SPECIAL REPORT

J Rehabil Med 2012; 44: 901912

J Rehabil Med 44 2012 The Authors. doi: 10.2340/16501977-1040
Journal Compilation 2012 Foundation of Rehabilitation Information. ISSN 1650-1977
Objectives: To systematically investigate current scientifc
evidence about the effectiveness of multidisciplinary team
rehabilitation for different health problems.
Data sources: A comprehensive literature search was con-
ducted in Cochrane, Medline, DARE, Embase, and Cinahl
databases, and research from existing systematic reviews
was critically appraised and summarized.
Study selection: Using the search terms rehabilitation,
multidisciplinary teams or team care, references were
identifed for existing studies published after 2000 that
examined multidisciplinary rehabilitation team care for
adults, without restrictions in terms of study population or
outcomes. The most recent reviews examining a study popu-
lation were selected.
Data extraction: Two reviewers independently extracted in-
formation about study populations, sample sizes, study de-
signs, rehabilitation settings, the team, interventions, and
fndings.
Data synthesis: A total of 14 reviews were included to sum-
marize the fndings of 12 different study populations. Evi-
dence was found to support improved functioning following
multidisciplinary rehabilitation team care for 10 of 12 dif-
ferent study population: elderly people, elderly people with
hip fracture, homeless people with mental illness, adults
with multiple sclerosis, stroke, aquired brain injury, chronic
arthropathy, chronic pain, low back pain, and fbromyalgia.
Whereas evidence was not found for adults with amyetrophic
lateral schlerosis, and neck and shoulder pain.
Conclusion: Although these studies included heterogeneous
patient groups the overall conclusion was that multidiscipli-
nary rehabilitation team care effectively improves rehabili-
tation intervention. However, further research in this area
is needed.
Key words: rehabilitation; patient care team; outcome assess-
ment; multidisciplinary team.
J Rehabil Med 2012; 44: 901912
Correspondence address: A. M. Momsen, MarselisborgCentret,
P. P. Oerums Gade 11, DK-8000 Aarhus C, Denmark. E-mail:
anne-mette.momsen@stab.rm.dk
Submitted January 27, 2012; accepted June 7, 2012
INTRODUCTION
In Denmark, as in other Western countries, the population is
ageing, and, consequently, chronic diseases are increasing. Yet
problems with rehabilitation remain that cannot be adressed
with medicine or surgery. Healthcare changes, including a
reduction in the number of hospitals, increased numbers of
specialized hospitals and shorter hospital stays, have resulted
in a greater demand for rehabilitation. Under the 2006 Dan-
ish Health Act, responsibility for the rehabilitation of patients
shifted towards local authorities in the municipalities (1). This
shift of responsibility requires cooperation and coordination
between health sectors and local authorities, and highlights the
need for standards and guidelines for rehabilitation services.
In addition, as rehabilitation requires the expertise of various
disciplines, methods for improving the performance of inter-
disciplinary teams are paramount.
Rehabilitation has been defned in the Danish White Paper as:
A goal-oriented, cooperative process involving a member of the
public, his/her relatives, and professionals over a specifed period
of time. The aim of this process is to ensure that the person in ques-
tion, who has, or is at risk of having, seriously diminished physi-
cal, mental and social functions, can achieve independence and a
meaningful life. Rehabilitation programmes consider the persons
situation and the decisions he or she must make, and consist of
coordinated, coherent, and knowledge-based measures (2).
The World Health Organization (WHO) has defned rehabili-
tation as The use of all means aimed at reducing the impact
of disabling and handicapping conditions and at enabling
people with disabilities to achieve optimal social integration
(3). A comprehensive description of Physical and Rehabilita-
tion Medicine (PRM), which is the medical specialty with
rehabilitation as its core health strategy, is well established in
all Western countries except Denmark (3).
WHO has created the International Classifcation of Func-
tioning, Disability and Health (ICF) for assessing health status,
for example in relation to rehabilitation (4). The ICF recognizes
human functioning as a universal human experience focusing
on the consequences and not on the causes of the limits of
functioning (5).
