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At least 19 recordsLinked to original sources
PubMed2000

Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures.

BACKGROUND: Hip fracture is a major cause of morbidity in older people and its impact, both on the individual and to society, is substantial. OBJECTIVES: To examine the effects of co-ordinated multidisciplinary inpatient rehabilitation, compared with usual orthopaedic care, for older patients with hip fracture. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline (up to April 1998), and reference lists of published papers and books. We also contacted colleagues and trialists. SELECTION CRITERIA: Randomised and quasi-randomised trials of postsurgical care using specialised rehabilitation of mainly older patients (aged 65 years or over) with hip fracture. DATA COLLECTION AND ANALYSIS: Trial assignment to included, excluded and awaiting assessment categories, was by consensus. Two reviewers independently assessed trial quality and extracted data. Limited additional information was sought from most trialists. As well as pooling of data from primary outcomes, supplementary analyses were performed to combine clinically relevant outcomes and investigate possible explanatory factors. MAIN RESULTS: In this minor update, one new trial is identified and has been placed in "studies awaiting assessment". Of another three trials previously pending assessment, one has now been excluded. The five included trials involved 1068 patients. The combined outcomes of death or requiring institutional care at final follow-up showed no significant difference between intervention and control groups (Peto odds ratio 0.92; 95% confidence interval 0.71 to 1.18). There was considerable heterogeneity in length of stay and cost data. Using death and deterioration in function as a further combined outcome variable yielded a Peto odds ratio of 0.83 (95% confidence interval 0.64 to 1. 07). This should be interpreted with caution due to heterogeneity. No quality of life measures were reported and the two trials investigating carer burden showed no detrimental effect from the intervention. The review update did not result in any new data for these outcomes. REVIEWER'S CONCLUSIONS: The trials reviewed had different aims, interventions and outcomes. As a consequence, results were heterogeneous and the question of effectiveness of different types of co-ordinated inpatient rehabilitation after hip fracture cannot be answered conclusively. There is a trend to effectiveness when combined outcome variables (death and institutional care, death and deterioration in function) are considered. Future trials of postsurgical care involving inpatient rehabilitation, or other models such as 'early supported discharge' and 'hospital at home' schemes, should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than attempt to evaluate its components.

Aged↗
PubMed1999

Vocational rehabilitation--early versus delayed. The effect of early vocational rehabilitation compared to delayed vocational rehabilitation among employed and unemployed, long-term sick-listed people.

The aim of the present study was to examine whether the wait before vocational rehabilitation affected the outcome for employed and unemployed, long-term sick-listed people. The study is based on sick-leave cases 90 days or longer, which started during 1992-1994 in a rural area in Sweden. The study included all sick-leavers with non-malignant musculoskeletal diagnoses from the neck, shoulder and back regions and who had undergone vocational rehabilitation. Of these, 391 were employed and 78 unemployed. Our hypothesis was that those who undergo early vocational rehabilitation, irrespective of employment status, often get well sooner, have fewer sick days and lower benefit levels after vocational rehabilitation than those who have to wait a long time for their rehabilitation. Our hypothesis was supported only regarding the employed who mainly reported well at 6 and 12 months after vocational rehabilitation. In the longer term (24 months) the effect was however no longer evident. Earlier studies indicate that more factors than an early start to rehabilitation are important for a successful outcome. A more important factor is probably that the right measures have been initiated at the right time, that the measures are of high quality and that the sick-leaver is mentally prepared for the measure. Although early vocational rehabilitation did not prove to be a determining factor for a successful outcome there is still reason to emphasize early involvement in the case to guarantee rehabilitation of high quality.

Absenteeism↗
PubMed2001

Cardiopulmonary rehabilitation and cancer rehabilitation. 3. Pulmonary rehabilitation.

UNLABELLED: This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with pulmonary diseases and in the pulmonary management of neurologic disorders. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Topics reviewed in the rehabilitation of pulmonary diseases include interdisciplinary programming for patients with chronic obstructive pulmonary disease, the role of rehabilitation in lung transplantation and lung volume reduction surgery, and chest physiotherapy and other rehabilitation strategies for patients with cystic fibrosis. The pulmonary management of several neuromuscular disorders is discussed, with attention to the recognition of early pulmonary dysfunction, the role of ventilatory muscle training, and the indications and options for assisted ventilation. OVERALL ARTICLE OBJECTIVE: (a) To review the assessment and therapeutic options in the rehabilitation of patients with pulmonary diseases and (b) to describe the pulmonary management of neurologic disorders.

Adolescent↗
PubMed2001

Cardiopulmonary rehabilitation and cancer rehabilitation. 1. Cardiac rehabilitation.

