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PHYSICAL MEDICINE & REHABILITATION FUNDAMENTALS

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The field of physical medicine and rehabilitation (PM&R) emerged in the 1930s to focus on musculoskeletal and neurologic issues of patients, and further evolved after World War II as veterans returned to the United States with disabling injuries. Restoration of functional ability was established as a fundamental goal of this new field. In 1947, the American Board of Medical Specialties granted PM&R the title of an independent specialty, also known as physiatry.

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PM&R focuses on the prevention, diagnosis, and treatment of disorders related to the nerves, muscles, and bones that may produce temporary or permanent impairment or disability. PM&R is often called the “quality of life profession,” because its goal is to enhance patient performance and improve function. The focus is on quality of life—medically, socially, emotionally, and vocationally—after an injury or disease. The approach to the patient is team based, with the physician, rehabilitation nurse, physical therapist, occupational therapist, speech language pathologist, rehabilitation psychologist, prosthetist/orthotist, social worker, therapeutic recreational therapist, and vocational counselor working in conjunction as a treatment team.

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The team considers the patient’s progress, future needs, and discharge planning on a weekly basis. The role of the physiatrist is to act as a medical leader of the team and guide the medical and therapy treatment. The interdisciplinary team promotes regular structured communication among all the members of the team to establish and accomplish the treatment goals. The goal of an inpatient rehabilitation facility is the return of the patient to a safe and functional environment, preferably his or her home or a community-based facility.

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American Academy of Physical Medicine and Rehabilitation: What is a physiatrist? Available at: http://www.aapmr.org.
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Hospital for Special Surgery. What is physiatry? Available at: http://www.hss.edu/what-is-physiatry.asp.
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Centers for Medicare and Medicaid Services. Available at: http://www.cms.hhs.gov/.

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CLINICAL SKILLS

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Patient History

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The PM&R history is a medicolegal document that follows the format used by other medical disciplines with the addition of key elements that are unique to physiatry. It serves as a tool of communication for members of the rehabilitation team, as well as nonrehabilitation health care professionals, the patient’s health insurance providers, and at times the facilities responsible for ongoing care postdischarge from an acute inpatient rehabilitation unit. Depending on the setting of patient care, the PM&R history may vary from a focused outpatient physiatric evaluation to a comprehensive inpatient assessment. Some patients, especially those being admitted to an acute inpatient rehabilitation unit, may have complex medical problems requiring input and confirmation of the history from the rehabilitation team members. Gathering a complete patient history can require several days as it often depends on input from the physiatrist, other members of the rehabilitation team, and the patient’s family members or caretakers.

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A. Chief Complaint
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The chief complaint of the rehabilitation ...

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