Physical and rehabilitation medicine and self-management education: a comparative analysis of two approaches.

Abstract

Discussion surrounds the publication The White Book on Physical and Rehabilitation Medicine in Europe as to whether the medical specialty termed "physical and rehabilitation medicine" is in fact a reality. To disclose previously undiscussed issues related to The White Book on Physical and Rehabilitation Medicine in Europe by juxtaposing its content with a body of work from a related healthcare approach termed "self-management education". Inspired by discourse analysis and actor network theory, texts on both approaches were contrasted as having vocabularies of their own expressed under certain material conditions. Four issues arose: (i) the difference in illness trajectories between a sudden transition from an able to disabled person after a disease with acute onset and the indefinite and unpredictable course of a chronic disease; (ii) the different material and social set-up of clinical and community rehabilitation settings; (iii) the influence of these different implementation environments on goal-setting; and (iv) the relative neglect of social theory in physical and rehabilitation medicine. If a bio-psycho-social functional approach to patients with acute and chronic conditions is regarded as essential for the identity of physical and rehabilitation medicine, the discourse on chronic illness should be paid more explicit attention.