Just as neuro specialists moved on from Bobath and respiratory specialists enhanced their ICU outcomes through early activity, MSK specialists have been sensibly moving towards functional rehabilitation and a unifying, cross-disciplinary model of care is emerging. Which is a shame, because it is doomed.
Allow me to spell out why. The clinical, operational, educational and political environments that would be conducive to quality, functional rehabilitation are so distant from the status quo that it is realistic, not pessimistic, to say so. Panic not you inherently optimistic rehabbers! I will later explain a route that might lead to a better future but first, allow me to give a few examples of why we have our work cut out:
First Contact Practitioners
A flagship primary care policy launched during a Physiotherapy staffing shortage, thus turning thousands of current or would-be rehab experts into triage agents who then refer patients into the services they just vacated… ‘for rehab’.
Staffing
Times of low quantity inevitably lead to high quality staff being especially sought after. When the money for employers (government, insurers, corporates etc) and the money for employees (in pocket) flows to those doing triage and diagnostics and not those scaling people’s functional ability through exposure to a safe but sufficient level of challenge; we get a quality and quantity problem when staffing rehab.
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