Rehabilitation and risk
When I teach medical students about giving advice to patients about returning to usual activities, I tell them to think about 2 related but distinct key concepts. The first key concept is whether the patient is actually able to perform the usual activity. This involves the assessment of function, and the ICF provides a really useful framework for what function is (but doesn’t tell us how to go about it). The second key concept is how risky it is for the patient to undertake the usual activity. Risk assessment is tricky. It demands a knowledge of the underlying pathology (rugby players might perform fine after a concussion but the risk of a second ‘hit’ is too much) as well as the ways the risk might be managed.
Management of risk is a common strategy in life as well as in rehabilitation clinical practice. This photo shows Kime Hut in the Tararua’s a couple of days ago. I was up there by myself, which is risky. But I (and my family) are reasonably happy with the management of that risk – well-equipped with warm gear, personal locator beacon, GPS, and an attitude to bail out when things turn dodgy (especially weather). Tragically, people die in this place, just 5 or 6 hours walk from civilisation. Kime Hut, itself is named after a tramper who died from hypothermia after being rescued and warmed too quickly.
Perception of risk is another interesting issue. The chances of death from driving in a car in the next year is 1 in 17,000 (2002) yet I encourage my teenage son to learn to drive. What are the risks of harm for a person living alone who needs assistance to get out of bed and into their motorised wheelchair? The overall risk of dying in a house fire in the next year are 1 in 90,000 (about 5 times less likely than dying in a car crash). There is a strong connection between autonomy and risk-taking so that the disability community can sometimes advocate for ‘the right to take risks’. If you are interested in reading more about this, take a look at this report from the Joseph Rowntree Foundation.
