Book Review

Physical Medicine and Rehabilitation

N Engl J Med 1996; 335:292-293July 25, 1996

Article

Physical Medicine and Rehabilitation
Edited by Randall L. Braddom. 1301 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $165. ISBN: 0-7216-5243-3

According to the Bureau of the Census, 1 in 10 adult Americans lives with a major disability. Most people have episodes of musculoskeletal pain that limit their function at some time during their lives. Yet physicians in training receive very limited formal instruction in rehabilitation. They are likely to be poorly prepared to deal with patients with pain syndromes and disabilities.

Does this book help solve the problem? Its goals are to cover physical medicine and rehabilitation broadly and to be practical, clinically useful, and user-friendly. There are four sections, on evaluation, treatment techniques and special equipment, the management of special problems, and the management of specific diagnoses. Most chapters are clearly organized into sections on pathophysiology and anatomy, followed by clinical applications for evaluation and management. There are numerous clear illustrations of equipment and techniques. For a book published early in 1996, the references are often remarkably current; some are as recent as 1994. The contributors include leaders in the field from numerous institutions.

The book does meet its goal of defining the scope of the physiatrist's practice. The choice of topics and the emphases reveal the priorities of the editor and by implication the field. There are 3 chapters on electrodiagnosis, 5 on prosthetics and orthotics, 7 on musculoskeletal disorders, and 10 on neurologic disorders. But there is only a single paragraph on hip fractures and nothing on the rehabilitation of poor vision, the impact of disability on the population, or developments in the organization and provision of rehabilitative services. The latter is particularly surprising in a field in which care is changing rapidly because of changing reimbursement incentives, such as capitation. A most notable gap in coverage is the extremely limited attention paid to the challenges, roles, and functions of multidisciplinary teams, an approach fundamental to effective rehabilitation.

This textbook will serve physiatrists well as a standard reference work on current practice. Some sections may be useful to other physicians, especially the chapters on the determination of disability and on disorders of the cervical spine, upper extremity, lower extremity, and lumbar spine. The book is less likely to serve as a resource for those in the broader realm of multidisciplinary rehabilitation.

Stephanie Studenski, M.D., M.P.H.
Univeristy of Kansas Medical Center, Kansas City, KS 66160