Reviews

Rehabilitation

Rehabilitation teams aim to foster patients' independence after injury or illness. The model they use has its origins in the care of disabled soldiers after the world wars and is elegantly described on the University of Pennsylvania's website (http://health.upenn.edu/rehabmed/history/chap2.shtml#ww1). The sudden influx to the United States of young, acutely disabled soldiers returning from Europe drew attention to the medical and social problems created by physical disability. This was the impetus to developing "hospitals for the reconstruction of disabled soldiers," the precursors to modern rehabilitation units, and to developing physical and other therapies. To find the origins of other medical interventions, you could try one of the medical history "meta-sites" collected together at www.anes.uab.edu/medhist.htm.

Rehabilitation professionals will doubtless be delighted to read in this week's BMJ (p 1107) that the model worksat least in promoting independence in elderly patients with mild or moderate dementia after they have had a hip fracture. Patients, too, place much faith in rehabilitation, particularly if they are "motivated" (www.bmj.com/cgi/content/full/321/7268/1051), but the outcome depends on who is being rehabilitated for what. I searched the abstracts of the Cochrane Collaboration, freely available at www.update-software.com/abstracts/default2.htm, and found, for example, that there was insufficient evidence to prove the effectiveness of cognitive rehabilitation for memory problems after stroke (www.update-software.com/abstracts/ab002293.htm).

Other abstracts I found with the search term "rehabilitation" left me somewhat perplexedis the treatment of bunions really a form of rehabilitation? Perhaps it is if rehabilitation is simply about "restoring function," as suggested by the American Academy of Physical Medicine and Rehabilitation (www.aapmr.org). But this definition seems overly mechanistic. Augustus Birrell, the British essayist, suggested that history is a "great dust-heap" (a quotation found through the reference engine xrefer, at www.xrefer.com), but going back to the historical roots of rehabilitation reminds us that it is about returning people to society, not just reconstructing them in isolation.

Gavin Yamey. 

BMJ gyamey{at}bmj.com