MULTIDISCIPLINARY TEAM CARE IN REHABILITATION:
AN OveRvIeW OF RevIeWs
Anne-Mette Momsen, PhD
1
, Jens Ole Rasmussen, PT
2
, Claus Vinther Nielsen, MD
1,5
,
Maura Daly Iversen, DPT, SD
3,4
and Hans Lund, PhD
4
From the
1
MarselisborgCentret, Public Health and Quality Improvement, Central Denmark Region,
2
Clinic of Physio-
therapy, Wichmandsgade, Odense, Denmark,
3
Department of Physical Therapy, School of Health Professions, Bouve
College of Health Sciences, Northeastern University, and Section of Clinical Sciences, Division of Rheumatology,
Brigham & Womens Hospital, Harvard Medical School, Boston, USA,
4
Research Unit for Musculoskeletal Function and
Physiotherapy, The Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark and
5
Section of Clinical Social Medicine and Rehabilitation, Institute of Public Health, Aarhus University, Aarhus, Denmark
902 A.-M. Momsen et al.
Three perspectives regarding good rehabilitation process
include: consideration of all aspects of a persons life, recog-
nizing the individual as the primary focus in the rehabilitation
process, and ensuring continuity and related interventions
across the sectors (2).
The present challenge is to implement evidence-based opti-
mal rehabilitation interventions between health and social serv-
ices. The focus of this review is multidisciplinary rehabilitative
team care (MTC). MTC can be defned as a group of diverse
clinicians who communicate with each other regularly about
the care of a defned group of patients and participate in that
care (6). The characteristics of optimal MTC in rehabilita-
tion include cooperation of all participants in a structured way
and directed towards common goals to develop individualized
plans, and to evaluate the processes used to achieve these
goals (79). The purpose of this review is to link knowledge
gained from existing work to provide insights into how best to
coordinate rehabilitation services across the health and social
services and across professions.
The aim of MTC is to optimize the rehabilitation process
at all levels according to ICF; body functioning, activity, and
participation. Levels of MTC can be divided according to levels
of cooperation (7), as follows:
(A) Interdisciplinary the highest level in which team mem-
bers work towards shared goals.
(B) Multidisciplinary different professionals work with the
same person, but within their own professional limits and
often without knowledge about each others practice.
(C) Transdisciplinary professionals cross the border into
another team members professionalism.
(D) Unidisciplinary/intradisciplinary only focused on ones
own profession.
This review highlights research addressing the cooperation
of professionals defned in levels (A) and (B), using the overall
term multidisciplinary team care. In MTC the profession-
als work towards shared goals using a common approach or
strategy. Among PRM specialists, the preferred pattern of team
working is interdisciplinary working. However, published
studies have tended to use the term multidisciplinary team
(10).
Aim
The primary aim of this literature review was to highlight cur-
rent scientifc evidence about MTC in rehabilitation in different
categories of patient groups. A secondary aim was to evaluate
whether rehabilitation based on MTC is more effective com-
pared with a control or usual rehabilitation intervention.
METHODS
Inclusion criteria were: systematic review; no restrictions in type of
populations, all types of patient groups considered; no restrictions in
type of outcome measures, all types of outcome measures; and MTC
defned as cooperation of all participants in a structured way towards
a common goal, development of individualized plans in order to attain
this, and evaluation of the process towards the goals.
Literature search
Data sources. We searched for critically appraised and summarized
research from existing systematic reviews and meta-analyses without
restrictions in terms of study population or outcomes, which were
published between 2000 and July 2010 (Table I). Agreement on the
criteria for selecting studies, quality assessment, and data extraction
and conclusions was reached by consensus. The types of rehabilitation
interventions included in this review were either multidisciplinary,
interdisciplinary team or team care, respectively. The main search terms
used were rehabilitation, interdisciplinary or multidisciplinary and
health care team or patient care team. The search was carried out
in the Cochrane Database of Systematic Reviews, Database of Abstract
of Reviews of Effects (DARE), Medline, Embase and Cinahl.
The search was carried out on 2 July and 5 July 2010. One re-
viewer (JOR) used a common search strategy for Cochrane, DARE,
and Medline, while search strategies were modifed appropriately by
a librarian for Embase and Cinahl. The complete search strategy is
available in Appendix S1 (available from http://www.medicaljournals.
se/jrm/content/?doi=10.2340/16501977-1040).
