11
Overarching Recommendations and Priorities

The previous chapters have illustrated the large potential for improving the health, productivity, and quality of life for the 49 million Americans with disabling conditions. Significant savings in health care costs, lost wages, and reduced emotional costs may well be realized by enhancing research in rehabilitation science and engineering. With this in mind, three fundamental needs emerged from the committee's assessment of the content, quality, and adequacy of the research and knowledge base in rehabilitation science and engineering. The first is a need to more widely recognize and accept rehabilitation science and engineering as an academic and scientific field of study, the continued development of which should result in significant contributions to the field, and ultimately to consumers. The second is a need to focus on a set of priorities for research that will advance the field of study and improve the health, productivity, and quality of life for people with disabling conditions. And perhaps most importantly, the third is a need to enhance the federal effort in rehabilitation science and engineering by expanding research, raising visibility, and improving coordination.

Each of these needs is important to improving research and enhancing knowledge. Enhanced education and training in rehabilitation science and engineering as a distinct multidisciplinary field of study will result in higher quality researchers and research. Setting research priorities will help focus the limited amount of energy and funding, and enhancing federal efforts should improve both the quantity and effectiveness of current federal efforts.



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--> 11 Overarching Recommendations and Priorities The previous chapters have illustrated the large potential for improving the health, productivity, and quality of life for the 49 million Americans with disabling conditions. Significant savings in health care costs, lost wages, and reduced emotional costs may well be realized by enhancing research in rehabilitation science and engineering. With this in mind, three fundamental needs emerged from the committee's assessment of the content, quality, and adequacy of the research and knowledge base in rehabilitation science and engineering. The first is a need to more widely recognize and accept rehabilitation science and engineering as an academic and scientific field of study, the continued development of which should result in significant contributions to the field, and ultimately to consumers. The second is a need to focus on a set of priorities for research that will advance the field of study and improve the health, productivity, and quality of life for people with disabling conditions. And perhaps most importantly, the third is a need to enhance the federal effort in rehabilitation science and engineering by expanding research, raising visibility, and improving coordination. Each of these needs is important to improving research and enhancing knowledge. Enhanced education and training in rehabilitation science and engineering as a distinct multidisciplinary field of study will result in higher quality researchers and research. Setting research priorities will help focus the limited amount of energy and funding, and enhancing federal efforts should improve both the quantity and effectiveness of current federal efforts.

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--> Three overarching recommendations are presented below to address these needs. Recognize the Field of Study Rehabilitation draws from a wide variety of disciplines—it is truly a multidisciplinary activity. Rehabilitation science and engineering is the body of knowledge that exists at the confluence of these disciplines—drawing from, and contributing to each. The continued development of a common knowledge base in rehabilitation science and engineering will be important to future research that can benefit people with disabling conditions. At this point in the evolution of the science there is a sufficient knowledge base and level of research to justify the recognition of a new field of study. Such recognition would facilitate accelerations in multidisciplinary education, training, and research, all of which would combine to advance the field of rehabilitation science and engineering and more effectively address the needs of people with disabling conditions. For these reasons, the first overarching recommendation focuses on establishing rehabilitation science and engineering as a recognized field of study, as follows. Overarching Recommendation 1. Rehabilitation science and engineering should be more widely recognized and accepted as an academic and scientific field of study. As such, the field should receive greater financial support, serve as the basis for developing new opportunities in multidisciplinary research and education, and ultimately improve the health and quality of life of people with disabling conditions. This new field should be consistent with the model of the enabling-disabling process that is defined and described in this report. Emphasize Priorities Several chapters of this report provide specific recommendations for future research in rehabilitation science and engineering. In addition, Appendix A contains suggested research priorities from various professional associations. Many topics and areas require investigation, and identifying priorities is not simple. The process cannot be based on prevalence alone or simply on cost. Moreover, the entire field has critical ecumenical needs such as creating a common terminology and taxonomy, agreeing on a model, and quantifying functional limitations and disability. Because of this, setting specific priority research topics may not be as important for this committee as setting general priorities for the field.

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--> Acknowledging the limited ability of any assembly of individuals to identify research priorities with great acuity or detail, the committee chose instead to describe general priorities that should be fundamentally important to any rehabilitation-related research and to the advancement of rehabilitation science and engineering as a whole. Thus, the second overarching recommendation focuses on establishing general priorities for rehabilitation science and engineering. Overarching Recommendation 2. As the field of rehabilitation science and engineering continues to evolve and gain recognition as an academic and scientific field of study, there are three general priorities that will and should be of fundamental importance to its growth and to the ultimate improvement of health, productivity, and quality of life for people with disabling conditions: strengthen the science, focus on the enabling-disabling process, and transfer the technology. (See Box 11-1.) Within the context of these priorities, resource distribution should somewhat favor activities that address the states of functional limitation and disability. This would help to correct a current imbalance to the basic science end of the spectrum. These priorities are appropriate and relevant for all federal agency programs that were reviewed by this committee. Enhance the Federal Effort In general, weaknesses in the current spectrum of federal programs in disability and rehabilitation research are not due to inappropriate priorities or other problems within the programs themselves, but rather to a general insufficiency in the magnitude of the overall program of research, its limited visibility, and a lack of effective coordination of the overall constellation of programs. Thus, the constellation of federal research programs in rehabilitation science and engineering needs to be reorganized and administered in a fashion that will improve interagency coordination, enhance visibility, and expand research for the purposes of improving the health, independence, productivity, and quality of life for people with disabling conditions. As the largest federal program with a focus on disability and rehabilitation research, NIDRR's program was of major interest to the committee. The NIDRR mission and its constituency of people with disabling conditions are fundamentally important to the research agenda of rehabilitation science and engineering espoused by this committee. The committee concluded, however, that despite vigorous pursuit of its mission, NIDRR has been restricted in its ability to fully execute its mission primarily by virtue of its administrative position within the U.S. Department of Educa-

