Sir,

I found your editorial entitled “Research and publishing in rehabilitation medicine” (1) very informative and interesting. However, I would like to suggest that, in addition to the recommendations made, emphasis should also be placed on the importance of the health economics perspective for this area of research.

I make this suggestion on the basis of the findings from a review of the health economic literature on neurorehabilitation services, carried out recently at government department level for the purposes of informing policy. The review demonstrated that the evidence base on the health economics of neurorehabilitation was limited and patchy. The information deficits in this topic area have been widely commented upon (2–4). However, the consensus view is that these information gaps can be rectified, as the research methodologies in health economics have been sufficiently well-developed that they can now be applied in rehabilitation medicine (2–7). A recent example, in stroke care, demonstrated that a cost-effectiveness study can be quite neatly carried out in conjunction with a study on clinical efficacy (8).

Research on the health economics of rehabilitation is very important for patients because information from such research is increasingly being used, both by policymakers and funders, to inform decisions about the optimal use of limited resources, often against a backdrop of many competing and disparate demands. It is mainly for this reason that I wish to highlight the importance of the health economics perspective in rehabilitation research and publishing.

Submitted December 21, 2009; accepted January 15, 2010

Fionnuala Cooney, MB, MSc Epi, MFPHMI

From the Department of Health and Children, Hawkins House, Dublin 2, Ireland. E-mail: fionnuala.cooney@hse.ie

Response to the Letter to the Editor by Cooney

Thank you very much for your Letter to the Editor. I very much agree with you in your concern that health economics should play an increasing part in rehabilitation research and publishing. Rehabilitation is a complex procedure with many factors involved, where the cost-effectiveness ought to be studied. We do indeed need to be aware of the cost when designing and comparing rehabilitation intervention programmes. In that specific Editorial, however, the aim was not to go through all different aspects of rehabilitation research and prioritize them, but mainly to make the readers aware of the organization and structure of human functioning research and rehabilitation research into distinct scientific fields based on the concepts set out in the International Classification of Functioning, Disability and Health (ICF), as proposed in some recent publications (9, 10). Within the field Integrative rehabilitation sciences (10), research areas orientated towards health economics can be found as exemplified:

“the development of payment schemes, that facilitate and provide incentives for optimal service provision”; and

“to assess the evidence with regards to the safety, efficacy, effectiveness and cost-effectiveness of products, procedures and intervention programmes”.

Unfortunately, too few studies related to health economics in rehabilitation are published, even if they may be found in other than specific rehabilitation journals. For example, during 2009 only 2 such papers were published in the Journal of Rehabilitation Medicine (11, 12). Thus we need more studies related to health economics in rehabilitation to be submitted and published, and this is an issue that we are aware of and have discussed within the Editorial Board.

Gunnar Grimby, MD, PhD, FRCP

Editor-in-Chief, Journal of Rehabilitation Medicine

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