Vigorous international debate continues regarding standards of evidence in rehabilitation and guidelines for evidence reviews, as these impact reimbursement and drive scientific and clinical practices. A large portion of rehabilitation research funding in the United States goes toward the development of standardized rating scales and taxonomies of treatments. Another trend—quality improvement—is increasingly evident in the study of services in medicine, nursing, and psychotherapy, and is just beginning to enter the rehabilitation literature. Among many contributions, international communities collaborating in quality improvement have promoted greater awareness of the challenges and opportunities posed by complex adaptive systems. In this chapter, after reviewing dominant trends, we describe how methods of research from the quality improvement tradition and other methods compatible with it may transform processes and outcomes in rehabilitation.

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