Two reviewers (A-MM, JOR) independently reviewed all titles and
identifed potentially relevant studies based on abstracts. Full papers
were retrieved if the abstract provided insuffcient data to enable
selection. Inclusion criteria were applied to full papers of potential
reviews by one of the reviewers.
Study selection. This review is based primarily on systematic reviews,
inasmuch as they may be a better guide than original studies and they
generally focus on randomized controlled trials (RCTs), which are
regarded as providing the most reliable estimates of effects (11). In
addition to the fact that systematic reviews are considered to be the
highest level of evidence (11), a compilation of systematic reviews
with the same focus will increase both implementation of the achieved
knowledge, and thereby increase the quality of daily clinical practice.
Overviews compile evidence from multiple systematic reviews into a
single accessible and usable document. each overview has its specifc
focus, for which there are two or more potential perspectives (for ex-
ample different patient groups, but the same type of intervention).
Inclusion criteria for this review are shown in Table I by the type
of study, population, intervention, and outcome measures. To capture
the most recent RCTs, only the most recent systematic reviews and
meta-analysis for each study population were included. The search
was not restricted to specifc languages, but captured only english
language reviews for inclusion. Exclusion criteria were: single studies
without a control group or without a description of the search strategy.
To improve the consistency of the search strategy, preliminary criteria
were pilot-tested in abstracts on a sample of articles from the initial
search. Two reviewers independently assessed the scientifc quality us-
ing the 10-item Overview Quality Assessment Questionnaire (OQAQ)
and consensus was reached prior to reporting (12, 13).
Data extraction. Data on study design, source population, sample size,
setting, team, intervention, length of follow-up, and outcome were
extracted from the selected reviews by one reviewer (JOR).
RESULTS
The initial search for rehabilitation and MTC yielded a total of
1,892 articles (Fig. 1): 22 records in the Cochrane database, 8
in DARE, 1,372 in Medline, 437 in Embase, and 53 in Cinahl.
All titles were screened after duplicates were removed (383),
and abstracts of the potentially relevant articles (236) were
reviewed.
A number of reviews represented the same study population,
thus we included the most recent review. For elderly people we
identifed 2 reviews (14, 15). For arthropathy and hip fractures
J Rehabil Med 44
903 Multidisciplinary rehabilitation an overview
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J Rehabil Med 44
908 A.-M. Momsen et al.
there were 2 reviews, respectively (1619). For stroke we found
3 reviews of interventions in different settings (either stroke units
or at home) (15, 20, 21). For musculoskeletal diseases MTC re-
views covered chronic pain (22) and fbromyalgia (23). some of
the reviews did not include RCTs. For low back pain there were
reviews on sub-acute and chronic pain (24, 25), respectively and
a review on back training (26). After selecting 49 articles for full
text reading, 14 articles met our inclusion criteria.
To summarize the fndings of MTC in rehabilitation, 14 sys-
tematic reviews were included, of which 7 were Cochrane Re-
views. This yielded a total of 182 studies and 26,819 participants.
Results for MTC for 12 different populations were reported:
elderly persons living in the community, older people with hip
fractures, adults with stroke, multiple sclerosis, amyotrophic
lateral sclerosis, chronic arthropathy, acquired brain injury,
chronic pain, back pain, neck and shoulder pain, fbromyalgia,
and homeless people with severe mental illness. The extracted in-
formation, the OQAQ score of the review, and conclusions about
the effect of MTC were organized by patient category (Table I).
The OQAQ score of review with fbromyalgia (24) showed major
faws, whereas the other reviews scored minor faws.
Table II presents some characteristics and examples of pos-
sible changes by MTC in rehabilitation with reference to the
included studies.
Table III shows a summation of results from the in cluded
studies graded after the level of evidence (A: quantita tive
analyses (meta-analyses) based on RCTs; B: qualitative
analyses based on RCTs, qualitative or observational
studies.)
A brief summary of potential implications for the practice
of MTC in rehabilitation is presented here:
For elderly people living in the community MTC can lead
to (14):
Increase in the elderly persons capacity (performance) and
participation.
