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Tesio L, Scarano S, Caronni A. Physical and Rehabilitation Medicine: say relational or functional, not holistic. Eur J Phys Rehabil Med 2024; 60:182-189. [PMID: 38483334 PMCID: PMC11135122 DOI: 10.23736/s1973-9087.24.08309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 04/13/2024]
Abstract
Modern medicine tends to privilege disciplines promising "objective" laws governing body parts (from molecules to organs). Studies on a person's illness and disability are (apparently) confined to "subjectivity." The Specialty of Physical and Rehabilitation Medicine is often regarded as a humanitarian approach, belonging at best to the family of "soft," "qualitative," or "quasi-experimental" sciences. This specialty often claims specificity by labelling itself as "functional" and "holistic." However, it is shown here that the former term is acceptable, yet redundant, and the second misleading. When human behaviors and perceptions are at stake, "function" indicates a person's relationship with the outer world (already tackled by the definitional term "physical" from the Greek "physis"). The word "holistic" emphasizes mind-body unity and person-environment interdependence but, in current usage, overshadows the complementary need for an analytic, experimental approach to any function. Medicine aims at fighting disease and disability in single persons. This endeavor requires knowing body parts and mechanisms and understanding how interventions on "parts" affect the "whole." This understanding rests on the experimental method. For instance, returning to a given societal role (participation) may require restoration of walking (activity), which may require reinforcement of weakened muscular groups (impairment). Working only on holistic bio-psycho-social "wholes" may miss the therapeutic mission of medicine.
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Affiliation(s)
- Luigi Tesio
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy -
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio Caronni
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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A Conversation Between Past and Present Chairs of the American Board of Physical Medicine and Rehabilitation: Four Decades of History and the Future of Board Certification. Am J Phys Med Rehabil 2022; 101:S5-S9. [PMID: 35706111 DOI: 10.1097/phm.0000000000002034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT On the 75th anniversary of the founding of the American Board of Physical Medicine and Rehabilitation, 11 of the surviving chairs of the board convened virtually to reflect on the past 40 years of major trends for the accrediting body of physiatrists. The field rapidly expanded in the 1980s, driven by changes in the reimbursement environment. This rapid expansion drove an improvement in the caliber of residents choosing the field and in the quality of training programs. As physical medicine and rehabilitation evolved from a small- to medium-sized specialty, the board addressed many challenges: securing a credible position within the American Board of Medical Specialties; addressing a rising demand for subspecialty certification; improving training and exposure to physiatry; enhancing the quality of the accreditation process; and reducing the burden of accreditation on diplomates. The future development of physiatry includes improving diversity, equity, and inclusion, while restoring provider morale, well-being, and meaningfulness in work. Although challenges remain, physiatry as a field has grown to be well established through the board's efforts and respected within the larger medical community.
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Timm H, Thuesen J, Clark D. Rehabilitation and palliative care: histories, dialectics and challenges. Wellcome Open Res 2022; 6:171. [PMID: 35118198 PMCID: PMC8790711 DOI: 10.12688/wellcomeopenres.16979.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
Rehabilitation and palliative care are health care fields with separate histories but some recent convergences. Both have been identified as components within universal health coverage and each is the subject of a supportive World Health Assembly Resolution. We draw on the historiography of the two specialties, a recent systematic review of their engagement with each other as described in 62 studies, and critical policy perspectives to examine how rehabilitation and palliative care have been framed as potential partners in care. We examine the changing patient groups served by each field and the organizational forms that combined rehabilitation and palliative care (CRPC) may take. We explore the implications of such collaboration for the underlying goals and values of the two specialties, where each is the subject of changing definitions with differing responsibilities for regulating access to services as well as assuring and documenting quality. We conclude that to be effective CRPC must adapt to the highly segmented and specialized systems in which it is required to operate, recognizing that rehabilitation and palliative care are themselves co-constructors of such segmentation and specialization, but also potential agents for change.
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Affiliation(s)
- Helle Timm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
| | - Jette Thuesen
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, 5800, Denmark
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, Scotland, DG2 OXY, UK
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Foord D. Fitting places in knowledge translation: Biomedical innovation in healthcare practice. Health Policy 2021; 125:1330-1339. [PMID: 34493378 DOI: 10.1016/j.healthpol.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to examine and further develop knowledge translation in the context of a biomedical device industry. Studies have yet to explain how science-based innovation is first reduced to practice in development of new biomedical technologies. To understand how this occurs, I investigated research and commercial product development in the powered prosthetic arm industry from 1945 to 2020. The findings demonstrate the foundational roles of basic knowledge translation in the production of new knowledge for the powered upper limb industry, and integrated knowledge translation in hospital and clinic-based development of powered hands. The focus on a biomedical engineering industry limits the generalizability of the findings. Future research directions include examination of other cases to identify practices in embedding research projects in locations-of-use as well as virtual fitting spaces.
