Overcoming Physical Medicine and Rehabilitation Challenges

in the Future

Tirza Z. Tamin

Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo General Hospital,

Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

Keywords: Physical Medicine and Rehabilitation, Challenges

Abstract: Medical sciences development was growing continually and fast, including in Physical Medicine and

Rehabilitation (PM&R). Besides the development in medical science, the health care system also faces

changes in conceptual and administration models which rise challenges to PM&R better services in the

future. several indicators can be used to assessed PM&R service improvement, these indicators include ease

of access for PM&R care, the ratio between population and PM&R specialist, also the availability of PM&R

facilities following hospital standardization. Proper strategies and steps of anticipation must be prepared to

tackle this rising challenge.

Medical sciences development was growing

continually and fast, including in Physical Medicine

and Rehabilitation (PM&R). Currently, and also in

the future, findings in biomedicine and technology

of assistive devices for disabled people are one of

the best inventions in PM&R. this advancement

results in the improvement of care and the disabled's

quality of life, however, it can also raise challenges

for a physiatrist to develop their skills and explore

the latest science following the advancement of

science and technology to provide the best care for

patients.

In general, several indicators can be used to

assessed PM&R service improvement, these

indicators include ease of access for PM&R care, the

ratio between population and PM&R specialist, also

the availability of PM&R facilities following

hospital standardization. Proper strategies and steps

of anticipation must be prepared to tackle this rising

challenge

Currently, the health care system faces

challenges that require conceptual changes and

organization administration model to ease access to

health care service, maintain a high quality of care,

and maintain financial viability simultaneously. As a

part of the health care system, PM&R service faces

equivocal challenges so improvements are required

to provide better service in the future.

Demographic change in society was one of the

changes occur in our health care system. Increased

in the geriatric population were seen in many

developing countries. This results in two

consequences: (1) high prevalence of functional

impairment caused by a normal degenerative process

which results in health deterioration, and (2)

pressure in society and health care system to provide

care for this age group. The direction of

organizational development and medical

rehabilitation service will be affected by these

consequences.

Currently, a shift in disease patterns was

occurring. An acute disease which previously

common was now predominated by chronic disease.

Many hospitals cares still set their focus on acute

disease therapy, while the majority of the case is

shifting towards the need for long term care. This

discrepancy between patients’ needs and the care

given by health care providers will rises challenges

for both sides (Faria, 2010).

The social model of functional impairment, as a

new rehabilitation paradigm, stresses the awareness

that environmental barriers on participation are the

main cause of disability and dependency. This

contrasts with the old paradigm, in which the

functional problem was seen as a consequence of

disability. The resolve for this issue requires, not

only disabled people and their families, but also an

Tamin, T.

Overcoming Physical Medicine and Rehabilitation Challenges in the Future.

DOI: 10.5220/0009062600670069

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 67-69

ISBN: 978-989-758-409-1

intervention involving the whole society, which is

created from clinical, social, and economic

interaction.

A higher functional impairment rate will result in

an increased dependency on daily activities. This

situation gives rises to the need for trained nurses

and a financial burden to pay for the provided care.

Otherwise, the family becomes the primary

caregiver in rehabilitation. Not uncommon, families

experience burnout in taking care of disabled

patients, thus requiring adaptation regarding attitude,

behavior, or even family roles modification. Besides

the social challenges, economic challenges also rise

and manifested as the need for financial aids as a

result of the disabled's loss job. Regarding these

problems, chances of exhaustion within the family

must be realized by the PM&R care team, thus the

team must be equipped with skills and ability to

educate matters related to disabled care to the

families. The primary purpose of this is to discuss

the solutions to their difficulties together, whilst

preparing independence in disabled patients or those

at risk of disability (European Journal of Physical

and Rehabilitation Medicine, 2018).

Ethical and necessity challenges rise for PM&R

physicians as patients currently have the right to

choose their preferred care service. This perspective

holds responsibility for PM&R physician to give

relevant information to help the disabled patients

make proper decisions regarding their rehabilitation

service according to their respective condition

(Gans, 2010).

The need for rehabilitation intervention had also

been affected by advances in the medical and

biotechnological industry. An example, the

development of new minimally invasive surgery

technique will result in faster recovery and minimize

the need for additional rehabilitation during in-

hospital stay, whilst the application of telemedicine,

robotic stereotactic navigation, and fluorescent

techniques in brain tumor surgery while increasing

life expectancy, also comes with increased long term

and intensive rehabilitation intervention needs.

Neuroplasticity based rehabilitation management

was one of the world-level advancements in PM&R

science, however, the implementation of this

advancement in Indonesia still faces difficulties as

long term stay in the hospital was not allowed by the

current administration. Nevertheless, these

approaches are expected to be developed

consistently and gain more attention as there was a

high prevalence of central nervous system injury and

the advancement of medical technology in

Indonesia.