Potential improvements in ADL, and self-reported life satis-
faction.
Decreased falls, removal from home.
Decreased length of hospital stay, and readmissions to hos-
pitals.
Home-based MTC for elderly people with hip fractures
showed favourable results compared with inpatient MTC
regarding (17):
Patient functioning.
Health professional strain.
Length of hospital stay decreased, and rehabilitation time
increased.
No conclusions can be drawn from the review due to study
heterogeneity. The data suggest trends for effects on all out-
comes, and MTC does not increase the costs compared with
standard treatment.
For adults with stroke, MTC showed signifcant improve-
ment in (21):
Potential chances to survive (death rate).
Being independent and living at home one year after the
stroke.
Trend towards less required institutional care.
Fig. 1. Flow diagram.

Records identified through
database searching
(n = 1892






)
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through other sources
(n = 0)
Records titles screened
n =1509

(n = 1509)
Records abstracts
screened
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Records not fulfilling the
inclusion criteria
(n = 187)
Full-text articles assessed
for eligibility
(n = 49)
Full-text articles excluded
(n = 30)
Due to no control group,
no description of the
search strategy
Studies included in
qualitative synthesis
(n = 14)
Studies included in
quantitative synthesis
(meta-analysis)
(n = 0)
Duplicates removed
(n = 383)
Exclusions of older reviews
of four of the same study
groups as included
(n = 5)
J Rehabil Med 44
909 Multidisciplinary rehabilitation an overview
However, no defnite conclusion could be drawn due to
small sample sizes.
The convincing impact of a stroke unit is probably due to a
number of factors (27) including: the mixture of professionals
inasmuch to the structure and location of the unit, the fact that these
professionals share a special interest in stroke and rehabilitation and
regular educational programmes (conferences held at a minimum of
once a week). A primary factor is the organization with integration
of the nursing staff into rehabilitation, the training of professionals,
and specialized nursing care these patients routinely receive.
For adults with multiple sclerosis there was strong evidence
for benefts regarding (28):
Activity and participation outcomes with in-patient MTC.
Quality of life (QoL) from less intensive, but long-term,
MTC interventions.
There was limited evidence for highly intensive home or
municipality-based interventions.
MTC for adults with amyotrophic lateral sclerosis revealed
a lack of RCTs, but the authors mention a number of single
interventions with published effects (29).
For adults with acquired brain injury there was evidence
for effect on (30):
Participation (including return to work from intensive in-
patient MTC and community-based MTC rehabilitation).
For adults with chronic arthropathy MTC improved the
following outcomes (13):
Functional capacity.
Reduced hospital stay.
MTC had to commence early after joint replacement.
For adults with chronic pain there was strong evidence for
a number of different interventions positive effects at all ICF
levels (22):
Body functioning (e.g. pain).
Activity (e.g. physical capacity, pain behaviour, emotional
strain).
Participation (QoL, return to work, use of healthcare).
The programmes used in these studies varied from 3 to 15
weeks and involved a number of health professionals.
For adults with chronic low back pain the meta-analyses
showed strong evidence of MTC rehabilitation (25):
Return to work improved by 21%.
The MTC rehabilitation was based on group intervention,
workplace visit and involved 2 or more healthcare disciplines.
Multidisciplinary back training showed positive effects on
participation outcomes only (26):
Work participation and QoL (1 RCT).
The intervention involved 2 or more professionals (26).
For adults with sub-acute low back pain there was moderate
evidence (2 RCTs) on (24):
Faster return to work.
Table III. Summation of the reviews results on multidisciplinary
rehabilitation team care, graded after level of evidence
Outcomes,
ICF-levels
Results, review(s), level of evidence
A: based on meta-analysis, RCTs; B: based on RCTs,
OCTs and observational studies
Body
functioning
More effect on functional status (18) A, (14) B
Faster recovery of functional status (18) A
Less reduction of function and health (14) B
Better mental status (14) B
Less psychiatric symptoms (32) A
Increased well being and satisfaction with life (14) A,
(23) B
Activity Increased level of ADL and performance of ADL (14) B
Less falling and fear of falling (14) B
Participation Less dependence on help from others (23) A, (21) B
More self-effcacy (21) A, (14) B
Increased social participation (1) B
Faster return to work (24) A
Less sickness absence (25) A
Other
outcomes
Better survival (21) A, (14) B
Fewer admissions to hospitals (32) A
Shorter stay in hospital (18) A, (14) B
Fewer post-operative complications (18) A
Later readmission to hospitals or moving to residential
homes (14) B
ICF: International Classifcation of Functioning, Disability and Health;
RCT: randomized controlled trials(s); ADL: activities of daily living;
OCT(s): observational controlled trial(s).