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Affiliation(s)
- David Foord
- Faculty of Management, University of New Brunswick, 7 Macaulay Lane, 255 Singer Hall, Fredericton E3B 5A3, Canada.
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PM&R Training in Amputation Rehabilitation: Past, Present and Future. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Valentinuzzi ME, Celani NML. Physical Rehabilitation: A Historical Look. IEEE Pulse 2020; 10:13-16. [PMID: 32011239 DOI: 10.1109/mpuls.2019.2958024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Medicine aims toward restoring, maintaining, and improving human health, and engineering aims toward restoring, maintaining and improving human wellness. Both disciplines apply knowledge from science and technology at large to accomplish such objectives. Bioengineering, also called biomedical engineering, is defined as the application of engineering principles and techniques to problems in medicine and biology (always with restoration, maintenance, and improvement in mind), which now also includes veterinary medicine, and the environment in general.
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Dijkers MP. The Archivesof Physical Medicine and Rehabilitation at 100: Its Development Set in Historical Context. Arch Phys Med Rehabil 2019; 101:374-381. [PMID: 31563551 DOI: 10.1016/j.apmr.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
The Archives of Physical Medicine and Rehabilitation was born as a radiology journal, and over its century of existence it has gone through various names and owners while shifting its contents from radiology to physical medicine to physical medicine and rehabilitation. These developments are sketched in light of the growth and eventual merger of physical medicine and rehabilitation in the United States and societal historical developments in the United States and elsewhere.
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Affiliation(s)
- Marcel P Dijkers
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan.
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Mitra R, Standaert CJ. The Value of Physical Medicine and Rehabilitation in the New Health Care Market. PM R 2018; 8:475-8. [PMID: 27173173 DOI: 10.1016/j.pmrj.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Raj Mitra
- Department of Rehabilitation Medicine, The University of Kansas, Medical Center Mail Stop 1046, 3901 Rainbow Blvd, Kansas City, KS 66160(∗).
| | - Christopher J Standaert
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, WA(†)
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Abstract
The creation of a new profession in the early 20th century, such as occupational therapy, required a commitment to certain ideas and a willingness to accept certain challenges. This study examines the commitment to the idea of therapeutic and health supporting occupation by the early leaders and proponents of the profession and the challenges they faced in gaining acceptance of occupational therapy as a profession capable of delivering a valued health care service to society. Six challenges are reviewed as they occurred in the history of the profession and as they continue to challenge the profession into the present era.
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Ditunno JF, Sandel ME. John Stanley Coulter, MD, and the Emergence of Physical Medicine and Rehabilitation in the Early 20th Century. PM R 2016; 9:193-199. [PMID: 27746368 DOI: 10.1016/j.pmrj.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Affiliation(s)
- John F Ditunno
- Rehabilitation Medicine, Jefferson Medical College, Regional Spinal Cord Injury Center of the Delaware Valley, Thomas Jefferson University, Philadelphia, PA(∗)
| | - M Elizabeth Sandel
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, 4860 Y Street, Sacramento, CA 95817; Paradigm Management Services, Walnut Creek, CA(†).
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Verville RE, Ditunno JF, Tuakli-Wosornu YA, Sandel ME. Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation. PM R 2015; 7:905-912. [PMID: 25978947 DOI: 10.1016/j.pmrj.2015.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - John F Ditunno
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Yetsa A Tuakli-Wosornu
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - M Elizabeth Sandel
- Department of Physical Medicine and Rehabilitation, University of California, Davis Health System, Sacramento, CA
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Conti AA. Western medical rehabilitation through time: a historical and epistemological review. ScientificWorldJournal 2014; 2014:432506. [PMID: 24550707 PMCID: PMC3914393 DOI: 10.1155/2014/432506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/10/2013] [Indexed: 11/29/2022] Open
Abstract
Medical rehabilitation is the process targeted to promote and facilitate the recovery from physical damage, psychological and mental disorders, and clinical disease. The history of medical rehabilitation is closely linked to the history of disability. In the ancient western world disabled subjects were excluded from social life. In ancient Greece disability was surmounted only by means of its complete removal, and given that disease was considered a punishment attributed by divinities to human beings because of their faults and sins, only a full physical, mental, and moral recovery could reinsert disabled subjects back in the society of "normal" people. In the Renaissance period, instead, general ideas functional for the prevention of diseases and the maintaining of health became increasingly technical notions, specifically targeted to rehabilitate disabled individuals. The history of medical rehabilitation is a fascinating journey through time, providing insights into many different branches of medicine. When modern rehabilitation emerges, around the middle of the twentieth century, it derives from a combination of management approaches focusing on the orthopaedic and biomechanical understanding of patterns of movement, on the mastering of neuropsychological mechanisms, and on the awareness of the social-occupational dimension of everyday reality.
