Description

The REHAB – Rehabilitation Evaluation Hall and Baker (REHB-23) is an observer-rated assessment instrument developed to evaluate functional ability and behavioral difficulties in individuals with chronic psychiatric disorders, both in inpatient and outpatient settings. Its primary purpose is to provide a structured assessment of everyday functioning and behaviors that may interfere with psychosocial adjustment and rehabilitation.

The instrument was developed by Baker and Hall in 1984 and consists of 23 items divided into two main sections. The first section evaluates deviant or problematic behaviors, including manifestations such as verbal aggression and talking to oneself. The second section assesses general functioning, including everyday abilities such as self-care.

A distinctive feature of the REHB-23 is that it is not completed directly by the patient. Instead, ratings are provided by nursing staff following observation of the patient over a period of one week. This observational approach allows the assessment to reflect actual behavior and functioning across everyday situations rather than relying exclusively on the individual’s subjective perception of their abilities.

The REHB-23 can therefore provide clinically meaningful information concerning both behavioral difficulties and practical functioning. Its structure makes it particularly relevant to psychiatric rehabilitation, schizophrenia research, mental health services, inpatient and community psychiatry, psychosocial assessment, and evaluation of rehabilitation outcomes.

Data Analysis and Use

Analysis of the REHB-23 can be conducted at both the section and overall levels. The first section consists of 7 items assessing deviant behavior, whereas the second consists of 16 items assessing general functioning. Separate scores can therefore be calculated for these two dimensions before deriving the overall assessment score.

This distinction is clinically important because behavioral disturbance and general functioning represent related but different aspects of psychiatric rehabilitation. An individual may demonstrate difficulties in everyday self-care and functional independence without exhibiting substantial behavioral disturbance, while another individual may maintain certain functional abilities despite presenting behaviors that interfere with social or therapeutic environments.

For research purposes, descriptive statistics such as means, standard deviations, medians, ranges, and score distributions can be calculated for the total score and the two sections. Comparative analyses may be used to examine differences between inpatient and outpatient populations, diagnostic groups, treatment conditions, or different stages of rehabilitation.

Repeated administration may also support the evaluation of changes in functioning over time. Consequently, REHB-23 scores can be used to investigate the effectiveness of psychiatric rehabilitation programs, psychosocial interventions, illness self-management programs, or other therapeutic approaches designed to improve everyday functioning.

Depending on the research design, scores may also be incorporated into correlation, regression, longitudinal, or multivariable analyses examining relationships between rehabilitation outcomes and psychiatric symptoms, cognitive functioning, treatment characteristics, or other psychosocial variables.

Objective

The primary objective of the REHAB-23 is to assess the level of functioning of individuals with psychiatric disorders in both inpatient and outpatient contexts.

The scale provides a structured framework for evaluating two complementary components of functioning: the presence of deviant or problematic behaviors and the individual’s level of general everyday functioning. Through these dimensions, the instrument can contribute to a more comprehensive understanding of the individual’s rehabilitation needs.

The results may be useful for documenting functional status, identifying areas requiring additional support, monitoring progress, and evaluating outcomes within psychiatric rehabilitation programs. However, REHB-23 scores should be interpreted as part of a broader clinical assessment rather than as an independent diagnostic measure.

Scoring

The REHB-23 consists of 23 items, divided into two sections. The Deviant Behavior section contains 7 items, while the General Functioning section contains 16 items. The score for each section is obtained by summing the ratings assigned to its corresponding items.

According to the source material, the overall score ranges from 5 to 115 points. Importantly, the direction of interpretation is inverse: lower scores indicate better patient functioning, whereas higher scores represent greater behavioral or functional difficulties.

This scoring direction should be considered carefully during statistical analysis, particularly when REHB-23 scores are correlated with measures in which higher scores represent better functioning or well-being. The two section scores can also be analyzed independently to distinguish behavioral problems from limitations in general functioning.

Validity

The available psychometric evidence supports the construct validity of the REHB-23. According to the source material, factor analysis demonstrated satisfactory construct validity, providing support for the scale’s ability to represent the functional and behavioral dimensions it was designed to assess.

The bibliography also documents application of the REHAB scale within a Greek context, supporting its relevance for cross-cultural psychiatric rehabilitation research.

Reliability

Reliability differs considerably between the two sections of the instrument. The Deviant Behavior section demonstrated a Cronbach’s alpha coefficient of 0.54, indicating relatively low internal consistency in the reported evaluation. In contrast, the General Functioning section demonstrated a Cronbach’s alpha coefficient of 0.92, indicating excellent internal consistency.

These differences are important when interpreting results. Although the General Functioning section demonstrates strong internal consistency, findings based on the Deviant Behavior section should be interpreted with greater caution, particularly when the scale is applied to new populations or used as a primary outcome measure.

References

Anzai, N., Yoneda, S., Kumagai, N., Nakamura, Y., Ikebuchi, E., & Liberman, R. P. (2002). Rehab Rounds: Training Persons with Schizophrenia in Illness Self-Management: A Randomized Controlled Trial in Japan. Psychiatric Services, 53(5), 545–547.

Baker, R. D., & Hall, J. N. (1984). REHAB: Rehabilitation Evaluation Hall and Baker. Aberdeen: Vine Publishing.

Baker, R., & Hall, J. N. (1988). REHAB: A New Assessment Instrument for Chronic Psychiatric Patients. Schizophrenia Bulletin, 14(1), 97–111.

Pinto, J. O., Dores, A. R., Geraldo, A., Peixoto, B., & Barbosa, F. (2020). Sensory Stimulation Programs in Dementia: A Systematic Review of Methods and Effectiveness. Expert Review of Neurotherapeutics, 20(12), 1229–1247.

Zissi, A., & Barry, M. (1997). Using the REHAB Scale in a Greek Context. International Journal of Rehabilitation Research, 20, 183–188.