitation for individuals with PTSD following severe illness should be provided by specifically trained registered health professionals.

What are the evidence limitations?

The evidence base for the use of physical rehabilitation in PTSD is poor. The one study found did not diagnose PTSD by using the DSM-IV and physical rehabilitation was delivered in combination with psycho-social interventions. Therefore interpreting this evidence should be undertaken with caution.

Recommendations

Based on the current lack of high quality evidence, rehabilitation cannot be recommended as a first-line, stand alone intervention for PTSD. It may be considered as an adjunct to other PTSD interventions, such as psychological and drug therapies.

Key References

Jones, C, Skirrow, P, Griffiths, R, Humphris, G, Ingleby, S, Eddleston, J, Waldmann, C & Gager, M 2003, ‘Rehabilitation after critical illness: A randomized, controlled trial’, Critical Care Medicine, vol. 31, pp. 2456 –2461.

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