Robert G. Frank
University of Florida
Isehabilitation “is defined as the development of a person to the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with his or her physiological or anatomical impairment and environmental limitations. Realistic goals are determined by the person and those concerned with the patient's care. Thus, one is working to obtain optimal function, despite residual disability, even if the impairment is caused by a pathological process, it cannot be reversed, even with the best of modern medical treatment” (DeLisa, Martin, & Currie, 1988, p. 3).
Rehabilitation is a broad, interdisciplinary field, composed of “health care teams. “Rehabilitation teams utilize either a multidisciplinary or an interdisciplinary approach. In the multidisciplinary approach, individuals from a variety of disciplines work in parallel to improve an individual's function. In contrast, interdisciplinary teams use a coordinated, integrated approach to treatment with a common focus on outcomes. Intrinsic to both approaches, however, is an inherent emphasis on restoring individuals to their highest level of function in multiple realms. As noted in the previous definition, psychological functions are an important rehabilitation outcome. Psychological factors have a significant influence in all domains involved in rehabilitation: physical, social, vocational, avocational, and educational. Psychologists are well accepted as a integral member of rehabilitation teams.
Over the last two decades, rehabilitation has been one of the fastest growing areas of the health care industry (Frank, Gluck, & Buckelew, 1990). The growth in rehabilitation has been fueled by a number of factors. Recent advances in medical management have led to higher survival rates for accident victims. Although survivors of traumatic injuries benefit from technological advances, many are left with residual disability requiring treatment (Frank et al., 1990). Second, the “graying of America” has led to an increase in individuals who suffer from chronic conditions, many requiring rehabilitation. Chronic conditions engender significant health care costs. In the Medicare program, for example, 10% of the beneficiaries account for 70% of medical expenditures (Hoffman, Rice, & Sung, 1995). Individuals with limitations in activities due to chronic conditions account for only 17% of the population, but 47% of the medical expenditures. As many as 100 million Americans had chronic conditions in 1995, and per capita costs for these individuals are three times higher than individuals without chronic health care costs (Hoffman et al., 1995).
Rehabilitation's growth has been tied to armed conflicts that have produced large numbers of disabled individuals. After World War I, improvements in battlefield management led to an increased number of veterans with residual disabilities. During World War II, dramatic improvements in battlefield management, and accompanying residual disability, led to the development of a medical specialty in the area of rehabilitation. The term physiatrist, originally used in 1938 to describe a physician specializing in rehabilitation, gained prominence. Until World War II, rehabilitation consisted of enabling individuals to ambulate to perform low energy activities. During World War II, Howard A. Rusk, a prominent early physiatrist, demonstrated that aggressive rehabilitation, including early ambulation after surgery, diverse recreational activities of varying intensity, and psychologically supported programs produced better outcomes (Frank et al., 1990).
Medicare is the primary payment source for rehabilitation programs. Almost half of all. rehabilitation care is funded by Medicare and a quarter of all rehabilitation outpatient stays