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Innovative Approaches to Managing Chronic Disease through Medical Rehabilitation

Chronic diseases often lead to disability, impacting health service utilization, hospitalization lengths, and social integration. Traditional diagnoses alone don't account for these complexities. Emphasizing rehabilitation over mere medical intervention can enable individuals with disabilities to maximize their physical, psychological, and social potential. Rehabilitation aims to reduce barriers to participation and support reintegration into society, ultimately minimizing dependency costs. Recognizing access to rehabilitation as a basic human right is essential to improving outcomes for those affected by chronic diseases.

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Innovative Approaches to Managing Chronic Disease through Medical Rehabilitation

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  1. a solution for managing chronic disease Medical Rehabilitation Mihai Berteanu

  2. “Diagnosis” alone fails to predict: • service needs(National Advisory Mental Health Council 1993) • length of hospitalization(McCrone and Phelan, 1994) • level of care(Burns, 1991) • outcome of hospitalization(Rabinowitz et al, 1994) • receipt of disability benefits(Massel et al, 1990) • work performance(Gatchel et al, 1994; Massel et al, 1990) • social integration(Ormel et al, 1993).

  3. Dx + “Disability” can predict: • health service utilization (Von Korff et al, 1992; Ormel et al, 1993) • Length of Hospitalization(Horn, 1990) • improvement in functioning after hospitalization(Rabinowitz et al, 1994) • return to work(Hlatky et al, 1986) • work performance(Massel et al, 1990) • recovery of social integration(Tate, 1989)

  4. Major changes in Health care • Prevalence of chronic > ac disease • Focus on consequences of disease, more than on disese itself • Persons w. disability have special needs

  5. Chronic disease = DISABILITY

  6. Epidemiology of disability • 10% general population (AM Chamberlaine, AB Ward 1996) Indicators: • HALE: Healty Life Expectancy • DALY: Disability-Adjusted Life-Years • Not only based on ethiological diagnoses

  7. Disability => REHABILITATION • DeNayer 1996: “if we resuscitate we rehabilitate” • Rehab. reduces burden of disability for individual and society • Enhances individual functioning and independent living

  8. Rehabilitation Aim • Enable people w. disability to attain their maximal physical, psycological, social, vocational and educational capacity by: • Overcome impairments • Reduce barriers to participation • Support reintegration into society • Reduces cost of dependency

  9. Rehabilitation • Medical act UEMS 2008 • ICHI: preventive, curative, +rehabilitation interventions (2009)

  10. WHO-ICF 2001biomedical vs. integrative model of functioning

  11. ICF 2001 applications • statistical tool • research tool • clinical tool • social policy tool • educational tool

  12. Medical Rehabilitation an obligation for managing chronic disease

  13. Disability & Human Rights • UN declaration of Human Rights 1994: • Not patient but citizen w. special needs • Council of Europe 2003 – Declaration of European Ministers • WHO Assembly Resolution 58.23 • Access to rehab = basic Human Right

  14. PRM in Rehabilitation sectors Long-term Rehabilitation Acute (early) Rehabilitation Post-acute Rehabilitation intensity In-patient or day clinic rehabilitation for patients with chronic conditions PRM in (acute) Hospital (ARU* and PRT**) PRM in post-acute rehab department (in-patient and day-clinic) PRM in community based rehabilitation and out-patient PRM services time * ARU = Acute Rehabilitation Unit ** PRT = Peripatetic Rehabilitation Team

  15. Assistive technology • Telemedicine • AAL

  16. White Book on PRM in Europe

  17. Prevention • Health Resort Medicine !

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