UNLABELLED: This self-directed learning module highlights cardiac rehabilitation issues facing able-bodied populations. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on various aspects of the management of cardiac disease and rehabilitation, including medication, exercise, risk-factor modification, secondary prevention, and surgery. Topics discussed include myocardial infarction, coronary artery disease, cardiomyopathy, and angina. New advances covered in this article include the various phases of cardiac rehabilitation, data on lifestyle adaptations for cardiac disease, and recent surgical advances for the treatment of severe heart failure. OVERALL ARTICLE OBJECTIVE: To review aspects of the management of cardiac disease and rehabilitation, including medication, exercise, risk-factor modification, secondary prevention, and surgery.

Aged↗
PubMed2001

Cardiopulmonary rehabilitation and cancer rehabilitation. 4. Oncologic rehabilitation.

UNLABELLED: This self-directed learning module highlights the treatment and rehabilitation of patients with cancer by means of a case study format. It is part of the chapter on cardiac, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article reviews medical and rehabilitation issues in patients with various types of cancer. Cases were selected to cover problems seen in both younger and older patient populations. Identification of common sequelae of cancer and cancer treatments, associated rehabilitation challenges, and appropriate interventions are included. OVERALL ARTICLE OBJECTIVE: To summarize the medical and rehabilitation issues in patients with various types of cancer.

Adolescent↗
PubMed2001

Cardiopulmonary rehabilitation and cancer rehabilitation. 2. Cardiac rehabilitation in disabled populations.

UNLABELLED: This self-directed learning module highlights the clinical characteristics, medical treatment, and rehabilitation interventions of several cardiac scenarios encountered in physiatric practice. It is part of the chapter on cardiac rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses myocardial infarction during amputation, stroke as a result of cardiac surgery, myocardial perfusion defects in spinal cord injury, and heart murmur in Down syndrome. It also covers current medical management and the benefits of comprehensive rehabilitation and interventions for specific impairments seen in these conditions. OVERALL ARTICLE OBJECTIVE: To describe the clinical characteristics, medical treatment, and rehabilitation interventions of 4 cardiac scenarios encountered in physiatric practice.

Aged↗
PubMed2003

[SF-36 Health Survey in Rehabilitation Research. Findings from the North German Network for Rehabilitation Research, NVRF, within the rehabilitation research funding program].

The SF-36 Health Survey and its 12-item abridged form is an instrument for the assessment of health related quality of life that can be used with healthy persons and patient populations. Its use has been recommended within a large German multicentre rehabilitation research programme. The paper examines missing data across all five study projects of the North German Network for Rehabilitation Research (NVRF) as well as psychometric properties of the instrument. In addition, data were compared to representative norm data using the SF-36 (SF-12) in the German National Health Survey. Results showed that there were few missing data in the SF-36. Examining the impact of age, gender and health status yielded effects of higher age and female gender on missing data. Psychometric analyses showed good to excellent results of the instrument in terms of scale fit and reliability. In terms of convergent validity, medium to high correlation of the SF-36 subscales with comparable instruments (e. g. SCL-90-R) could be found. Summarizing, the SF-36/SF-12 can be recommended for use in rehabilitation research. Analyses regarding sensitivity should be conducted in future studies.

Activities of Daily Living↗
PubMed1999

[Possibility of discharge and need for rehabilitation of psychiatric patients hospitalized for one year or more in Japan: a preliminary report. Committee on Rehabilitation Affairs, Subcommittee of Survey on Rehabilitation Need].

A total of 19,342 psychiatric patients staying in a total of 143 hospitals in Japan for one year or more entered in this study in order to determine the possibility of discharge (POD) and the need for rehabilitation. Those who were assessed by the psychiatrist in charge to have POD provided community support was assured accounted for 32.5%. As for the levels of daily life functions measured with the GAF score, those assessed to have POD showed the maximum frequency between scores 51 and 60, while the others, who were not considered suitable for discharge, showed the maximum frequency between scores 21 and 30. On the other hand, the control group, consisting of subjects with psychiatric disabilities and living in the community while using day care or rehabilitation facilities, showed the maximum frequency of GAF scores between 51 and 60. Two-thirds of the study subjects were older than fifty, while in the control group those aged between 30 and 49 accounted for 49.0%, thus indicating that the residents of mental hospitals tend to be older. More than 60% of the study subjects had been staying in hospital for five years or more. Those without their own home accounted for about 60%.

Adult↗
PubMedDate not supplied

Tri-state region pulmonary rehabilitation survey. Delivery of exercise conditioning services. The Pulmonary Rehabilitation Committee, Tri-State Society for Cardiovascular and Pulmonary Rehabilitation.

