How should the medical community utilize the post rehab professional and post rehab programs?
First and foremost, the post rehab professional (PRP) is not trained to nor has the ability to replace the physical therapist, chiropractor or any other medical professional. The PRP should limit his or her practice to the development of functional conditioning programs for clients after their discharge from physical therapy and/or chiropractic care. The post rehab program should be developed based on feedback from the client’s physician and physical therapist. This maximizes the possibility of a positive functional outcome.
With the aging of North America, or the “silver tsunami”, the number of babyboomers being discharged from rehab in the next 10 years will become staggering. Research studies estimate more than 800,000 total knee and hip replacements were performed in 2004. That number is expected to increase 22% by 2010 for total hip replacements and 63% by 2010 for total knee replacements. Babyboomers between ages 50 and 75 will need the bulk of these total joint replacements. Each patient will need a regimen of physical therapy but the bigger issue is the maintenance of the functional gains made in rehab and the use of exercise to manage the residual functional deficits that remain after rehab. These deficits include lack of strength and endurance; balance dysfunction, joint instability, minimal muscle fiber recruitment, limited proprioception and power and restricted flexibility. Each of these deficits is treated by the physical therapist or chiropractor using various treatment modalities but at some point, due to insurance restrictions or the patient’s plateau of progress, the patient must be discharged. This is the point where the licensed rehabilitation professional should refer the client to a certified post rehab professional or program (the term aftercare fitness is also used).
Physical therapists, occupational therapists and chiropractors over the next decade will be overwhelmed by a steady stream of boomers seeking treatment for a wide range of musculoskeletal, cardiovascular, neurological and metabolic disorders. The smart therapist or chiropractor will establish a network of trained and certified medical exercise specialists and post rehab conditioning specialists to refer his or her patients to at the time of their discharge. The MES’ and PRCS’ should be well trained in post rehab program design as well as being adept at identifying post rehab “red flags” that indicate the need to refer the client back to the physical therapist, physician or chiropractor. As you can see, the post rehab professional can augment the physical therapist’s treatment plan and ensure the highest possible functional outcome for the client.
There are a few important basics that make the “post rehab model” work. They are 1) the client when discharged and referred to the PRP must be “medically stable”. Medically stable means no radiating pain or significant swelling; no night pain or significant functional loss; normal vital signs, no open wounds and the client must have fair+ strength in the effected region. It is the medical professionals responsibility to ensure the client is medically stable before referring the client to a post rehab program. If the client demonstrates these “red flags” the possibility of a positive outcome is significantly decreased. The “red flag” client needs further medical treatment and is not a good candidate for referral to post rehab. The medical professional should not refer this client until the client is medically stable. 2) The post rehab professional must understand his or her role is to develop the post rehab exercise program and progress the client through the exercise sessions. The PRP must assess the client’s progress at 30-day intervals and report that progress to the referring medical professional. Not reporting the client’s progress to the referral source impairs the overall medical management of the client’s condition. This is also unprofessional and should warrant the elimination of any future referrals to the PRP. 3) The client must be compliant with the program and attend as well as participate in the post rehab exercise sessions. 4) the PRP must have skills and knowledge to design of post rehab programs for a wide range of medical conditions. The PRP should hold a certification to design programs for post rehab clients. 5) All the members of the rehab spectrum; physician, physical therapist, occupational therapist, nurse, chiropractor and post rehab professional; must understand the post rehab program is not part of the treatment process but it is a means of improving on or maintaining the functional gains made during rehabilitation program provided by the licensed medical professional. The treatment is performed by the medical professionals, once the client is stable, the PRP steps in and provides safe and effective functional conditioning programs. If the PRP fully understands and accepts his or her role, the utilization of PRP’s will become an essential part of the rehab spectrum as well as positively affecting the functional outcome of rehab programs. I predict, over the next decade, the PRP will become a more integral part and accepted member of the rehab network.