An Overview of Rehabilitation for Doctors

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Original Editor - Daphne Xuan

Top Contributors - Daphne Xuan, Ewa Jaraczewska, Tarina van der Stockt, Kim Jackson and Jess Bell  

What Is Rehabilitation?

A Global Need

A study in 2019 found that there were 2.4 billion people worldwide who were living with a health condition that would benefit from rehabilitation at some point in the course of their illness or injury, which equates to about one in three people in the world. This was equivalent to 310 million years of life lived with disability. These numbers have already increased by 63% since about 30 years ago and are expected to continue to increase significantly as the global population grows, ages, and lives longer, many with chronic conditions and non-communicable diseases. The three largest groups of health conditions found to contribute to disability were musculoskeletal disorders, sensory impairments, and neurological disorders.

Unfortunately, many people who require rehabilitation are not receiving it. More than half of the people who need rehabilitation in some low- and middle-income countries do not receive it. By 2050, low- and middle-income countries will be home to 80% of the global population aged 60 and up. Rehabilitation in many countries is often under-resourced and seen as a backup for when other interventions fail. The World Health Organization (WHO) has identified that, among other factors, one of the barriers we face is ineffective and under-utilised referral pathways to rehabilitation. Cieza and colleagues suggest that rehabilitation services need better integration into the health system at the primary care level.

Misconceptions exist about who needs rehabilitation services: that it is only for people with certain long-term impairments or disabilities, that it's a luxury service, or that it's only for when other interventions fail. In reality, anyone can require rehabilitation at some point in the course of their lives and it is a core healthcare service that should be available to all who need it.

Definition

The WHO defines rehabilitation as the following:

"A set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment... rehabilitation helps a child, adult, or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation, and meaningful life roles such as taking care of family."

Rehabilitation is accomplished through selecting evidence-based and person-centred interventions to address conditions and limitations, improve function, and provide support. It can play a big role in health promotion, maintenance, and prevention. Specific goals will differ person to person depending on their goals and preferences.

Rehabilitation professionals will typically go through a process that includes some or all of the following:

• Assessment
• Diagnosis
• Planning
• Education
• Intervention
• Evaluation/re-evaluation
• Collaboration

Where Does Rehabilitation Occur?

• Hospitals (inpatient/outpatient)
• Private clinics
• Institutions (e.g. schools, prisons)
• Rehabilitation centres
• Community settings (e.g. an individual's home)
• Long-term care
• Workplaces
• And more

Benefits of Rehabilitation

On an individual level, rehabilitation can reduce the impact of health conditions; minimise or delay the effects of chronic conditions; increase independence; enable participation in work, school, and other life activities; and improve quality of life. For example, if everyone who had hearing loss who required a hearing aid used one, the associated disability would be decreased by 59%.

On a system and societal level, rehabilitation can reduce hospitalisation and length of stays, prevent readmissions, and subsequently reduce overall costs. In addition, it allows individuals to continue to contribute to and participate in society as fully as possible for as long as possible.

Members of the Rehabilitation Team

Physical Medicine and Rehabilitation (PM&R) Doctor/Physiatrist

Rehabilitation Nurse

Physiotherapist/Physical Therapist

According to World Physiotherapy, a physiotherapist provides services that "develop, maintain, and restore maximum movement and functional ability throughout the lifespan. The service is provided in circumstances where movement and function are threatened by ageing, injury, pain, diseases, disorders, conditions and/or environmental factors and with the understanding that functional movement is central to what it means to be healthy."

A physiotherapist has a deep understanding of the body's structure and function and can provide services related to orthopaedic, neurological, respiratory, cardiovascular, sexual, visual, and vestibular function. Physiotherapists take an active functional rehabilitation approach in therapy.

Interventions can include:

• Therapeutic exercise
• Manual therapy
• Functional training
• Use of assistive devices
• Airway clearance
• Electrotherapeutic and mechanical modalities
• Modification of environment or home
• And more

Occupational Therapist

Speech and Language Therapist/Pathologist

Audiologist

Orthotist/Prosthetist

Clinical Psychologist

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