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--> BOX 11-1 General Priorities for Rehabilitation Science and Engineering As the field of rehabilitation science and engineering continues to evolve and gain recognition as an academic and scientific field of study, there are three general priorities that will and should be of fundamental importance to its growth and to the ultimate improvement of health, productivity, and quality of life for people with disabling conditions 1.   Strengthen the science. Develop and validate accurate tools for measuring and predicting functional limitations, disability, and outcomes. 2.   Focus on the enabling-disabling process. Investigate critical factors in the physical, social, and psychological environments that can affect transitions in the enabling-disabling process over the lifecourse. 3.   Transfer the technology. Develop and implement effective linkages between research and practice that will involve consumers, assure quality, and enhance service delivery. tion, and the Interagency Committee on Disability Research's lack of real authority An important example of the former is the need for improved peer review processes that are unobtainable in the present administrative location For the purpose of improving the overall federal effort and addressing the priorities described in the second overarching recommendation, the committee restates Recommendation 10.1 as the third overarching recommendation since its implementation has such broad potential impact and significance Overarching Recommendation 3. The committee recommends that the NIDRR program of activities and its annual appropriation of approximately $70 million should be moved from the U.S. Department of Education to DHHS and serve as the foundation for the creation of a new Agency on Disability and Rehabilitation Research (ADRR). ADRR would assume the tasks that were formerly assigned to the Interagency Committee on Disability Research and be given enhanced authority through review of disability and rehabilitation research plans and control of funding for interagency collaboration. To further support and enhance the overall federal effort, all major programs in disability and rehabilitation research should be elevated within their respective agencies or departments. (Recommendation 10.1) In keeping with the committee's task of making recommendations within differing levels of fiscal expenditure, Chapter 10 presents guidance on how funds could be distributed in a configuration of programs

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--> TABLE 11-1 Overarching Recommendations and General Priorities for Rehabilitation Science and Engineering Overarching Recommendation Individual Chapter Recommendation Government Agency Involved 1. Recognize the Field of Study. Rehabilitation science and engineering should be more widely recognized and accepted as an academic and scientific field of study. As such, the field should receive greater financial support, serve as the basis for developing new opportunities in multidisciplinary research and education, and ultimately improve the health and quality of life of people with disabling conditions. This new field should be consistent with the model of the enabling-disabling process that is defined and described in this report. 7.3, 9.1, 9.2, 9.3 U.S. Department of Health and Human Services (DHHS,) National Science Foundation (NSF), U.S. Department of Education, U.S. Department of Veteran Affairs (VA) 2. Emphasize General Priorities. As the field of rehabilitation science and engineering continues to evolve and gain recognition as an academic and scientific field of study, there are three general priorities that will be of fundamental importance to its growth and to the ultimate improvement of health, productivity, and quality of life for people with disabling conditions. 2.1, 2.2, 3.1, 3.2, 4.3, 5.1, 5.4, 6.4, 7.1 (Item 1), 7.2, 7.4, 8.3, 8.4 DHHS, NSF, U.S. Department of Education, VA DHHS, NSF, U.S. Department of Education, VA General Priorities     1. Strengthen the science. Develop and validate accurate tools for measuring and predicting functional limitations, disability, and outcomes. 4.1, 4.2, 5.2, 5.3, 5.5, 5.6, 5.7 6.1, 6.2, 6.3, 7.1 (Items 2 and 3), 9.4   2. Focus on the enabling-disabling process. Investigate critical factors in the physical, social, and psychological environments that can affect transitions in the enabling-disabling process over the lifecourse. 8.1, 8.2, 8.5, 8.6, 8.7, 8.8 10.1   3. Transfer the technology. Develop and implement effective linkages between research and practice that will involve consumers, ensure quality, and enhance service delivery.    

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--> Overarching Recommendation Individual Chapter Recommendation Government Agency Involved 3. Enhance the Federal Effort. The NIDRR program of activities and its annual appropriation of approximately $70 million should be moved from the U.S. Department of Education to DHHS and serve as the foundation for the creation of a new Agency on Disability and Rehabilitation Research (ADRR). ADRR would assume the tasks that were formerly assigned to the Interagency Committee on Disability Research and be given enhanced authority through review of disability and rehabilitation research plans and control of funding for interagency collaboration. To further support and enhance the overall federal effort, all major programs in disability and rehabilitation-related research should be elevated within their respective agencies or departments. 10.1 DHHS, NSF, U.S. Department of Education, VA consistent with this committee's recommendations. Table 10-4 in Chapter 10 shows the present funding levels and two options for expanded programs of research at a cost of $100 and $200 million. Finally, Table 11-1 shows the relationship of the three overarching recommendations and general priorities to each of the individual recommendations in the preceding chapters.