Table II. Characteristics of rehabilitation and possible changes by multidisciplinary rehabilitation team care (MTC)
Characteristics of rehabilitation Possible changes due to the MTC interventions in the reviews
An individually adjusted intervention The person in need is the focus of the intervention (23)
Each professional is obliged to care for only a few persons in need, which leads to a more intensive
contact with each person (32)
Offers in the local community, give a more direct contact instead of intermediate communication (32)
A 24-h covering service provides possibilities for contact with professionals (32)
All relevant parts are involved The MTC is either a trans- and/or an inter-disciplinary intervention (14, 21)
Habitually, the nursing staff is involved in the rehabilitation (21)
The workplace is more often involved in return to work after rehabilitation (24, 25)
Working towards a common goal and
common assessment of effciency
Documents on common agreements, goals, guidelines for the teams work are elaborated (14)
Follow-up is regarded as important and realized (30)
Frequent contacts between all parties
involved
Honest and continuous communication about planning and setting goals is taking place (14)
There are close relations in cooperation, awareness of communication, and sharing of knowledge
within the team (14)
To coordinate MTC joint conferences are held at least once a week (21)
A high professional standard Regular education and training programmes for the professionals are implemented (21)
J Rehabil Med 44
910 A.-M. Momsen et al.
MTC interventions involved workplace visit or more com-
prehensive occupational healthcare.
For adults with neck and shoulder pain the 2 MTC interven-
tions (1 RCT) showed no signifcant difference at 12 years
follow-up (31).
For fbromyalgia MTC interventions (424 weeks) showed
signifcant effects on all ICF levels of outcomes (23):
Body functioning (symptoms).
Activity (self-effcacy).
Participation (return to work and QoL).
For homeless with severe mental illness, the meta-analysis
showed signifcant effects on 2 ICF levels (32):
Psychiatric symptoms reduced by 26%.
Homelessness reduced by 37%.
In the following section we present 3 examples of MTC
studies in rehabilitation:
(i) MTC intervention for adults with acquired brain injury
(30).
The study involved meetings with the principal investi-
gator, neuropsychological and personality assessment, and
consultation with a physical therapist who specializes in
post-concussion problems.
The purpose of the study was to compare an education-
oriented single session treatment (SS) to a more extensive
assessment, education, and treatment-as-needed intervention
(TAN) for adults with mild traumatic brain injury (MTBI).
Persons in the SS group met with the principal investigator
and discussed any concerns they had about their injury. They
also read the National Head Injury Foundations Minor Head
Injury brochure, chosen because of its reported helpfulness
in a previous MTBI treatment study, and discussed any ques-
tions about it with the principal investigator.
Subjects were told that no further MTBI treatment would
be provided as part of the study, and that any further con-
cerns should be addressed with their family physician.
Persons in the TAN group received the same base treatment
along with a 34 hour neuropsychological and personality
assessment, consultation with a physical therapist who
specializes in post-concussion problems (e.g. dizziness),
a feedback session on the psychological test results, and
thereafter treatment-as-needed for MTBI complaints. The
treatment available included further psychological care
and physical therapy and access as needed, to the Glenrose
Rehabilitation Hospitals full multidisciplinary outpatient
brain injury treatment programme. Treatment for non-MTBI
issues was coordinated by the patients family physician and
provided by the usual community-based services for such
non-MTBI problems.
Overall, the aim of SS treatment was to:
Legitimize the participants post-MTBI experience as being
real, and not brush aside their concerns or tell them that
there was nothing wrong with them.
Educate participants about common complaints after
MTBI.
Provide participants with suggestions about how to cope
with common problems, especially by encouraging rest as
needed and gradual reintegration into activities.
