Concepts and Models of Physical and Rehabilitation Medicine Services

From a health perspective, rehabilitation can be regarded as a general health strategy with the aim of enabling persons with health conditions experiencing or likely to experience disability to achieve and maintain optimal functioning. Physical and Rehabilitation Medicine (PRM) is a medical specialty with a holistic approach of patients and deals with the consequences of a health condition, not only at the level of impairments (structure and function) but also of activity limitations and participation restrictions. As described in the framework of the International classification of Function, Disability and Health (ICF) it also takes into account personal and environmental factors. In 2005 – 2007 a study was performed in Belgium by government order on the organization and financing of musculoskeletal and neurological rehabilitation. The current situation was analysed and proposals for improvement were made. A stratified model comprising three levels of rehabilitation was developed. The levels were general, specific and highly specific rehabilitation, depending upon the level of complexity of the patient's rehabilitation needs and the incidence/prevalence of the health condition. Patients are to be assigned to a PRM service offering the adequate level of rehabilitation by means of a patient classification system. Services at these different levels should collaborate in a network and patients should move in the network depending on the phase and their rehabilitation needs at that point. There is also a need for a comprehensive classification system of health-related rehabilitation services. In this lecture data from the Belgian study will be presented, followed by a conceptual description of health-related rehabilitation as a basis for a classification of health-related rehabilitation services.

References:

[1] https://kce.fgov.be/publication/report/organisation-and-financing-of-musculoskeletal-and-neurological-rehabilitation-in-#.VUaTy_msWSo ISPRM discussion paper: Proposing a conceptual description of health-related rehabilitation services. Meyer T1, Gutenbrunner C, Kiekens C, Skempes D, Melvin JL, Schedler K, Imamura M, Stucki G. J Rehabil Med. 2014 Jan;46(1):1 – 6.