An Overview of Rehabilitation for Doctors
Original Editor - Daphne Xuan
What is Rehabilitation?[edit | edit source]
A study in 2019 found that 2.4 billion people worldwide were living with a health condition that would benefit from rehabilitation at some point in the course of their illness or injury. This equates to about one in three people in the world, and is equivalent to 310 million years of life lived with disability. These numbers have already increased by 63% since about 30 years ago, and they are expected to continue to increase significantly as the global population grows, ages, and lives longer, often 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 is 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 of Rehabilitation[edit | edit source]
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 across an individual's entire lifespan. 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:
Rehabilitation Settings[edit | edit source]
- Hospitals (inpatient/outpatient)
- Private clinics
- Institutions (e.g. schools, prisons)
- Rehabilitation centres
- Community settings (e.g. an individual's home)
- Long-term care
- And more
Benefits of rehabilitation[edit | edit source]
There are multiple 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 and 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[edit | edit source]
The following are eight key members of the rehabilitation team, although it is not limited to these professions and can vary depending on the context.
Physical Medicine and Rehabilitation (PM&R) Doctor / Physiatrist[edit | edit source]
According to the American Academy of Physical Medicine and Rehabilitation, physiatrists "evaluate and treat patients with short- or long-term physical/cognitive impairments and disabilities that result from musculoskeletal conditions, neurological conditions, or medical other conditions. Their goal is to decrease pain and enhance performance without surgery."
Physiatrists usually lead a team of other professionals in order to provide optimal and holistic care.
Interventions can include:
- Prescription of pharmacological treatments
- Ultrasound and fluoroscopy-guided procedures
- Nerve stimulators
- Spasticity treatment
- And more
Rehabilitation Nurse[edit | edit source]
Rehabilitation nurses provide care to individuals right after the onset of any disabling injury or chronic illness and follow them through until they reach their goals.  Rehabilitation nurses' role encompasses personal care, activities of daily living, short- and long-term health, social and independence issues, emotional support, as well as educating the patient and family. They are often present with the patient "24-7", spending more cumulative time with the patient than the rest of the team members.
There is currently a shift towards a more proactive approach in rehabilitation nursing, in that nurses are delivering care with the patient rather than just for the patient, and encouraging the individual to participate in their own care as much as they are able to.
Physiotherapist / Physical Therapist[edit | edit source]
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
- Gait training
- Wheelchair management
- Wound care
- Pelvic floor rehabilitation
- And more
To learn more about the role of a physiotherapist, please review this page.
Occupational Therapist[edit | edit source]
The World Federation of Occupational Therapists defines occupational therapy as "a client-centred health profession concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement." In this context, "occupations" refers to the activities people do every day, whether that is by themselves or with other people.
Occupational therapists have been educated in the medical, social behavioural, psychological, psychosocial, and occupational sciences and work with a wide range of conditions, though most often in relation to physical, mental, affective, and cognitive problems.
Interventions can include:
- Therapeutic use of occupations, exercises, and activities
- Training in self-management
- Modification of environment
- Assistive technology and devices
- Driver rehabilitation
- Wheelchair management
- Adaptation of processes
- Visual rehabilitation
- And more
To learn more about the role of an occupational therapist, please review this page.
Speech and Language Therapist / Pathologist[edit | edit source]
Speech and language therapists assess and treat people of all ages with speech, language, communication, eating, drinking, and swallowing problems. Communication refers to processes associated with comprehension and production of language, whether it is oral, written, non-verbal, or an alternative form of communication. It also includes the social and cognitive aspects of communication. Speech and language therapists have extensive knowledge of the head, neck, and respiratory system.
Interventions can include:
- Therapeutic exercises
- Augmentative and alternative communication (AAC) technologies
- Biofeedback systems
- And more
To learn more about the role of a speech and language therapist, please review this page.
Audiologist[edit | edit source]
Audiologists provide services related to the assessment, treatment, and prevention of hearing loss and auditory and vestibular impairments and disorders. This includes tinnitus, vertigo, ototoxicity, auditory processing disorders, and various types of hearing loss. Audiologists also prescribe and fit hearing aids and assistive listening and alerting devices.
Interventions can include:
- Auditory training
- Cerumen management
- Communication strategies
- Technology interventions
- Auditory and vestibular rehabilitation
To learn more about the role of an audiologist, please review this page.
Orthotist / Prosthetist[edit | edit source]
Orthotists and prosthetists treat individuals through the fabrication and application of orthoses and prostheses to optimise function. An orthosis is a device externally applied to the body to modify structural and functional characteristics, such as braces or splints. A prosthesis is a device externally applied to the body to completely or partially replace an absent or deficient limb segment, such as an artificial leg. Orthotic and prosthetic devices can also include mobility aids, such as walking frames.
To learn more about the role of an orthotist and/or prosthetist, please review this page.
Clinical Psychologist[edit | edit source]
Clinical psychologists assess and treat individuals with a range of psychological difficulties relating to both mental and physical health. Conditions can include anxiety, depression, psychosis, eating disorders, addictions, et cetera.
