Specialists in Physical and Rehabilitation Medicine manage a complex role, which starts with a clear medical diagnosis followed by a functional and social assessment and continues with the documentation of the patient's rehabilitation goals. The rehabilitation process involves a comprehensive interdisciplinary strategy usually delivered by an interdisciplinary rehabilitation team. The process ends with an assessment of rehabilitation outcomes.
A PRM Programme of Care is a good way to describe PRM activity and may be the best approach to help others understand our specialty. A PRM programme of care can be defined on the following basis :
- Epidemiological needs and scientific evidence sustaining the programme design.
- A target population, with inclusion and exclusion criteria.
- General goals, expressed with respect to the ICF core
- A well structured content, with details about the different stages, diagnosis and assessment tools (for the initial, follow up and final periods), scheduled interventions (direct treatment, education and training, rehabilitation), and the precise role of each participant in the programme
- Adapted equipment and manpower required including eam management.
- Validated assessment tools which help the rehabilitation team make clinical decisions and to provide objective data on the effectiveness of the programme.
- Discharge criteria should be described and the final report should incorporate recommendations for long term follow up.
Describing a PRM Programme of Care in writing documents our rehabilitation practice in a structured framework, rather than to import a ready-to-use procedure. This process allows better understanding of the goals and the nature of each intervention and provides a structure for PRM activity.
Clearly describing a PRM Programme of Care is a good basis for developing a quality approach. Describing a Programme of Care will help emphasise the core elements of rehabilitation activity. The accreditation process may raise elements which can be improved through a further action plan. Structured accreditation assessments can also produce interesting data about rehabilitation outcomes.
PRM Programmes of Care can adapt general principles applicable to rehabilitation in different settings. For example, early PRM intervention in an acute care hospital for people with a brain injury will be a different programme than a community based unit. A Posture and Movement Assessment Unit may involve another type of programme structure. If you work in an urban academic environment which receives tertiary referrals from other centres, your programme may address a specific population.. On the other hand, your programme may have to satisfy diverse rehabilitation needs of a mainly rural population. Various types of rehabilitation programmes can be considered for accreditation.
Programmes of Care must address one specific clinical element, rather than describe the overall activity of a PRM Department. For example, it would bee appropriate to focus on a "stroke programme" rather than submitting a programme about "neurological conditions" at large.
The main criteria describing a submitted programme include :
- An impairment (pathology): spinal cord injury, knee ligament reconstruction, stroke...
- An activity and participation limitation : walking disability, aphasia...
- A vocational goal : independent living for brain injured people, employment for people with chronic low back pain
- A significant functional limitation e.g. sportsmen(women) with musculo-skeletal injuries, manual workers with low back pain, elderly people with falls risks...
If you wish to submit a programme, please go to next section.
Prof Mark Delargy
Chairman of the Clinical Affairs Committee