These challenges presented above requires that in

the future, rehabilitation program must be oriented

towards new priorities and therefore, a shift in

organization administration is needed. Clinical

experience from the last decade has confirmed that,

as the number of neurologic patients was arising,

neurorehabilitation-based science involving high-

level technological devices such as rehabilitation

robots, virtual reality rehabilitation, and

telerehabilitation will progress rapidly in the future

(Kwakkel et al, 2008). Rehabilitation clinics will

then become modern technological institutions and

subspecialized experts from rehabilitation

disciplines can deliver intensive, comprehensive,

and appropriate rehabilitation programs for each

individual.

The cost of health care becomes another

challenge. The meeting point of economical and

humanistic perspective thus becomes an important

matter to be carefully considered. The pressure was

held on PM&R physicians to fulfill their roles, and

on the other hand, face the conflict between patients

and administration.

As a consequence of these changes and

challenges, PM&R teams will need certain

modifications to be able to provide the health care

service in demand. Medical rehabilitation teams

should be exposed to technological advancement

and opened to contributions from other professions,

including informatics and engineering fields, to help

them adapt to the changes. Other professionals may

become new members of the medical rehabilitation

team, and not only limited to those currently known

as parts of the PM&R team, as PM&R science

advances. PM&R team must also increase the

awareness of financing effectivity by hospital

administration and management division. Thus,

researches measuring outputs showing the values

and benefits of rehabilitation programs are needed.

Evidence-Based Medicine (EBM) has its importance

in the development of PM&R. Experiments of high

quality, such as Randomized Controlled Trial (RCT)

were rarely done in the past, trials on high-level

science, especially in PM&R faced many challenges

and controversies which resulted in execution

difficulties and gave rise to large obstacles. Issues

related to ethics, technology, economy, and public

health becomes a future challenge on PM&R

research as it is affecting research and health care

fees.

The lack of recognition towards PM&R

specialists has been a worldwide issue (Chin et al,

2006). Researches and studies have been conducted

and unfortunately show that this issue also exists in

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

Indonesia. This emphasizes the need to take this

aspect into further consideration. Other challenges

for PM&R specialist in Indonesia is the unequal

distribution of PM&R care and specialist across the

country. This condition was also experienced by the

American PM&R physician. The number of PM&R

specialist was still lacking to reach out to the whole

of Indonesia's population and some provinces do not

even have any PM&R specialists yet. Across 13

branches of PERDOSRI in Indonesia, the recorded

number of PM&R specialists in Indonesia was 685

physicians, up to May 2018. Further PM&R

organization development and better organizational

administration with strong leadership are needed to

tackle this challenge.

Some strategies must be prepared by PM&R in

Indonesia to overcome these future challenges, these

include:

1. Improving PM&R human resources quality.

This can be achieved by:

 Establishing more PM&R specialist (Sp-1)

academic institutions.

 Establishing subspecialist (Sp-2) education

for PM&R

 Distributing equal PM&R service across

Indonesia

 Establishing the competence of general

practitioners to provide PM&R care in

primary care facilities

 Improving and developing education and/or

training for non-PM&R physician workers

such as nurses, physical therapists, speech

therapists, orthotic-prosthetics, and medical

technicians.

 Creating special education module for

rehabilitation nurses

 Educating and conducting training to increase

the community's participation in Community

Resourced Rehabilitation activity.

2. Collaborate with academic institutions and

medical rehabilitation centers to provide

education and service of better quality.

3. Building a stronger relationship and systematic

hierarchy between PM&R physicians and

colleagues from many different scientific

disciplines

4. Develop networking between PM&R and

community organization related to functional

impairments (non-governmental organizations,

or non-profit organizations in the fields of

functional impairments, sports and art, post-

disaster, matra health, research organizations,

and so on)

5. Increasing PM&R relationship intensity with

mass media.

6. Improving collaboration with policy-making

organizations related to functional impairments

(with ISRPM to WHO as an analogy)

7. Improving early rehabilitation service by

developing PM&R in-patient care.

8. Increasing PM&R participation in making

medical decisions on multidisciplinary cases

since the beginning to attain the best optimal

function

9. Enabling PM&R participation in analysis

technology engineering and functional treatment

(mechanomyography (MMG) and EMG),

engineering (robotics), virtual technology, and

diagnostic tool utilization related to function.

10. Enabling PM&R participation in the latest

biotechnology advancement (such as stem cell

therapy, rich plasma platelet injection, and so on)

11. Enabling PM&R participation in the making of

medical rehabilitation policies of health care

service system in the health care facility, service

system, either domestically or overseas and also

financing system in Indonesia

12. Developing a standardized system or medical

rehabilitation specific accreditation both

nationally and internationally

13. Developing disabled people registry in Indonesia

14. Developing electronic health record specific for

medical rehabilitation teams

15. Increasing scientific publications in accredited

journals with large impact factor.

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Overcoming Physical Medicine and Rehabilitation Challenges in the Future