Ethical complexities in rehabilitation research: an integrative review of challenges and principles

Rehabilitation research involves unique ethical complexities due to the heterogeneous nature of disability and participant vulnerability. Despite established international ethical principles, there appears to be a significant gap in context-sensitive ethical frameworks specifically tailored for rehabilitation settings. This integrative review aims to analyze the ethical challenges and principles reported in rehabilitation research. Following the integrative review methodology by Whittemore and Knafl (2005), a comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Cochrane, and Web of Science from their inception to December 2024. The search strategy used controlled vocabulary and keywords related to ethics, rehabilitation, and disability. Additional hand searching of reference lists and key journals was conducted to ensure comprehensive coverage. The review included all studies published in English, focusing on ethical issues in rehabilitation research. Data were analyzed using the constant comparative method. From 150 initially identified records, nine studies met full inclusion criteria. The analysis and subsequent interpretation of the evidence identified seven interconnected ethical domains: (1) systemic neglect of specialized ethical guidelines; (2) methodological challenges jeopardizing ethical rigor; (2) complexities in decision-making capacity and informed consent; (4) therapeutic misconception and inflated hope for a cure; (5) communication barriers; (6) ethical ambiguities in participant incentives; and (7) institutional and systemic barriers within ethics review boards. The synthesized evidence suggests that ethical challenges in rehabilitation research are multifaceted and deeply interconnected. The findings highlight the need to shift from reactive compliance toward a more proactive, integrated system of ethical governance. Future efforts can focus on developing context-sensitive ethical guidance, strengthening stakeholder engagement, and promoting adaptive research methodologies to ensure rehabilitation research remains ethically grounded and socially relevant.