Exploring maintenance rehabilitation in adults with chronic conditions: a scoping review of the literature

Individuals with chronic conditions have long-term needs which can be addressed by maintenance rehabilitation. The 2013 <i>Jimmo v Sebelius</i> settlement in the United States (US) clarified the Medicare coverage of maintenance rehabilitation as a skilled service, even when no improvement is expected. A scoping review was conducted to describe maintenance rehabilitation. A systematic search was performed across 9 databases. Maintenance rehabilitation was defined as services (e.g. occupational, physical, or speech language therapies), intended to maintain a person’s condition and prevent decline. Studies focused on medical, or non-rehabilitative, interventions (e.g. opioid cessation or chemotherapy) were excluded. Of the 734 abstracts reviewed, 90 met inclusion criteria. Two reviewers extracted data and used descriptive statistics. An exploratory thematic analysis in a convenience sample contextualized the works. Most works (90%) were peer-reviewed publications. The works represented 12,638 individuals, with predominant populations being cardiac (4,122 individuals) and pulmonary (2,324 individuals). Physical activity interventions were identified most frequently (87%). Outcome measures primarily focused on activities (49%) or body systems (42%). Thematic analysis suggests maintenance rehabilitation may support domains contributing to quality of life. While evidence exists for maintenance therapy, future research on intervention design will guide implementation by health systems. The largest number of maintenance rehabilitation studies are focused on physical activity interventions in cardiac and pulmonary populations.Most studies measured body systems and activity outcomes rather than participation.Themes of individualized and structured interventions were identified as factors that support maintenance rehabilitation. The largest number of maintenance rehabilitation studies are focused on physical activity interventions in cardiac and pulmonary populations. Most studies measured body systems and activity outcomes rather than participation. Themes of individualized and structured interventions were identified as factors that support maintenance rehabilitation.