What is the role of a physiatrist in patient care, particularly for adults and geriatric individuals with physical disabilities or impairments?

What Does a Physiatrist Do?

A physiatrist is a physician who specializes in Physical Medicine and Rehabilitation (PM&R), coordinating interdisciplinary rehabilitation teams and managing medical conditions to restore function in individuals with physical disabilities, ranging from simple mobility problems to complex cognitive issues. 1

Core Clinical Role

Physiatrists serve as the medical coordinators of rehabilitation teams, managing complex medical issues while addressing the functional consequences of disease, injury, or disability. 1 Their primary focus is on maximizing functional outcomes and quality of life rather than curing disease. 2

Primary Responsibilities Include:

• Comprehensive functional assessment using musculoskeletal and neurologic examinations, along with instruments measuring activities of daily living (ADL) and instrumental activities of daily living (IADL) 1
• Medical management of comorbidities that affect rehabilitation potential, including stroke, cardiac disease, chronic lung disease, and other conditions 1
• Coordination of interdisciplinary teams consisting of physical therapists, occupational therapists, speech-language pathologists, recreational therapists, social workers, dietitians, and nurses 1
• Development and revision of rehabilitation goals in consultation with team members, patients, and families, including discharge planning 1

Scope of Practice

Diagnostic and Treatment Capabilities:

• Prescription of therapeutic modalities including exercise programs, physical agents (heat, cold), and assistive technology such as canes, walkers, wheelchairs, adaptive devices, bracing, and splinting 1
• Pain management using the least invasive modalities first, including medication management, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures 2
• Electrodiagnostic expertise for evaluating neuromuscular conditions 3
• Exercise prescription across the entire disease continuum, from prevention through palliative care 1

Patient Populations:

Physiatrists treat patients across all age groups and settings (acute care, subacute care, nursing homes, inpatient rehabilitation, home care, ambulatory clinics, and day care) 1. They are particularly skilled in managing patients with disabilities affecting the musculoskeletal system, brain, and spinal cord. 2

Team Leadership and Coordination

The interdisciplinary team-management system is the key to physiatric success. 3 Physiatrists must understand the expertise and roles of each rehabilitation team member and interact appropriately in interdisciplinary team conferences. 1

Critical Team Coordination Functions:

• Establishing care plans to maintain optimal wellness using a holistic approach that addresses medical, environmental, spiritual, vocational, and educational needs 1
• Monitoring recovery and enhancing community reintegration through ongoing assessment 1
• Evaluating rehabilitation potential by assessing medical status, psychosocial setting, cognitive function, affect, and communication skills 1

Specialized Clinical Contexts

Cancer Rehabilitation:

Physiatrists are uniquely suited to assist in acute and long-term management of cancer patients due to their specific training in identifying and treating functional loss, including management of medically complex conditions. 1 They prescribe exercise interventions across all cancer phases (prehabilitation, restorative, supportive, and palliative) to reduce symptom burden and increase independence. 1

Geriatric Rehabilitation:

Goals include limiting disability extent, preventing functional and social decline, and delaying or preventing loss of independence and institutionalization. 1 Physiatrists must modify goals and select rehabilitation procedures with careful consideration of patients' functional and disease status, recognizing that older persons may have impaired strength and ability to learn new techniques. 1

Stroke Rehabilitation:

Physiatrists coordinate stroke rehabilitation teams, managing medical conditions pertaining to stroke and comorbidities while focusing on restoration of function. 1 Organized, interdisciplinary stroke care coordinated by physiatrists reduces mortality rates, likelihood of institutional care, and long-term disability while enhancing recovery and increasing ADL independence. 1

Practice Settings and Evolution

Physiatrists work in both inpatient and outpatient settings. 2 Outpatient physiatrists are particularly valuable resources for treating patients experiencing musculoskeletal pain affecting the hip, knee, and back. 2

The need for physiatrists is increasing with the aging population, expanding workforce of older adults, and growing population of people with disabilities, especially since the COVID-19 pandemic. 2 Physical Medicine and Rehabilitation has been identified as the second-fastest-growing medical specialty in the United States. 3

Common Pitfalls to Avoid

• Failing to assess patient values, beliefs, and preferences when adjusting rehabilitation goals 1
• Inadequate evaluation of cognitive function, affect, and communication skills that impact rehabilitation potential 1
• Not involving families and caregivers in decision-making and treatment planning early and throughout rehabilitation 4
• Overlooking the importance of ongoing reassessment and care plan updates when functional decline is identified 4