PURPOSE: This report analyzes the delivery of exercise conditioning services in the 1991 Pennsylvania, New Jersey, and Delaware regional survey of pulmonary rehabilitation programs. METHODS: Data from a questionnaire was analyzed with special consideration given to whether the program provided services for patients with only pulmonary diseases (n = 41) or with cardiac and pulmonary diseases (n = 18). RESULTS: All 59 programs included exercise conditioning. Most programs (67%) used oxygen saturation and/or expired gas analysis for writing exercise prescriptions. Only pulmonary programs used 6- or 12-minute walk data. The exercise prescription was written by nonphysicians in 51% of the programs. Most pulmonary-only programs used respiratory therapists by themselves or in combination with other professionals as exercise supervisors (71%). Cardiopulmonary programs used exercise physiologists by themselves (22%) or nurses by themselves or in combination with other professionals (50%). For all programs, the standard for ratio of patients to exercise staff averaged 3.0:1. Pulmonary-only programs did slightly but significantly more continuous arterial oxygen percent saturation (SaO2) monitoring rather than spot checking. A standard determining the use of supplemental oxygen during exercise was reported by 78% of all programs. Most used supplemental oxygen after observing the SaO2 level falling to < 90%. Electrocardiograph monitoring was done in 66% of pulmonary-only programs, but in 94% of the cardiopulmonary programs. Maintenance sessions were offered by 64% of the pulmonary-only programs and also by 78% of the cardiopulmonary programs. CONCLUSION: The type of rehabilitation program, either pulmonary-only or cardiopulmonary, appears to influence the exercise conditioning services used by the pulmonary patient.

Delaware↗
PubMedDate not supplied

[Group specific improvements in activities of daily living in elderly stroke patients in the rehabilitation phase. A report from the study, "Rehabilitation in geriatrics--analysis and evaluation of rehabilitation procedures in over-60 stroke patients with reference to its epidemiologic aspects")].

Significant as well as non-significant but still distinct improvements in the average functional status of Activities of Daily Living (ADL), according to the Barthel Index and Rüstigkeitsskala as shown by the total patient group of two rehabilitation clinics are presented. The initial status and the time elapsed between stroke and rehabilitation are of great importance for the changes which can be attained. Patient groups which differ in factors such as age, sex, and family status also show clear differences in the average improvement of their functional status.

Activities of Daily Living↗
PubMed1982

Rehabilitation of the geriatric patient. Stroke rehabilitation, the rehabilitation team, and the usefulness of functional assessment.

Salient features of rehabilitation in the elderly are illustrated through the case history of a stroke patient. The efforts of the multidisciplinary rehabilitation team and the consideration of alternative settings and levels of care are critical factors in the restoration and preservation of function in the elderly. Systematic functional assessment, using instruments such as the Barthel index, is recommended to document patient outcomes.

Aged↗
PubMed2000

Exercise-based rehabilitation for coronary heart disease.

