Development of a Functional Recovery Ecology (FRE) Model for Medical Rehabilitation Outcomes

Thesis Abstract

Functional recovery after medical rehabilitation is shaped by dynamic interactions between biological, psychosocial, and environmental factors, yet existing models inadequately integrate ecological principles with rehabilitation outcomes. This study develops a Functional Recovery Ecology (FRE) model to explain and predict functional recovery trajectories by synthesizing ontogenetic, sociocultural, and environmental affordances influencing patient adaptation and participation. The aim is to construct and validate a theory-driven framework that links physiological recovery, activity opportunities, and individual-environment fit to functional independence across rehabilitation pathways. Specific objectives are (1) to delineate core ecological constructs relevant to medical rehabilitation, including resource accessibility, task affordances, and person–environment congruence; (2) to operationalize these constructs into measurable domains suitable for longitudinal assessment; (3) to examine the relative contributions of biological recovery, ecological affordances, and psychosocial mediators to functional outcome; (4) to test the FRE model using multi-wave data to identify key predictors and interaction effects; and (5) to compare FRE model performance across musculoskeletal, neurological, and cardiopulmonary rehabilitation populations. The methodology adopts a longitudinal explanatory design grounded in ecological psychology and systems theory, combining quantitative modeling with qualitative insights. The population comprises adults aged 40–75 undergoing inpatient or outpatient rehabilitation for musculoskeletal, cerebrovascular, or cardiac conditions across three regional centers. A stratified random sample of 600 participants will be recruited, with 200 from each condition domain, and followed for 12 months with assessments at 0, 3, 6, and 12 months post-admission. Data collection instruments include (a) the Functional Independence Measure (FIM) for core functional outcomes; (b) the FRE-Index, a novel composite capturing environmental affordances (transport access, home modification, social support, and community participation opportunities); (c) the Biodynamics of Recovery Scale (biosignature indicators such as gait speed, range of motion, strength); (d) the Montreal Cognitive Assessment (MoCA) for cognitive status; (e) the Hospital Anxiety and Depression Scale (HADS); and (f) semi-structured interviews at 6 and 12 months to elicit perceived ecological fit and adaptation strategies. Validity and reliability will be established via pilot testing (n=60) and confirmatory factor analysis. Multilevel structural equation modeling (MSEM) will be employed to assess direct and indirect effects of ecological and biological factors on functional outcomes, with model comparison against a baseline medical-model framework. The analysis will test moderated mediation and interaction effects, evaluating whether environmental affordances moderate the impact of biological recovery on functional independence. Thematic analysis of interview data will triangulate quantitative findings and illuminate experiential mechanisms underlying FRE pathways. Key expected findings include (i) a robust FRE model in which ecological factors account for additional variance in functional outcomes beyond medical recovery alone; (ii) evidence that home modifications, transportation access, and social support amplify the translation of biological gains into functional independence, particularly for older adults and those with cognitive comorbidity; (iii) identification of differential FRE pathways across musculoskeletal, neurological, and cardiopulmonary rehabilitation groups, with neurology showing stronger mediation by cognitive and psychosocial ecological factors; and (iv) notable interactions where high ecological fit buffers adverse effects of slower biological recovery on daily functioning. The study contributes to knowledge by operationalizing an integrative framework that unites ecological theory with rehabilitation science, offering a transferable model for predicting outcomes and guiding individualized interventions. It advances rehabilitation practice by informing patient-centered care planning, environmental modification strategies, and community reintegration programs that optimize functional recovery trajectories. The main conclusion posits that functional outcomes in medical rehabilitation are maximally achieved when treatment plans align with ecological affordances and person–environment congruence, beyond biomedical restoration alone. Recommendations include the adoption of FRE-informed assessment protocols in clinical settings, targeted environmental interventions (home and community-level adaptations), and policy initiatives to improve accessibility and social support networks to enhance recovery equity across diverse patient populations.