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Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 111-112

6.3A Clinical sciences in physical and rehabilitation medicine: A brief commentary

1 Department of Physical Medicine, Rehabilitation and Sports Medicine, School of Medicine, University of Puerto Rico, Puerto Rico, San Juan, PR, USA
2 Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany

Date of Web Publication11-Jun-2019

Correspondence Address:
Prof. Walter R Frontera
Department of Physical Medicine, Rehabilitation and Sports Medicine, School of Medicine, University of Puerto Rico, Puerto Rico, San Juan, PR
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisprm.jisprm_26_19

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How to cite this article:
Frontera WR, Guttenbrunner C, Nugraha B. 6.3A Clinical sciences in physical and rehabilitation medicine: A brief commentary. J Int Soc Phys Rehabil Med 2019;2, Suppl S1:111-2

How to cite this URL:
Frontera WR, Guttenbrunner C, Nugraha B. 6.3A Clinical sciences in physical and rehabilitation medicine: A brief commentary. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2019 Aug 20];2, Suppl S1:111-2. Available from: http://www.jisprm.org/text.asp?2019/2/2/111/259352

Like all medical specialties, the value of physical and rehabilitation medicine (PRM) in a clinical setting depends on many factors. Arguably, one of the most important factors is the strength of the evidence that supports the clinical practice of PRM and the use of various rehabilitation interventions. This evidence-based approach to the practice of clinical medicine is grounded on the principle that clinical decisions should relate to the available scientific evidence.[1] In other words, the art of clinical medicine must be supported by evidence generated during the conduct of scientific investigations. In every instance, when we have an interest in validating a new outcomes scale, testing a new assistive device, or study the efficacy of a new procedure, it is necessary to apply acceptable clinical and scientific principles.

The strength of the evidence is an important determinant factor of the priority, we assigned to rehabilitation interventions in persons with chronic health conditions and/or experiencing disability. The generation of the new knowledge needed to strengthen PRM and to deliver the best possible clinical care can be accomplished using several approaches. The use of clinical study designs that, by their very nature, generate evidence that can be trusted more than uncontrolled experimentation is an example of this approach. A specific illustration is the conduct of well-designed randomized clinical trials (RCTs) considered by many the gold standard for clinical research. It is important to note that, despite the strength of the evidence generated by RCTs, these are not always possible, nor desirable, in the context of a rehabilitation question. For example, blinding, an important element of traditional RCTs, is not achievable in many rehabilitation trials due to the nature of the intervention such as strengthening exercises. In addition, the value of other study designs should not be underestimated.[2],[3] Improving our methodological approach for the generation of evidence is one of the most important challenges for PRM. It is of interest to note that PRM is not the only medical specialty that is facing similar challenges and focusing on the importance of the strength of the different levels of evidence.[4]

Another approach to the translation of science to clinical practice is the use of systematic reviews with specialized statistical techniques (meta-analysis) to consolidate evidence from different studies. An example of this tactic is the typical Cochrane review.[5] The establishment of Cochrane Rehabilitation, as an official field within the Cochrane system, should contribute to our goal of strengthening rehabilitation research and clinical practice. Although there is some debate about the exact definition of “translation science,” the ultimate objective of translational research is to make clinical sciences stronger and more trustworthy.[6]

In addition to the “classical” clinical research that may lead to the best effective rehabilitation interventions and guidelines for patients, clinical PRM sciences also relate to organization and quality management of clinical services, coordination, education and training of professionals in clinical rehabilitation, and evaluation of the rehabilitation team and multidisciplinary care.[7]

Notwithstanding the particular challenges of rehabilitation research, in terms of the generation of new knowledge and the publication of stronger evidence, the field of PRM has made significant advances in the past three decades. The number of articles published in the categories of “rehabilitation” and “rehabilitation medicine” has increased dramatically by a factor of 3 and 6, respectively, since 2000.[8] A similar trend has been noted in the number of published clinical trials in the same period. Because of the increase in rehabilitation research activity around the world, this positive trend is likely to continue.

The following chapter is an extensive reflection on this topic and will provide the reader with a thorough discussion of the subject matter.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn't. BMJ 1996;312:71-2.  Back to cited text no. 1
Benson K, Hartz AJ. A comparison of observational studies and randomized controlled trials. N Engl J Med 2000;342:1878-86.  Back to cited text no. 2
Dijkers MP, Bushnik T, Heinemann AW, Heller T, Libin AV, Starks J, et al. Systematic reviews for informing rehabilitation practice: An introduction. Arch Phys Med Rehabil 2012;93:912-8.  Back to cited text no. 3
Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011;128:305-10.  Back to cited text no. 4
Kiekens C, Negrini S, Thomson D, Frontera W. Cochrane physical and rehabilitation medicine: Current state of development and next steps. Am J Phys Med Rehabil 2016;95:235-8.  Back to cited text no. 5
Fort DG, Herr TM, Shaw PL, Gutzman KE, Starren JB. Mapping the evolving definitions of translational research. J Clin Transl Sci 2017;1:60-6.  Back to cited text no. 6
Stucki G, Grimby G. Organizing human functioning and rehabilitation research into distinct scientific fields. Part I: Developing a comprehensive structure from the cell to society. J Rehabil Med 2007;39:293-8.  Back to cited text no. 7
Frontera WR. The scientific article and the future of physical and rehabilitation medicine. J Int Soc Phys Rehabil Med 2018;1:4-8.  Back to cited text no. 8
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