Provide reassurance of a good outcome.
In short, the TAN intervention was an abbreviated model of
treatment commonly used, in this setting, with more severe
TBI and with MTBI survivors who have persisting, signifcant
complaints (33).
(ii) A brief summary of an MTC intervention for adults with
fbromyalgia (23, 34).
The professionals of the team were physiotherapists,
psychologist, and nurses. The program lasted 6 weeks and
consisted of 2 exercise classes and 2 multidisciplinary
educational sessions per week. Exercise classes were con-
ducted in a warm, therapeutic pool and were 30 minutes
long. Each class consisted of 20 minutes of walking/jogging/
side-stepping/arm exercises against water resistance and 5
minutes of stretching at the beginning and end of each class.
Educational sessions were one hour long and were run in a
group setting, immediately prior to pool classes. During edu-
cational sessions, patients were provided with information on
exercise, postural correction, activities of daily living, sleep,
relaxation, medication, nutrition, and psychosocial coping
strategies. The format for the educational sessions varied
but included didactic lectures, interactive discussions, and
hands-on learning (e.g. relaxation techniques) (34).
(iii) A synopsis of a study of Assertive Community Treatment
(ACT) for homeless people with mental disorders (32).
The team consisted of 12 full-time equivalent staff,
including a program director with a masters degree in
social work, a full-time psychiatrist and medical director, 6
clinical case managers (social workers, psychiatric nurses,
and rehabilitation counsellors), 2 consumer advocates, a
secretary-receptionist, a part-time family outreach worker
from the Alliance for the Mentally Ill of Metropolitan Balti-
more, and a part-time nurse practitioner who treats chronic
medical problems. Each patient was assigned to a mini-
team consisting of a clinical case manager (case load,
1012 patients), an attending psychiatrist, and a consumer
advocate. The entire ACT team, including the consumer
advocates, worked together in decision making and each
staff member was knowledgeable about most of the patients.
Teamwork was fostered through daily sign-out rounds and
twice-weekly treatment planning meetings. The ACT teams
long-term commitment was to promote continuity of care,
and the team was available 24 hours every day.
DISCUSSION
In optimal rehabilitation, the focus is on the patient and his/
her level of functioning, and not the diagnosis. The process
of rehabilitation and the effectiveness of MTC are presented
in this review. specifcally, the following elements have been
described, and will be discussed (10, 35):
J Rehabil Med 44
911 Multidisciplinary rehabilitation an overview
Identifcation of the need for rehabilitation.
Mutually agreed aims and outcomes of MTC and a shared
understanding of how to achieve these aims.
Establishing a team based on the patients need with the
person in need as a central actor.
Communication and coordination between all parties in-
volved in the patients care including relatives and profes-
sionals.
An appropriate range of knowledge and skills of the MTC
team.
Willingness to share knowledge and mutual trust to speak
openly.
Evaluation of the aims and, if necessary, adjustment of these
aims.
Identifcation of needs
The theory behind the interventions employed in these reviews is
not described, except for MTC being based on the bio-psycho-
social thinking (24, 31). Apart from this theoretical basis there is
little evidence about key elements of successful MTC (10, 36).
It is suggested that the framework of the ICF provides ele-
ments of a theory about rehabilitation (37, 38). The model
provides a taxonomic system of human functioning, and may
well be used to help prioritize and provide a description of
the composition of the professionals needed to treat different
sub-groups. The ICF can be used to test hypotheses about the
composition of MTC (39), and as a common framework in
which to set criteria for the aim of rehabilitation and how to
organize MTC. The process surrounding the development of
common goals is described in one review through participation
in honest and continuous communication among the patient
and professionals involved in the patients care (16).
Mutual aims and outcomes
Within the context of treating adults with fbromyalgia, (23,
34) an important goal is to change the patients perception of
self-effcacy. Through patient education and the use of cogni-
tive behavioural strategies and exercises, patients can learn to
move from feelings of hopelessness to taking responsibility
for their own health promotion.
As seen in Table II, there are some common characteristics
across studies. The diversity of interventions and professionals
involved illustrate that MTC can be effcient in several forms.
A generalization between different sub-groups is possible,
because the interventions typically are focused on common
functional problems despite the specifc diagnoses.
