|CHAPTER 3: PHYSICAL AND REHABILITATION MEDICINE (PRM) - CLINICAL SCOPE
|Year : 2019 | Volume
| Issue : 2 | Page : 25-28
3.1 Physical and rehabilitation medicine: Clinical scope – Definition and basic competencies
Christoph Gutenbrunner1, Anthony B Ward2, Boya Nugraha1
1 Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany
2 North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke-on-Trent, UK
|Date of Web Publication||11-Jun-2019|
Prof. Christoph Gutenbrunner
Department of Rehabilitation Medicine, Hannover Medical School, Hannover
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gutenbrunner C, Ward AB, Nugraha B. 3.1 Physical and rehabilitation medicine: Clinical scope – Definition and basic competencies. J Int Soc Phys Rehabil Med 2019;2, Suppl S1:25-8
|How to cite this URL:|
Gutenbrunner C, Ward AB, Nugraha B. 3.1 Physical and rehabilitation medicine: Clinical scope – Definition and basic competencies. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2019 Aug 20];2, Suppl S1:25-8. Available from: http://www.jisprm.org/text.asp?2019/2/2/25/259370
| Definitions|| |
In coincidence with the conceptual description of rehabilitation as a health strategy (see chapter 2.1), physical and rehabilitation medicine (PRM) has been described as the medical specialty that uses rehabilitation as its core health strategy and therefore follows the overall goal to enable persons with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning in interaction with the environment. To reach this goal, PRM physicians have to diagnose health conditions taking into account the International Classification of Diseases, assesses functioning in relation to health conditions, personal and environmental factors and perform, and apply and/or prescribe biomedical and technological interventions. PRM core competencies also include to lead and coordinate (complex) intervention programs that should be performed as a patient-centered problem-solving process and as a partnership between the person and provider and in appreciation of the person's perception of his or her position in life. Such interventions programs besides physical medicine interventions mostly include psychological and behavioral, educational and counseling, occupational and vocational, social and supportive, and physical environmental interventions. PRM physicians are trained to deliver health-related rehabilitation over the course of a health condition (in acute, postacute, long-term, and progressive phases), for all age groups and in various settings (including hospitals, rehabilitation facilities, and the community) and across sectors (including health, education, labor, and social affairs). In addition, training in PRM also includes skills to provide education to patients and relatives to promote functioning and health, to manage rehabilitation, health, and multi-sectoral services and to inform and advise the public and decision-makers about suitable policies and programs.
Another definition of the specialty has been proposed by the European Alliance of PRM Bodies. It reads as follows: “PRM is the primary medical specialty responsible for the prevention, medical diagnosis, treatment, and rehabilitation management of persons of all ages with disabling health conditions and their comorbidities, specifically addressing their impairments and activity limitations in order to facilitate their physical and cognitive functioning (including behaviour), participation (including quality of life), and modifying personal and environmental factors.”
| Clinical Competencies|| |
Besides basic principles of clinical work (including the concept of evidence-based medicine) and the model of functioning, daily clinical practice varies a lot among countries and health systems [Figure 1]. At the micro-level PRM physician's work has to respond to the pathologies treated and the level of disabilities experienced by the patients (micro level of health care). The level and structure of the service in which the individual PRM physician works also influences the competency levels, for example, depending on technical equipment, team structure, payment and reimbursement system, and other factors (meso level of health care). Last but not least, factors such as epidemiology, health-care system organization, and health policies influence PRM practice, for example, by responding to special needs of the populations and to follow specific goals of the health-care system (e.g., return-to-work) (micro level of health care).
|Figure 1: Scheme on the curative and rehabilitative strategy as well as the comprehensive approach of physical and rehabilitation medicine (modified) (with permission)|
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PRM physicians either work as single doctor, for example, when establishing the diagnosis, conducting functional assessments, and applying or prescribing treatments (including medicines, physical therapies, and other rehabilitation interventions) [Figure 2]. In many cases, he or she will collaborate with other medical specialists. This is of great importance for instance in postsurgical care, in intensive or intermediate care units, and in very complex pathologies (including rare diseases). As mentioned before, rehabilitation programs will be delivered as teamwork with many different health and other professionals, for example, Physiotherapists, Occupational Therapist, Speech and Language Therapists, Nurses, Psychologists, Social Workers, Prosthetic, and Orthotic Technicians.
|Figure 2: The field of competence of physical and rehabilitation medicine: leading principles (above) and fields of activity at micro, meso and macro level of rehabilitation care (with permission)|
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More specifically and in clinical work, PRM physicians have to respond to a large variety of patient's needs [Table 1]. This ranges from the prevention of complications in acute care, evaluation of functioning during postacute rehabilitation to musculoskeletal interventions, patient education, and workplace adaptation. This is one of the reasons why PRM physicians need a wide range of competencies and continue training even after specialization [Figure 3] and [Figure 4]., An overview on skills of PRM is given in [Table 2].
|Table 1: Patient's needs during acute, post-acute and long-term phases of rehabilitation as well as in prevention|
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|Figure 4: Level of training physical and rehabilitation medicine specialists: from basic skills to subspecialization (with permission)|
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|Table 2: Competencies of physical and rehabilitation medicine specialists|
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| Conclusion|| |
As the tasks performed by PRM physicians vary the Professional Practice Committee of the UEMS-PRM Section and Board is working on a series of papers to describe the role of PRM in specific health conditions and treatment and rehabilitation programs. These papers are published in an ebook format at www.euro-prm.org. The health problems and impairments of the patients treated by PRM physicians, the diagnostic tools and the allied interventions are described in the following subchapters.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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Gutenbrunner C, Neumann V, Lemoine F, Delarque A. Describing and developing the field of competence in physical and rehabilitation medicine (PRM) in Europe – Preface to a series of papers published by the professional practice committee of the PRM section of the union of European medical specialists (UEMS). Ann Phys Rehabil Med 2010;53:593-7.
Gutenbrunner C, Lemoine F, Yelnik A, Joseph PA, de Korvin G, Neumann V, et al.
The field of competence of the specialist in physical and rehabilitation medicine (PRM). Ann Phys Rehabil Med 2011;54:298-318.
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Gutenbrunner CW, Chamberlain MA, editors. White book on physical and rehabilitation medicine in Europe. J Rehabil Med 2007;39 Suppl 45:1-48.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]