Precision rehabilitation, from foundational concepts to contemporary perspectives: a mixed-methods scoping review

 For stroke this requires:

1. An objective damage diagnosis, a 3d rendering of dead and damaged gray and white matter. mRS and the Berthel Index ARE NOT DAMAGE DIAGNOSES, they do not give you the 3d location of your dead and damaged neurons. All problems relate to those damaged or dead neurons so if you don't know what you are dealing with you CAN'T FIX ANYTHING WITH PRECISION!
2. EXACT REHAB PROTOCOLS; numbers and movement or thought patterns.

Don't worry, nothing will occur, your stroke medical 'professionals' haven't done any thinking since entering medical school.

Precision rehabilitation, from foundational concepts to contemporary perspectives: a mixed-methods scoping review

• Annie Pouliot-Laforte,
• Évemie Dubé,
• Dahlia Kairy &
• Danielle E. Levac 

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Abstract

Background

Precision health approaches aim to predict, deliver and optimize the right intervention, at the right time, for the right person. While precision medicine is well-established, its application in rehabilitation remains nascent. This study aimed to (1) Map foundational concepts of precision rehabilitation by describing the extent, scope and nature of the literature, identifying similarities and differences with precision medicine, and describing the role of technologies and artificial intelligence (AI); (2) Describe knowledge users’ perspectives on precision rehabilitation; and (3) Integrate quantitative and qualitative results to develop a working definition of precision rehabilitation.

Methods

A convergent mixed-methods design was used to conduct a scoping review with a qualitative consultation phase. The scoping review followed Johanna Briggs Institute methodological recommendations and PRISMA-ScR reporting guidelines. Five databases were searched for adjacent keywords ‘precision’ AND ‘rehabilitation’. Data were extracted and analyzed descriptively and thematically. In parallel, individual interviews were conducted with knowledge users at three North American rehabilitation centers. Transcripts were analyzed using deductive content analysis. Mixed method integration synthesized and contrasted literature-derived and knowledge users-derived insights.

Results

Forty-nine articles met inclusion criteria; 26 (53%) were primary research studies, while 23 (47%) were non-empirical publications. Amongst research studies, 14 (54%) involved technology use, while 5 (19%) used AI. Seven (14%) articles included a definition of precision medicine, while 22 (45%) included a definition of precision rehabilitation. Interviews with 16 knowledge users highlighted that personalization is uniquely expressed in precision rehabilitation as compared to medicine and identified rehabilitation-specific facilitators and barriers to precision approaches. Data integration confirmed that a focus on function differentiates precision approaches in rehabilitation from medicine, clarified rehabilitation-specific logistical barriers to technology-enabled data collection in precision approaches, and attributed limited AI use to concerns about predictions based solely on data that excludes psychosocial factors and population heterogeneity.

Conclusions

Results indicate greater similarities than differences between precision approaches in rehabilitation and medicine, while highlighting rehabilitation’s emphasis on personalization, function and participation. Findings identify key barriers and facilitators and support a proposed definition of precision rehabilitation for further refinement through peer consensus to accompany advances in research and clinical practice.