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Affiliation(s)
- Andrea A. Conti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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Kinney CL, DePompolo R. "Rehabilitation … a key word in medicine": the legacy of Dr. Frank H. Krusen. PM R 2013; 5:163-8. [PMID: 23481327 DOI: 10.1016/j.pmrj.2013.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Carolyn L Kinney
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, AZ, USA
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Ditunno JF, Verville RE. Dr. Robert L. Bennett: pioneer and definer of modern physiatry. PM R 2013; 5:83-9. [PMID: 23415248 DOI: 10.1016/j.pmrj.2013.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/08/2013] [Indexed: 11/19/2022]
Affiliation(s)
- John F Ditunno
- Regional Spinal Cord Injury Center of the Delaware Valley, Department of Rehabilitation Medicine, Thomas Jefferson University, 132 South 10th Street, 375 Main, Philadelphia, PA 19107, USA.
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Swanson ME, Dicianno BE. Physiatrists and developmental pediatricians working together to improve outcomes in children with spina bifida. Pediatr Clin North Am 2010; 57:973-81. [PMID: 20883886 DOI: 10.1016/j.pcl.2010.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Based on the experience of 2 physicians from physiatry and developmental pediatrics, this article proposes a framework for improving care and outcomes for children with spina bifida. The combined skills of physiatrists and developmental pediatricians, along with other disciplines, can form the ideal team to manage the complex issues faced by this population. The developmental pediatrician is best suited for directing care for younger children through the elementary and middle school years, during which time behavioral and educational issues are prominent. As the child assumes more responsibility for self-management in adolescence, the physiatrist is ideally suited to provide major clinical input that improves functional outcomes. The addition of the discipline of physiatry to traditional, developmentally oriented pediatric interdisciplinary teams can add the much needed dimensions of activity and participation, and improve functional outcomes at the adult level by encouraging activities in adolescence that lead to full participation in adulthood.
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Affiliation(s)
- Mark E Swanson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Turk MA. 40th Walter J. Zeiter Lecture, 2008 PM&R Evolution: Adaptation or Extinction? PM R 2010. [DOI: 10.1016/j.pmrj.2010.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sayer NA, Cifu DX, McNamee S, Chiros CE, Sigford BJ, Scott S, Lew HL. Rehabilitation Needs of Combat-Injured Service Members Admitted to the VA Polytrauma Rehabilitation Centers: The Role of PM&R in the Care of Wounded Warriors. PM R 2009; 1:23-8. [DOI: 10.1016/j.pmrj.2008.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 10/16/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
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Webster JB, Parker JC, Moore DP, Johnson JC. Research activities and perspectives of individuals completing a research enrichment program for physiatrists. Am J Phys Med Rehabil 2003; 82:403-9. [PMID: 12704282 DOI: 10.1097/01.phm.0000064738.76934.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the research activity and perspectives, and the predictors and barriers to research activity, in a cohort of individuals completing a research enrichment program for physiatrists. DESIGN A retrospective cohort study design was utilized. Data collection was accomplished with a mailed survey, which was sent to 68 individuals who had completed the Research Enrichment Program for Physiatrists between 1991 and 1998. Data analysis was performed using both descriptive and inferential statistical methods. RESULTS Eighty-five percent (58 of 68) of surveys were completed and returned. The majority of respondents were in academic-based practice (83%) at the assistant professor level (59%). Sixty-nine percent of the group reported spending no time in research, and 64% reported having no "protected" time for research. The mean number of peer-reviewed journal publications was 2.4, and the average number of research grants was 1.6, with 57% of the cohort reporting no grant funding. Departmental PhD, statistical, and secretarial support for research were all noted to be inadequate or not available for >50% of the cohort. High demand for clinical productivity, lack of protected research time, and lack of research funding were all identified as major barriers to research activity. Cluster analysis found greater research time and support to be associated with measures of research productivity. CONCLUSION Long-term research success seems to require ongoing support, funding, and mentorship at the departmental and institutional level. Despite adequate training and motivation for research, research support was perceived as inadequate for many Research Enrichment Program graduates.
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Affiliation(s)
- Joseph B Webster
- Brody School of Medicine/East Carolina University, Greenville, North Carolina, USA
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Gelfman R, Peters DJ, Opitz JL, Folz TJ. The history of physical medicine and rehabilitation as recorded in the diary of Dr. Frank Krusen: Part 3. Consolidating the position (1948-1953). Arch Phys Med Rehabil 1997; 78:556-61. [PMID: 9161383 DOI: 10.1016/s0003-9993(97)90178-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article is a continuation of the story of the struggle to win recognition of physical medicine and rehabilitation as a medical specialty, as told in the pages of a daily diary kept by Frank H. Krusen, MD, from 1943 through 1967. The first two articles described Dr. Krusen's professional development before 1943, his efforts to establish a certifying Board for physiatrists, and the role of the Baruch Committee on Physical Medicine in Krusen's eventual successes. This article focuses on how Krusen and his physiatric colleagues campaigned to gain acceptance by organized medicine of the new specialty, to unite the fields of physical medicine and rehabilitation, and to identify and maintain the scope of physiatric practice despite challenges from other specialties.
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Affiliation(s)
- R Gelfman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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