Eur J Phys Rehabil Med. 2018 Apr;54(2):166-176. doi: 10.23736/S1973-9087.18.05145-6.
In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper describes the background to the context of PRM services and comprises the following: - Epidemiological Aspects of Functioning and Disability - Ethical Aspects and Human Rights - Rehabilitation and Health Systems - Economic Burden of Disability - Effects of Lack of Rehabilitation Health care service planning accounts for the burden of disability among society and the chapter describes the justification for specialist rehabilitation, the background of PRM and why making a functional diagnosis and a management plan based on function is its core competence. The chapter describes the increasing burden of disability due to conditions seen in PRM practice rather than on all those diseases contributing to physical disablement and does not include mental illness, learning disabilities, etc. Ten percent of Western Europe's population have a disability and are surviving longer, resulting in higher costs for health and social care and a greater impact of co-morbidities. The chapter also describes the impact and increased costs in the absence of rehabilitation. Not only is money spent on rehabilitation recovered with five to nine-fold savings (e.g. in return to work), but rehabilitation is effective in all phases of health conditions. Specialized rehabilitation (as delivered by PRM services) is highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients. Disability discrimination has been outlawed and the text describes the legal context and status of a person living in Europe with a disability. The second part highlights the United Nations Conventions on human rights, confirmed in the World Report on Disability, but also on the principles of ethical practice among PRM physicians. The third part addresses the variability of access to and funding of rehabilitation services across countries. The chapter also distinguishes highly specialist interventions (such as those provided by a PRM physician) from specialized therapies, (such as pressure ulcer management) and generic therapies (e.g. after an uncomplicated limb fracture). It will be important for healthcare authorities, public health organizations, payers, providers, healthcare professionals, consumers and the community. The economic and social burden of disability on society is considerable and will get worse, although this is difficult to quantify. Direct costs are variable and include disabled persons' additional costs for daily living and state disability benefits. Rehabilitation has a pivotal role in reducing these costs through promoting personal recovery and increasing function through altering environmental factors. This part describes cost savings studies through rehabilitation for persons with severe disabilities.
在欧洲物理医学与康复（PRM）白皮书的背景下，本文描述了 PRM 服务的背景，包括以下内容：
功能障碍和残疾的流行病学方面
伦理和人权
康复和卫生系统
残疾的经济负担
缺乏康复的影响
卫生保健服务规划考虑到了社会残疾负担，本章描述了为专业康复服务提供资金的理由、PRM 的背景以及为何基于功能进行功能诊断和管理计划是其核心能力。本章描述了由于 PRM 实践中所见的疾病状况而导致的残疾负担增加，而不是所有导致身体残疾的疾病，也不包括精神疾病、学习障碍等。西欧有 10%的人口有残疾，且存活时间更长，导致医疗和社会保健费用增加，共病的影响更大。本章还描述了缺乏康复的影响和增加的成本。康复不仅能使投入的资金得到回收，而且还能以五到九倍的节省（例如，恢复工作），而且在所有健康状况阶段都具有康复效果。所有神经疾病的专业康复（如 PRM 服务提供的康复）都具有很高的成本效益，能大大降低持续护理成本，尤其是对高依赖患者。残疾歧视已被取缔，本文描述了生活在欧洲的残疾人士的法律背景和地位。第二部分重点介绍了联合国人权公约，这些公约在《世界残疾报告》中得到确认，也介绍了 PRM 医生职业道德实践的原则。第三部分涉及到各国康复服务的获取和资金情况的差异。本章还区分了高度专业的干预措施（如 PRM 医生提供的干预措施）与专业治疗（如压疮管理）和通用治疗（如简单四肢骨折后）。这对卫生保健当局、公共卫生组织、支付方、提供者、卫生保健专业人员、消费者和社区都很重要。残疾给社会带来的经济和社会负担相当大，而且还会越来越严重，尽管这很难量化。直接成本是可变的，包括残疾人日常生活的额外费用和国家残疾福利。康复通过促进个人康复和通过改变环境因素增加功能，在降低这些成本方面发挥着关键作用。这部分描述了通过康复为严重残疾人士进行成本节约研究。
