Thursday, January 21, 2010

What’s the Goal of Rehabilitation?

Recently I had the pleasure to sit through a presentation by a well know Stroke specialists on the management of severe stroke. Two things I took away from the presentation.

The first was evident even when I entered the field of Physical Therapy some 18 years ago. People, especially younger people with severe unilateral strokes have a tremendous capacity for recovery. Despite the staggering deficits they may present with after their acute hospital recovery, there still may be great potential for functional recovery and a positive quality of life.

The second was that perhaps in acute and sub-acute settings we have the wrong priorities on the purpose of rehabilitation. What was discussed during the doctor’s presentation was that even in those patients those don’t have a significant recovery of function, can still have the capacity to be discharged home at a significantly lower cost of future care compared to placement in long-term care settings.
I can also draw a parallel from my past experience in working in a workers’ compensation focused rehabilitation facility. Traditionally, if I was to ask PTs what the most important goal was for PT to achieve with patients, the answer 90+% of staff would provide would be something like “maximize functional recovery” or “maximize quality of life”. While it took a change in paradigms, we move to a goal of “return to work” (which would seem obvious, give the workers’ compensation clientele)… if not the client’s original profession or employer, than any other employment. What resulted was we were suddenly getting a lot more clients back to into the workforce. Sure, some may still have had a capacity for further functional recovery, but the vast majority of clients (employees) and employers were more satisfied with services they received during their rehabilitation.

I have started to preach that the primary goal of rehabilitation in acute care is discharge, plain and simple. Discharge preferably to home, but, if not home, to some other less costly level of service like a rehabilitation facility or long-term care setting. All our initially energy in rehabilitation should be to facilitate this goal of discharge. Desirable results such as functional gains, independence, and quality of life should be secondary (but not forgotten).

PT Wonk

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