1. Chesbro, Steven B. PT, DPT, EdD, GCS, Issue Editor

Article Content


More than handouts and instructions

Providing education is an assumption of practice for most rehabilitation professions, and it is well accepted that we must educate caregivers, consumers, and other providers. However, the process by which education is used varies according to the discipline, education, and experiences of the provider. The process of using educational intervention in healthcare is referred to using a number of synonymous terms: health education, health promotion, patient education, and others. While each of these terms has a specific meaning that identifies the differences in processes, each has a foundation in the use of educational intervention.


As the population in the United States continues to age, the need for educational interventions will grow in all phases of the rehabilitation process and will be provided by all disciplines involved. Increased incidence of chronic and debilitating conditions frequently associated with aging will require that rehabilitation providers not only deliver information, but become skilled in the art of facilitating learning. No longer will giving verbal instructions and handouts suffice in a payer-driven market that demands improved outcomes in fewer visits. The length of service for most conditions related to aging has progressively shortened and will likely continue to do so, given the rising costs associated with healthcare.


While the process of using education in healthcare practice is discussed in the literature, the emphasis is slight compared to other interventions commonly used with most, if not all, consumers. Historically, the process of patient education first appeared in the nursing literature in the 1950s. This process was further encouraged by the Patient's Bill of Rights published in 1975 by the American Medical Association that suggested patients have the right to know and understand their diagnosis, prognosis, proposed treatments, and the potential risks and benefits of those treatments.1 In the early 1990s, an increasing number of authors described the use of education in practice, and began to survey practitioners and observe practice in order to create a profile of the educational process in clinical situations.2,3


The growth of health maintenance organizations (HMOs) throughout the 1990s created a significant change in how rehabilitation providers practiced. The amount of service was significantly decreased for HMO members in all rehabilitation settings. Similarly, those in fee-for-service and preferred provider organizations (PPOs) experienced reduced coverage, but not to the level of those by HMOs. Thus, these length-of-stay changes in acute care and long-term rehabilitation settings placed more emphasis on rehabilitation provided in home care, outpatient, and skilled nursing facility settings. This shift led to growth in the home health and skilled nursing industry, and these professionals were expected to provide care to patients whose levels of illness and disability had traditionally been addressed in hospital-like settings. The Balance Budget Act of 1997 changed rehabilitation practice even more significantly by placing cost limits on occupational therapy, physical therapy, and speech-language pathology services, and on non-hospital-based home care agencies, outpatient facilities, and skilled nursing facilities. Thus, the amount of services available to many consumers was limited. Education is critical to maximizing outcomes under these circumstances.


The use of education as an intervention can be viewed as a goal, process, or an attribute of the learner. Healthcare providers frequently write goals to address education needs identified by the patients and the rehabilitation team. Now, more than ever before, these goals are expected to be functional and measurable. Viewing educational intervention as a complete process, from initial contact with a consumer to discharge, is rare in the literature. However, research supports the idea that the process includes a variety of considerations: identifying the patient's needs, past history, learning needs and barriers, culture, family situation, and life stage. Each of these considerations impact educational strategies used by rehabilitation providers.4,5


To address this gap in the literature, this issue of Topics in Geriatric Rehabilitation (TGR) includes commentaries, perspectives, research reports, and research reviews related to various aspects of the educational intervention process. Using current literature as a foundation, each article integrates experience and clinical application tips, to aid the reader in applying various educational strategies into practice. The contributors to this issue offer insight into various aspects of the educational process as it relates to intervention in geriatric rehabilitation. This issue of TGR adds much to the current literature on the topic of educational intervention in geriatric rehabilitation.


Carolyn Wilken and Mary Isaacson present a compelling case for understanding the educational needs of caregivers of older adults. Because there is a large number of older adults who rely on others for assistance, practical tips have been included to maximize caregiver understanding of needed information and abilities. Stanley Wilson and Rachelle Dorne discuss the issue of cultural competence and its role in the geriatric rehabilitation process. Concepts are presented to facilitate reader understanding of the significance of culture in educational interactions. Barbara Billek-Sawhney and Anne Reicherter present an eye-opening article describing health literacy issues. Practical tips are presented to guide development of written material and facilitation of consumer learning through pictographs and written words. Considering the role of wellness and health promotion, Reicherter and Revenda Greene guide the reader through critical concepts applicable to practice. Key models and theories of health promotion are presented with clinician-friendly assessment and intervention tools. Working with older adults who have dementia can be a challenging endeavor. Lori Davis reviews the current literature related to educating older adults with dementia, and provides clinically oriented examples. Helpful strategies are presented to provide the reader with useful tools to support practice. Aphasia is another diagnosis that can make the processes of teaching and learning difficult. Tammy Hopper and Audrey Holland integrate concepts of adult education with aphasia and make a case for applying adult education principles to maximize learning outcomes.


Two research articles present concepts that are clinically useful for all rehabilitation professions when considering educational interventions in actual practice settings. Presenting support for the value of using a behavioral contract to effect learning outcomes, Bernadette Williams, Janet Bezner, Ronnie Leavitt, and I present a study that examined the effect of a behavioral contract on goal attainment for a walking program with postmenopausal African American women. By combining concepts of learning contracts and patient goal setting, a helpful model is presented to aid clinicians in improving adherence to rehabilitation programs. Gary Conti, Bernadette Williams, and I also present research on the identification of a consumer's preferred learning strategy. This study compares use of the Assessing the Learning Strategies of Adults (ATLAS) tool on the basis of age and level of assistance required to complete activities of daily living and instrumental activities of daily living. An applied case demonstrates how this tool can be used in practice. Stacy Martin and Ryan Girrbach offer reviews of current research related to the use of education to address dementia, osteoporosis, and total hip arthroplasty. Each review includes a commentary on the clinical application to geriatric rehabilitation.


I hope readers find this issue of TGR valuable, and are motivated to apply these concepts to their clinical practice. I also encourage readers to continue their professional development in the use of educational intervention by accessing the various references listed in these articles, and by contacting authors to maximize the functional use of the information provided.


Steven B. Chesbro, PT, DPT, EdD, GCS, Issue Editor


Department of Physical Therapy, Howard University, Washington, DC




1. Falvo D. Effective Patient Education: A Guide to Increased Compliance. 2nd ed. Gaithersburg, MD: Aspen; 1999. [Context Link]


2. Chase L, Elkins J, Readinger JL, Shepard KF. Perceptions of physical therapists toward patient education. Phys Ther. 1993;73:787-795. [Context Link]


3. Sluijs EM. A checklist to assess patient education in physical therapy practice: development and reliability. Phys Ther. 1991;71:561-569. [Context Link]


4. Davis LA, Chesbro SB. Integrating health promotion, patient education, and adult education principles with the older adult: A perspective for rehabilitation professionals. J Allied Health. 2003;32(2):106-109. [Context Link]


5. Chesbro SB, Davis LA. Applying Knowles' model of andragogy to individualized osteoporosis education. J Geriatr Phys Ther. 2002;25(2):8-11. [Context Link]