It is a pleasure to highlight some of the programs and patient care activities of the Department of Physical Medicine and Rehabilitation (PM&R) at the University of Missouri in this issue of Missouri Medicine.
Since 1947, when Physical Medicine and Rehabilitation became a board certified specialty, our field has continued to grow and diversify in our areas of practice.1 While there are 12,155 board certified physical medicine and rehabilitation specialists, patients and other physicians often struggle with our identity.2 Unlike some specialties, PM&R is not linked to one specific organ or body system, rather our field takes a global view of how a disease or impairment affects a patient’s function. With this relatively low number of PM&R specialists and the diversity of our practice there can often be confusion regarding how patients and physicians refer to us.
Physiatrists (PM&R physicians) are often referred to as therapy doctors, PM&R docs, therapists, rehab docs, spine docs, brain injury doc, or identified based on our area of PM&R practice specialty. Regardless of this fact, one thing all PM&R physicians agree on is that we are doctors that specialize in function. This unique perspective on patient care allows physiatrists to be integrated into multiple care teams, service lines, and evolving models of patient care. Whether assisting in the acute care setting, providing consultation on appropriate levels of post-acute care, managing the rehabilitation of stroke patients, developing models of spine care (determining non-operative vs. operative care), managing intrathecal pumps for spasticity, evaluating and treating pelvic pain, or any other clinical practice, our focus is always grounded in how our treatment will impact each individual patient’s functional status.
This issue has articles highlighting not only the diversity of the field of PM&R, but also that of our PM&R department and faculty at the University of Missouri. Drs. Chis Wolf and Katie Fast’s article on concussion provides updated evidence on the management and treatment of concussions as well as decisions on return to play. As the recognition and management of concussion has gained greater national awareness, Dr. Wolf and a group of multi-disciplinary specialists (physical therapy, occupational therapy, neuropsychology) have developed an interdisciplinary clinic specializing in concussion management. The article by Joseph Burris, MD, on stroke rehabilitation, highlights the recent American Stroke Association guidelines and its implications on practice. Dr. Burris was recently selected to be a member on an American Academy of Physical Medicine and Rehabilitation (AAPM&R) national task force to develop guidelines for physiatrists and other clinicians to assist with matching acute hospital patient needs with the appropriate post-acute care setting. This includes evaluating the needs of patients who have suffered strokes or other disabling conditions such as: traumatic brain injuries, amputations, spinal cord injuries, multi-trauma, or other catastrophic events. In the area of program development, Mark Drymalski, MD, and Mohammad Agha, MD, have drawn from evidence-based literature to develop a new and innovative spine care program here at the University of Missouri Health System. Both Drs. Drymalski and Agha have worked to develop pathways at the Missouri Orthopaedic Institute for patients referred with back pain. Working in collaboration with the Departments of Orthopaedic Surgery, Neurosurgery, and Physical Therapy, they are developing processes to place patients with the right type of provider (surgical or non-surgical) at the correct time. Sarah Hwang, MD, has developed a program to evaluate, diagnose, and treat women with pelvic pain. Not only does she see patients in the Obstetrics-Gynecology Clinic, she has developed a specialized Pelvic Pain Clinic in conjunction with pelvic floor-trained physical therapists. Initially the clinic focused on female patients, but this program is now expanding to males who have undergone pelvic surgeries or suffer similar pain. Rez Farid, MD, a pediatric PM&R specialist, provides information on trouble shooting and caring for patients with intrathecal drug delivery systems.
Our opportunities for research continue to grow just as our clinical programs continue to grow. The recent addition of the Mizzou Advantage Stroke Registry Program will allow clinicians and researchers to evaluate and improve care and treatment for stroke patients. This grant allowed a data registry to be developed for tracking patients with strokes in the acute, post-acute, and chronic care management. This data set will be useful to further develop evidence based practice here at our institution and provide the opportunity to collaborate with other centers as well.
Conclusion
The past present and future continue to be bright for the Department of PM&R here at the University of Missouri. While we continue to grow and be involved in multiple service lines including: pediatrics, injured workers, regenerative medicine, cancer care, sports medicine, post acute care, and a multitude of other areas, our focus remains on the patient and his or her function. I hope you will take the time to read the diversity of articles presented in this edition of Missouri Medicine. While we all face many challenges ahead, it truly is an exciting time to be a member of the Department of PM&R at the University of Missouri.
Biography
Gregory M. Worsowicz, MD, MBA, MSMA member since 2003, is Chair, Department of Physical Medicine and Rehabilitation, University of Missouri Health Care, and Medical Director, HealthSouth Rusk Rehabilitation Center.
Contact: worsowiczg@health.missouri.edu
References
- 1.What is the ABPMR Available at https://www.abpmr.org/consumers/what_is_abpmr.html Accessed November 8, 2016.
- 2.American Board of Physical Medicine and Rehabilitation Examination Statistics Available at https://www.abpmr.org/candidates/exam_statistics.html Accessed November 8, 2016.