Treatment aims to reduce distress and symptoms, improve coping and functioning to allow individuals to participate in their relationships as well as activities.  This includes different psychotherapy approaches, such as behavioural, cognitive, family, and more.
The Role of Doctors on the Interdisciplinary Rehabilitation Team[edit | edit source]
Doctors have an important role and responsibility within the interdisciplinary rehabilitation team.
Interdisciplinary Teamwork[edit | edit source]
The terms 'interdisciplinary' and 'multidisciplinary' are sometimes used interchangeably, but there is a distinction between the two. On a multidisciplinary team, all members work parallel to each other. They have specifically defined roles based on their professions and there is a hierarchy of authority. The physician is responsible for leading the team and coordinating the care carried out, but each team member will develop their own goals for the client or patient. While the physician communicates with all of the team members, the other team members would not necessarily communicate with each other.
On an interdisciplinary team, while the physician can still be responsible for leading the team, the team members work together with the patient to determine collective goals and treatment plans. There should be no hierarchy as everyone is seen as being on the same level. The team meets regularly to collaborate and communicate. Korner notes that "communication is continuous and multilateral" on an interdisciplinary team.
As Hooker and Emery-Tiburcio have pointed out, "no single professional is likely to achieve optimal results alone." Available evidence suggests multiple benefits to the interdisciplinary approach, including improved outcomes in patients with chronic pain, traumatic brain injury, pulmonary rehabilitation, low back pain, and stroke. Shorter lengths of stay, reduced hospital costs, and increased patient/family/staff satisfaction have also been found. Singh et al. credits the effectiveness of this approach to the acceptance of blurred boundaries between different team members. This facilitates more efficient information transfer as well as earlier interventions and discharge.
The Role of Doctors[edit | edit source]
While the success of the team is the responsibility of all of the members on the team, doctors have been the ones to lead the teams in most healthcare settings. In this sense, they have the responsibility of coordinating the collaboration of the team. In addition, in many countries, the legal responsibility for the patient and decisions made for the patient often lies with the doctor, so the doctor must be aware of any decisions made as well as be able to defend them.
The doctor should ensure that the appropriate health professionals are on the team in order to meet the care needs of the patient, that there is effective coordination and communication of the team, and that the team is working with a unified purpose, ultimately to optimise the outcomes for the patient. In addition, in many places in the world, individuals are still unable to access rehabilitation professionals directly. This means their first point of contact will be with the doctor, who then has the power to provide referrals to other professionals or for imaging. As such, it is extremely important that doctors have a thorough understanding of who the members of the rehabilitation team are and the knowledge and skills that each provides. The doctor should ensure that the appropriate rehabilitation team is put in place right from the start of care as part of the primary care team. Through collaboration with the team, the doctor is also able to order the appropriate assessments and ongoing treatments for the patient.
A successful interdisciplinary rehabilitation team would include the following features:
- Agreed aims
- Agreement and understanding on how best to achieve these aims
- Avoiding jargon unique to particular professions during communication
- Appropriate range of knowledge and skills for the agreed task
- Mutual trust and respect
- Willingness to share knowledge and expertise and speak openly (being comfortable with blurred professional boundaries)
- Regular meetings
- Patient / client-focused care with shared decision making
Resources[edit | edit source]
References[edit | edit source]
- Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021 Dec 19;396(10267):2006-2017.
- Cieza A, Kwamie A, Magaqa Q, Paichadze N, Sabariego C, Blanchet K, Zia N, Bachani AM, Ghaffar A, Mikkelsen B. Framing rehabilitation through health policy and systems research: priorities for strengthening rehabilitation. Health Res Policy Syst. 2022 Sep 20;20(1):101.
- World. Rehabilitation [Internet]. Who.int. World Health Organization: WHO; 2021 [cited 2022 May 16]. Available from: https://www.who.int/news-room/fact-sheets/detail/rehabilitation
- Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health, functioning, and disability in older adults--present status and future implications. Lancet. 2015 Feb 7;385(9967):563-75.
- Stucki G, Bickenbach J, Gutenbrunner C, Melvin J. Rehabilitation: The health strategy of the 21st century. J Rehabil Med. 2018 Apr 18;50(4):309-316
- Orji A, Kamenov K, Dirac M, Davis A, Chadha S, Vos T. Global and regional needs, unmet needs and access to hearing aids. Int J Audiol. 2020 Mar;59(3):166-172.
- About Physical Medicine & Rehabilitation [Internet]. aapmr.org. 2021 [cited 2022 May 17]. Available from: https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation
- Singh R, Küçükdeveci AA, Grabljevec K, Gray A. The role of Interdisciplinary Teams in Physical and Rehabilitation Medicine. J Rehabil Med. 2018 Aug 22;50(8):673-678.
