The Health Change Process Theory provides an inclusive framework within which acute and chronic rehabilitation healthcare can be merged to maximise health outcomes. Nevertheless, a need remains to develop a quantitative measure of individual holistic health, based on this theory, to facilitate its use in rehabilitation practice. This paper forwards an explanation for the process that people experiencing chronic physical disabilities undergo as they achieve health. A concept of self that identifies the spiritual core as the component that determines the constancy and continuity of self as a whole which is necessary for health is presented as the basis of the rehabilitative health process.

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Objective: To examine the health status of people with fibromyalgia syndrome approximately 10 years after an intensive rehabilitation intervention to identify biopsychosocial factors for further research.Methods: Baseline data, collected upon admission to the rehabilitation intervention was compared to follow-up data collected by telephone interview. Data was evaluated for differences and relationships using the appropriate parametric or non-parametric tests. Results:The 29 participants were interviewed an average of 9.4 years after their admissions. All participants reported the persistence of fibromyalgia and use of related medication. Differences between baseline and follow-up were: increased paid employment (P < 0.001), social networks (P < 0.05) and decreased stress levels (P < 0.05). Correlations with paid employment were: younger age (r s = -0.66, P < 0.01); larger social networks (r s = -0.40, P < 0.05) and transformation rehabilitation intervention experience (r s = .46, P < 0.05). Follow-up stress and sleep status were also related (r s = 0.46, P < 0.05). Conclusion:Fibromyalgia symptoms and medication use persist over time. The wider issues concerning social integration and participation appear to be worthy of further investigation.

The QEHS possessed sufficient reliability and validity as a spiritually-based holistic measure of health to warrant further investigation.

Although physical, social and psychological interventions are essential aspects of health intervention, by themselves they are not sufficient. Also required for health is a strong resilient self resulting from interaction and connection with other people and the natural world. Moreover, development of such an identity requires a spiritual world-view comprising an acknowledgement of the essence of self and focus upon the nature of the connection of this essence with all other aspects of life. Further research is required to advance understanding of the process by which this occurs for people with chronic disorders.