Establishing a team
The results (Table I) show evidence for MTC in rehabilitation
in 10 of the 12 different patient groups. Most studies limited
their description of MTC to the professionals involved, and
their general performance, such as close cooperation, aware-
ness of communication and sharing of knowledge within the
team (16). The element of close contact was described in a
review as assignment to a mini-team with 24-hour provision
of local, direct and individual contact (28).
In certain situations, rehabilitation may require the par-
ticipation of only one profession for certain periods. Whereas
effective team working produces better patient outcomes
(including better survival rates) in a range of disorders, notably
following stroke (10).
Competencies
The components of the MTC interventions were most often
described in general terms, such as educational sessions of
group therapy, exercise, behavioural cognitive training, and
assertive communicative training. We suggest that the CON-
SORT criteria are used in order to improve the reporting of
future RCTs performed in this feld (40).
Evaluation of aims
The results demonstrate the heterogeneity of outcomes em-
ployed in clinical trials of non-pharmacological interventions.
some reviews have outcomes at all ICF levels, but as Table I
illustrates, the outcomes are highly variable and some are
lacking the level of participation.
The lack of standard measures appropriate for studying proc-
esses of care and the number of different outcomes is a limita-
tion. A set of outcomes would be necessary to compare studies
on effectiveness in clinical practice. We suggest use of the ICF
to guide the selection of outcomes, and to defne infuencing
factors on functioning. However, unfortunately data are not
gathered consistently, and there is no common defnition of dis-
ability across countries (41). Functioning at all levels is relevant
and is the main goal of rehabilitation, and is relevant to disease
prevention, cure, and to target strategies for support.
There are some limitations of this review that should be noted.
First, the external validity of the review can be questioned, as it
presents research only on specifc patient groups. However, as
the person in need may have equal limitations of functioning no
matter what their diagnosis, there are a number of characteristics
from MTC that can be generalized to other groups of patients.
The authors of the review on multiple sclerosis discuss the
issue of applying the RCT design on assessment of MTC in
rehabilitation. It is questioned whether the evidence base for
effectiveness coming from clinical trials and outcomes research
can be applied to assessment of outcomes in the context of
rehabilitation.
There is a need for more RCTs in other patient groups.
Whereas there are reviews on both in-patient and out-patient
MTC rehabilitation programmes for a number of musculoskel-
etal disorders, there is a lack of reviews on conditions such
as pulmonary diseases (COL) and different forms of cancer.
As suggested by Groote, research within rehabilitation should
address all dimensions of the ICF, and the WHO World Report
on Disability includes work in multi-professional teams (36).
Although the literature provides limited evidence concerning
the key components of MTC, the theoretical basis of a multi-
professional team is well described: agreed aims and shared
J Rehabil Med 44
912 A.-M. Momsen et al.
understanding on how to best achieve these, an appropriate range
of knowledge and skills, mutual trust and respect, willingness to
share knowledge and expertise; and to speak openly (10).
Conclusion
Despite the variety of interventions and level of MTC, the
literature demonstrates that MTC promotes the effects of
rehabilitation compared with a control group or standard re-
habilitative care in 10 of 12 patient groups. There is not one
single MTC method, but some general characteristics of MTC
in rehabilitation of different patient groups are presented.
ReFeReNCes
1. Danish Health and Medicines Authorities. [According to the 2006
Danish Health Act, the responsibility for the rehabilitation of
patients was shifted towards the local authorities in the munici-
palities.] Available from: https://www.retsinformation.dk/Forms/
R0900.aspx?s21=sundhedsloven&s20=2006&s22=%7c50%7c%
7c60%7c&s113=0 (in Danish).
2. Marselisborg Centret. [Rehabilitation in Denmark: The white
paper of the rehabilitation concept.] rhus: Marselisborgcentret;
2004 (in Danish).
3. Gutenbrunner C, Ward AB, Chamberlain MA, Bardot A, Barat M,
Bensoussan L, et al. White Book on Physical and Rehabilitation
Medicine in Europe. J Rehabil Med 2007; 39 suppl 45: 148.
4. International Classifcation of Functioning, Disability and Health (ICF).
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