BACKGROUND: The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Circulatory diseases, including myocardial infarction (MI) and stroke, kill more people than any other disease. Cardiac rehabilitation aims to restore patients who have suffered myocardial infarction to optimal health through exercise only based rehabilitation or comprehensive cardiac rehabilitation (eg. smoking cessation advice, diet and counselling as well as exercise). Data from two published and widely cited meta-analyses (Oldridge 1988, O'Connor 1989) of over 4,000 patients each have demonstrated that patients randomised to exercise-based cardiac rehabilitation after MI have a statistically significant reduction in all-cause and cardiac mortality of about 20 to 25% compared to patients receiving conventional care. However, the trials included were small and often of poor methodological quality. Incomplete literature review methods may have resulted in publication bias thereby resulting in an over-estimate of the benefit of cardiac rehabilitation. The randomised controlled trials used in the reviews have focused almost exclusively on low-risk, middle-aged males post MI, thereby excluding women and the elderly. OBJECTIVES: To determine the effectiveness of exercise only rehabilitation and exercise in addition to other rehabilitation interventions (termed comprehensive cardiac rehabilitation) compared with usual care on the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease. SEARCH STRATEGY: Electronic databases were searched for randomised controlled trials, using standardised trial filters, from the earliest date available to December 31st 1998. SELECTION CRITERIA: Men and women of all ages, in both hospital-based and community-based settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined by angiography have been included. Studies involving participants following heart transplant, heart valve surgery or heart failure have been excluded. Follow up periods of less than 6 months were excluded. DATA COLLECTION AND ANALYSIS: Studies were selected independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information. MAIN RESULTS: The current systematic review has allowed analysis of an increased number of patients from approximately 4500 in the earlier meta-analyses to 7683 (2582 in exercise only and 5101 in the comprehensive cardiac rehabilitation group). The quality of reporting overall was poor, with generally high losses to follow up. The pooled effect estimate for total mortality for the exercise only intervention shows a 27% reduction in all cause mortality (random effects model OR 0.73 (0.54, 0.98)). Similarly, comprehensive cardiac rehabilitation reduced all cause mortality compared to usual care, but to a lesser degree (OR 0.87 (0.71, 1.05)). Total cardiac mortality was reduced by 31% (random effects model OR 0.69 (0.51, 0.94)) and 26% (random effects model OR 0.74 (0.57, 0.96)) in the exercise only and comprehensive cardiac rehabilitation intervention groups respectively when compared to usual care. Neither intervention had any effect on the ocurrence of non-fatal myocardial infarction. There was a significant net reduction in total cholesterol in the comprehensive cardiac rehabilitation group (pooled WMD random effects model -0.57 mmol/l (-0.83, -0.31)), but not the exercise only rehabilitation group. Similarly, LDL was significantly reduced in the comprehensive cardiac rehabilitation group (pooled WMD random effects model -0.51 mmol/l (-0.82, -0.19). The effect of exercise only rehabilitation or comprehensive cardiac rehabilitation interventions on revascularisation rates, blood pressure or smoking behaviour could not be determined by this meta-analysis due to the small number of trials reporting these outcomes and heterogeneity between trials. It was not possible to combine the data from studies reporting HRQoL as an outcome. Eighteen different instruments were used to assess HRQoL in the 11 studies reporting it as an outcome. The data are presented qualitatively, only one trial reporting significant improvements with the intervention. REVIEWER'S CONCLUSIONS: Exercise-based cardiac rehabilitation appears to be effective in reducing cardiac deaths but the evidence base is weakened by poor quality trials. It is not clear from this review whether exercise only or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominately male, middle aged and low risk. Identification of the ethnic origin of the participants was seldom reported. (ABSTRACT TRUNCATED)

Coronary Disease↗
PubMed1997

[Quality assurance by patient surveys in medical rehabilitation: assessment and evaluation of rehabilitation structures and processes ("satisfaction of rehabilitation patients")].

Since 1994 Germany's statutory pension insurance schemes have been developing a multifaceted programme to assure and optimize the quality of their medical rehabilitation measures. One part aimed at developing a postal questionnaire for patients 8 to 12 weeks after rehab. It comprises two sections: one for the assessment of patients' perceptions and ratings in relation to rehab structures and processes, the other of changes of their health status. The article describes the development of the first part ("rehabilitee satisfaction"). We basically defined relevant sectors and qualities of medical rehab, analysing existing questionnaires, letters of complaint, results of expert interviews and patient focus groups. Mainly based on results from one large study of rehabilitees from two different pension insurance schemes (for blue or white collar workers), we report on psychometric properties of the final instrument, especially its contents, reliability, internal structure, validity and reference values. In February 1997, the instrument was accepted by the association of German pension schemes and may now be used in the routine phase of the quality programme, except for patients with psychosomatic disorders or substance abuse.

Activities of Daily Living↗
PubMed2000

Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults.

BACKGROUND: Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. Despite questionable scientific evidence of their effectiveness, they are widely used. Neck and shoulder complaints are common among working age adults and they are often associated with physical work load and stress. Pain in the neck and shoulder area cause biopsychosocial difficulties for the patient especially if disability due to pain is prolonged. To help patients with biopsychosocial problems or to prevent their development, multidisciplinary biopsychosocial programs are applied on rehabilitation for neck and shoulder pain patients. Nevertheless multidisciplinary treatment programmes are often laborious and rather long processes and require good collaboration between the patient, the rehabilitation team and the work place. OBJECTIVES: The objective of this systematic review was to determine the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. SEARCH STRATEGY: The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for more broad area of musculoskeletal disorders. Trials on neck and shoulder pain were separated afterwards. SELECTION CRITERIA: From all references found in our original search we selected randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). Trials had to assess the effectiveness of biopsychosocial rehabilitation for patients suffering from neck and shoulder pain among working age adults. The rehabilitation program was required to be multidisciplinary, i.e.; it had to consist of a physician's consultation plus either a psychological, social or vocational intervention, or a combination of these. DATA COLLECTION AND ANALYSIS: Four blinded reviewers selected the randomized controlled trials and controlled trials that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies to actual clinical use. Two other blinded reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation. MAIN RESULTS: After screening 1808 abstracts, and the references of 65 reviews, we found only 2 relevant studies that satisfied our criteria. One of these was considered methodologically low quality randomized controlled trial and the other one was a methodologically low quality controlled clinical trial. The clinical relevance of included studies was satisfactory. The level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation was limited for neck and shoulder pain. REVIEWER'S CONCLUSIONS: We conclude that there appears to be little scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation facilities on neck and shoulder pain. Multidisciplinary rehabilitation is a commonly used intervention for chronic neck and shoulder complaints, therefore we see an urgent need for high quality trials in this field.

