Psychology and Medical Rehabilitation: Moving Toward a Consumer-Driven Health Care System

Changes in health care will provide both opportunities and threats for rehabilitation psychologists. We must demonstrate the relevance of our clinical services to important outcomes or risk being excluded as treatment providers. With shifts to nonhospital settings, we can provide increasing clinical and administrative leadership. However, we must redefine models of treatment to include home care and “telepsychology,” practice guidelines and critical paths, involvement of paraprofessionals, case management, injury prevention, and health promotion. We should be involved when datasets are established to define disability-related health policies and reimbursement and be proactive in Medicare, Medicaid, and managed care reform to develop treatment packages to decrease long-term handicap. Collaboration with consumers is critical. We must frame research questions to address current policy issues. Our skills can help improve the effectiveness of human behavior, whether it be patients with illness, consumers with disability, health care providers, health systems managers, or legislators.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44860/1/10880_2004_Article_425355.pd

Behavioral rehabilitation of functional alexia

A 10-year-old boy with a functional reading deficit (i.e. functional alexia) was successfully treated with hospital based escape/avoidance procedures. A multiple baseline design was used to evaluate the effectiveness of treatment. Generalization of treatment effects across individuals, settings and time was demonstrated. Extension of these procedures to other functional deficits is discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26688/1/0000235.pd

The power of nonspecific effects in healing: Implications for psychosocial and biological treatments

We evaluate the hypothesis that the power of nonspecific effects may account for as much as two thirds of successful treatment outcomes when both the healer and the patient believe in the efficacy of a treatment. Five medical and surgical treatments, once considered to be efficacious by their proponents but no longer considered effective based upon later controlled trials, were selected according to strict inclusion criteria. A search of the English literature was conducted for all studies published for each treatment area. The results of these studies were categorized, where possible, into excellent, good, and poor outcomes. For these five treatments combined, 40 % excellent, 30 % good, and 30 % poor results were reported by proponents. We conclude that, under conditions of heightened expectations, the power of nonspecific effects far exceeds that commonly reported in the literature. The implications of these results in evaluating the relative efficacy of biological and psychosocial treatments is discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31080/1/0000757.pd

An alternative perspective on biofeedback efficacy studies: A reply to Steiner and Dince

Clinical applications of biofeedback have proliferated and considerable lore surrounding the application of these techniques has evolved. Many assertions about the effectiveness of biofeedback training are based on findings of the least well-controlled studies, while many of the better controlled studies have failed to show that biofeedback directly mediates target symptoms or is superior to other treatments. Steiner and Dince (1981) suggest that the failure of these controlled studies is primarily attributable to methodological deficiencies. We believe that the question of whether or not there is a specific effect of biofeedback training is still frequently confused with the question of whether or not the treatment package as a whole has therapeutic value. Biofeedback is often therapeutic; however, evidence is often lacking that its effectiveness is due to biofeedback-trained changes in a target physiological process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44088/1/10484_2005_Article_BF00998755.pd