Defining the treatment targets and active ingredients of rehabilitation: Implications for rehabilitation psychology.
Rehabilitation is a complex field incorporating many disciplines, settings, interventions, and populations, with patient goals ranging from improvement in function to enhanced participation in societal roles. Although there has been progress in measuring the inputs to the rehabilitation process, such as patient characteristics, and the outputs (i.e., outcomes) of the process, little attention has been devoted to specifying and measuring the process itself: the treatment. In this article, the authors describe a framework by which rehabilitation interventions, including those delivered by rehabilitation psychologists, may be defined according to the treatment theories underlying them. The tripartite structure of a treatment theory-the targets, active ingredients, and mechanisms of action-may be specified, often in hypothesized form, for each treatment component used to effect desired changes for each patient. Targets are specific, measurable aspects of patient functioning in which change is desired; active ingredients are specific, measurable actions performed by a clinician to effect these changes; and mechanisms of action are the often invisible and inferred ways in which ingredients work to cause the desired effects. To illustrate these concepts, the authors present how they might be applied in 2 areas of treatment that frequently involve rehabilitation psychologists: management of memory disorders and interventions for chronic pain. This type of systematic approach to defining and, ultimately, measuring the quality and quantity (dose) of specific treatments stands to enhance research, practice, and training in rehabilitation as well as communication across the treatment team and other stakeholders in the process and outcomes of rehabilitation.