Adult↗
PubMed2000

Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults.

BACKGROUND: Multidisciplinary biopsychosocial rehabilitation programs are widely applied for chronic low back pain patients. The biopsychosocial approach for low back pain could also be considered to prevent chronicity by carrying out the rehabilitation if the acute pain is prolonged. Nevertheless multidisciplinary treatment programmes are often laborious and long processes and require good collaboration between the patient, the rehabilitation team and the work place. By workplace visits and close relationship with occupational health care one might expect results in terms of patients working ability. OBJECTIVES: The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for subacute low back pain among working age adults. SEARCH STRATEGY: The reviewed studies for this structured Cochrane review were identified from electronic bibliographic databases, the Science Citation Index, reference checking and consulting experts in the rehabilitation field. The original search was planned and performed for more broad area of musculoskeletal disorders. Trials on subacute low back pain were separated afterwards. SELECTION CRITERIA: From all references found in our original search we selected randomized controlled trials (RCTs) and non-randomized controlled clinical trials (CCTs). Trials had to assess the effectiveness of multidisciplinary rehabilitation for working age patients suffering from subacute low back pain (more than 4 weeks but less than 3 months). The rehabilitation program was required to be multidisciplinary, i.e.; it had to consist of a physician's consultation plus either a psychological, social or vocational intervention, or a combination of these. DATA COLLECTION AND ANALYSIS: Four blinded reviewers selected the randomized controlled trials and controlled trials that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the clinical relevance and applicability of the findings of the selected studies to actual clinical use. Two other blinded reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary rehabilitation. MAIN RESULTS: After screening 1808 abstracts, and the references of 65 reviews, we found only 2 relevant studies that satisfied our criteria on subacute low back pain. They were both considered to be methodologically low quality randomized controlled trials. The clinical relevance of included studies was sufficient. The level of scientific evidence for the effectiveness of multidisciplinary rehabilitation was moderate on subacute low back pain showing that multidisciplinary rehabilitation which includes workplace visit or more comprehensive occupational health care intervention helps patients to return to work faster, makes sick leaves less and alleviates subjective disability. REVIEWER'S CONCLUSIONS: We conclude that there is moderate evidence of positive effectiveness of multidisciplinary rehabilitation for subacute low back pain and workplace visit increases the effectiveness. But because this evidence is based on the trials that had some methodological shortcomings and several expensive multidisciplinary rehabilitation programmes are commonly used for common subacute low back problems, there is an obvious need for high quality trials in this field.

Acute Disease↗
PubMed1998

Pulmonary rehabilitation in the acute inpatient rehabilitation hospital.

In closing, pulmonary rehabilitation in an inpatient rehabilitation hospital is not a new idea, but is now becoming more popular as the burden of care shifts away from the acute care hospital. Pulmonary rehabilitation has been demonstrated to be cost-effective, improve quality of life, and decrease the number of future hospital days for the patient. A few surveys have shown, however, that only 5% of pulmonary rehabilitation programs serviced inpatients in a rehabilitation hospital, and only 1% of 283 programs had a physiatrist as the medical director of the pulmonary rehabilitation program. Nine percent of programs surveyed serviced inpatients in rehabilitation units within the acute care hospital. Clearly, the majority of pulmonary rehabilitation programs are on an outpatient basis, and many of these are located within the walls of a rehabilitation hospital. Effective pulmonary rehabilitation can be done in the home setting when combined with outpatient therapy visits over a 12-week duration. The spectrum of pulmonary rehabilitation will continue to evolve into the twenty-first century, and clearly the rehabilitation hospital will be part of that change. Whether caring for very elderly COPD patients who are too debilitated to return home from the acute care hospital or managing ventilator-dependent patients with COPD, spinal cord injury, or neuromuscular disease, the IPR team and the rehabilitation hospital will have to demonstrate cost-effective outcomes. Physiatrists should play a major role in this evolution, on both a patient-benefit level and legislative level, to increase awareness of pulmonary rehabilitation.

Health Care Reform↗