FIGURE 1 The structure of the UEMS PRM. UEMS indicates Union of European Medical Specialist; PRM, physical and rehabilitation medicine; EU, European Union.
As a follow-up to the UEMS PRM meeting in Latvia in 2008, the UEMS PRM Professional Practice Committee published a special report on IDTs working in PRM in the Journal of Rehabilitation Medicine.2 The overwhelming view within this working group of European PRM specialists is that team working, especially ‘‘interdisciplinary working,’’ is the preferred pattern and that ‘‘team working’’ plays a crucial role in PRM. Team working is considered essential for many reasons, including the need for a broad range of knowledge and skills required to diagnose and assess complex impairments, activity limitations, and participation restrictions; select treatment options; coordinate varied interventions to achieve agreed goals; and critically evaluate and revise plans/goals to respond to changes in the patients’ health and function. In a review of the scientific evidence supporting the effectiveness of MDT working, Neumann et al.2 also note that the evidence is strongest for cerebrovascular disease; however, two studies on MDT working and brain injury were noteworthy. In one randomized controlled trial study of communitybased brain injury MDT working vs. information only,3 the MDT intervention was better than information alone. In another quasi-random study by Semylen et al.,4 MDT interventions for severe TBI compared with standard hospital care reported better clinical outcomes and less distressed carers. It was the opinion of the UEMS PRM Professional Practice Committee that the evidence from published scientific literature indicated that PRM pro-
grams with MDTs achieve better result and that there was a very strong case for recommending MDTs and IDTs working within PRM programs in Europe.
REHABILITATION MDT INTERVENTIONS ACUTE TO COMMUNITIES IN EUROPE Ireland is good example of how MDT interventions are used effectively in European countries across the spectrum of healthcare delivery for the acute, postacute, and livelong management of complex impairment, activity, and participation restrictions associated with TBI. There is limited trauma system development in Ireland, and in the acute phase, most TBI patients requiring neurosurgical services are transported to one of two centers and returned to a regional acute hospital, where the MDT rehabilitation interventions may be limited or variable. Those patients with severe TBI requiring acute inpatient rehabilitation are admitted to the National Rehabilitation Hospital. The National Rehabilitation Hospital is the only acute inpatient interdisciplinary rehabilitation program for TBI and serves the Republic of Ireland, a population of approximately 4 million people. The National Rehabilitation Hospital is a Comprehensive Accredited Rehabilitation Facility for its brain injury, spinal cord injury, and amputee programs. Rehabilitation care is delivered through IDTs and MDTs led by PRM consultants. The National Rehabilitation Hospital provides IDT and MDT inpatient,