- What Types of Treatments and Procedures Do Physiatrists Perform [Internet]. aapmr.org. 2021 [cited 2022 May 17]. Available from: https://www.aapmr.org/career-support/medical-student-resources/a-medical-students-guide-to-pm-r/what-types-of-treatments-and-procedures-do-physiatrists-perform%0A%0A
- Gutenbrunner C, Stievano A, Nugraha B, Stewart D, Catton H. Nursing–a core element of rehabilitation. International Nursing Review. 2022 Mar;69(1):13-9.
- Rehabilitation Team Members [Internet]. Physiopedia. 2020 [cited 2022 May 17]. Available from: https://www.physio-pedia.com/Rehabilitation_Team_Members
- Gutenbrunner C, Stievano A, Nugraha B, Stewart D, Catton H. Nursing - a core element of rehabilitation. Int Nurs Rev. 2022 Mar;69(1):13-19.
- What is physiotherapy? [Internet]. World Physiotherapy. 2021 [cited 2022 May 17]. Available from: https://world.physio/resources/what-is-physiotherapy
- Description of physical therapy Policy statement [Internet]. Available from: https://world.physio/sites/default/files/2020-07/PS-2019-Description-of-physical-therapy.pdf
- Role of Physiotherapist in a Rehabilitation Team [Internet]. Physiopedia. 2019 [cited 2022 May 17]. Available from: https://www.physio-pedia.com/Role_of_Physiotherapist_in_a_Rehabilitation_Team
- World Federation of Occupational Therapists [Internet]. WFOT. 2017 [cited 2022 May 17]. Available from: https://wfot.org/about/about-occupational-therapy
- World Federation of Occupational Therapists. Statement on Occupational Therapy [Internet]. WFOT. 2010 [cited 2022 May 17]. Available from: https://www.wfot.org/resources/statement-on-occupational-therapy
- World Federation of Occupational Therapists. Definitions of Occupational Therapy from Member Organisations [Internet]. WFOT. 2012 [cited 2022 May 17]. Available from: https://wfot.org/resources/definitions-of-occupational-therapy-from-member-organisations
- Role of Speech and Language Therapist in a Rehabilitation Team [Internet]. Physiopedia. 2019 [cited 2022 May 17]. Available from: https://www.physio-pedia.com/Role_of_Speech_and_Language_Therapist_in_a_Rehabilitation_Team
- Scope of Practice - The American Academy of Audiology [Internet]. The American Academy of Audiology. 2022 [cited 2022 May 17]. Available from: https://www.audiology.org/practice-resources/practice-guidelines-and-standards/scope-of-practice/
- Role of Audiologist in a Rehabilitation Team [Internet]. Physiopedia. 2017 [cited 2022 May 17]. Available from: https://www.physio-pedia.com/Role_of_Audiologist_in_a_Rehabilitation_Team#cite_ref-:0_1-1
- Scope of Practice in Audiology [Internet]. Asha.org. 2018 [cited 2022 May 17]. Available from: https://www.asha.org/policy/sp2018-00353/
- ISPO Education Standards for Prosthetic/Orthotic Occupations [Internet]. [cited 2022 May 17]. Available from: https://cdn.ymaws.com/www.ispoint.org/resource/resmgr/3_learn/ispo_standards_nov2018_sprea.pdf
- Standards for Prosthetics and Orthotics [Internet]. World Health Organization. 2017 [Cited 2022 May 17]. Available from:https://apps.who.int/iris/bitstream/handle/10665/259209/9789241512480-part1-eng.pdf.
- What is an orthotist/prosthetist? - The Australian Orthotic Prosthetic Association Ltd. (AOPA) [Internet]. Aopa.org.au. 2022 [cited 2022 May 17]. Available from: https://www.aopa.org.au/careers/what-is-an-orthotistprosthetist-2
- Clinical psychologist. Clinical psychologist [Internet]. Health Careers. 2015 [cited 2022 May 17]. Available from: https://www.healthcareers.nhs.uk/explore-roles/psychological-therapies/roles/clinical-psychologist
- Clinical Psychology Section - Canadian Psychological Association [Internet]. Canadian Psychological Association - The national voice for psychology in Canada. 2018 [cited 2022 May 17]. Available from: https://cpa.ca/sections/clinicalpsychology/
- Körner M. Interprofessional teamwork in medical rehabilitation: a comparison of multidisciplinary and interdisciplinary team approach. Clin Rehabil. 2010 Aug;24(8):745-55.
- Hooker S, Emery-Tiburcio EE. Interdisciplinary Team Rehabilitation. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology, 2018;Springer, Cham.
- Neumann V, Gutenbrunner C, Fialka-Moser V, Christodoulou N, Varela E, Giustini A, Delarque A. Interdisciplinary team working in physical and rehabilitation medicine. J Rehabil Med. 2010 Jan;42(1):4-8.
- Behm J, Gray N. Chapter 5: Interdisciplinary Rehabilitation Team [Internet]. Rehabilitation Nursing. 2012 [cited 2022 May 17]. Available from: https://samples.jbpub.com/9781449634476/80593_ch05_5806.pdf