Physical and Rehabilitation Medicine (PRM) is a medical specialty that helps people regain body functions they lost due to medical conditions or injury. It is responsible for the prevention, diagnosis, treatment and rehabilitation management of persons of all ages with disabling health conditions. It specifically addresses impairments and activity limitations in order to facilitate people’s functioning (physical and cognitive) and participation in meaningful activities, thus improving quality of life.
Health professionals in this field include physical therapists, occupational therapists, speech and language therapists, psychologists, rehabilitation nurses and PRM doctors (physiatrists). Other medical specialties important to this field include neurology, orthopedics. Effective rehabilitation demands a teamwork approach where team members include the various healthcare professionals, the patient and their family or caregivers.
Most common conditions in PRM are disabling diseases or injuries. Examples include brain disorders (e.g. stroke, multiple sclerosis, cerebral palsy), long-term (chronic) pain (e.g. back pain, shoulder or other joint pains), major bone or joint surgery, severe burns or limb amputations, arthritis, severe weakness after recovery from a serious illness, spinal cord or brain injuries. Physical and rehabilitation medicine also include sports medicine and injury prevention in various occupational or lifestyle settings.
Physical and Rehabilitation Medicine (PRM) is a medical specialty that helps people regain body functions they lost due to medical conditions or injury.
Why PRM is essential
Surviving from serious disease, trauma or injury leaves many people with complex problems and functional deficits. Examples may include chronic pain, deficits in self care, mobility and communication that would limit their ability to perform activities of daily living or participation in meaningful activities in the community.
These events may occur during active years of individuals, sometimes early in life, leaving victims with many decades of survival. In the cases of stroke, traumatic brain injury, polytrauma (multiple injuries) or childhood cancer for instance, one may have to battle with secondary complications of immobility and chronic pain such as pressure ulcers, contractures, behavioral problems and mood changes for a long time. Well organized acute care and rehabilitation services in these events are essential for greater survival and better outcomes.
In long-term conditions, especially those of neurological nature, specialized rehabilitation services are highly cost-efficient, producing substantial savings in ongoing care costs, especially in high-dependency patients. Where rehabilitation services are not employed, patients may suffer preventable complications and will end up incurring greater expenditure on health and social care elsewhere or subsequently as a consequence
Levels of PRM Services
PRM services in clinal settings are offered at three main levels, categorized as follows:
- Acute rehabilitation. These services start during intensive care, mostly delivered in hospitals at the secondary and tertiary levels and are performed in multi-professional teams working in collaborative way.
- Post-acute rehabilitation. This level entails services delivered immediately or shortly after discharge from acute care units. Patients with less restrictions can be referred to out-patient post-acute rehabilitation services, but in more severe cases they are done in in-patient settings, that is where a patient has substantial nursing and medical needs, or has important limitations in mobility and activities of daily living.
- Long-term rehabilitation. This level aims to maintain (and improve) functioning for persons with long-term disability or disabling health conditions including those borne with (congenital) and those acquired through injury or long-term (chronic) disease. If no specialized rehabilitation exists, Community Based Rehabilitation (CBR) is used as a model to provide minimum rehabilitation services to persons in need.
The main goal of rehabilitation therapy is independence – teaching people how to take care of themselves as much as possible. It focuses on enabling patients to perform activities of daily living such as eating, bathing, using the bathroom and moving from one place to another, with appropriate use of necessary assistive devices where necessary.
Physical and rehabilitation medicine plays important roles across different levels of healthcare systems, from prevention, promotion, treatment and support to rehabilitation. It improves the quality of lives of people living with various forms of disabling conditions. Provision of these services is effective in reducing the burden of disability, thus enhancing opportunities for everyone.