Rehabilitation Medicine Service Research Articles

Predictors of cancer rehabilitation medicine referral and utilization based on the Moving Through Cancer physical activity screening assessment.

Cancer survivors experience high rates of physical inactivity that often go unaddressed. The My Wellness Check program (MWC) is an EHR-integrated screening and referral system that includes surveillance of physical activity and triage to cancer rehabilitation medicine services. This study examined assessment of physical activity and subsequent referrals to cancer rehabilitation medicine. A secondary analysis was performed for survivors who completed the MWC between April 2021 and January 2022. Univariable and multivariable logistic regression modeled determinants of qualification for a physical activity referral and provider completion of referral to cancer rehabilitation medicine. Referral was based on responses to the Moving Through Cancer questionnaire. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95% CI) were calculated. There were 1,174 survivors who completed the assessment, of which 46% (n = 540) reported physical inactivity. After controlling for group differences, individuals with moderate-severe physical dysfunction (aOR: 1.750; 95% CI: 1.137, 2.693) had higher odds, and self-reporting Hispanic or Latino ethnicity (aOR: 0.720; CI: 0.556, 0.932) had lower odds of physical inactivity. Only 31% (n = 168) received a completed physician referral to cancer rehabilitation medicine following identification of physical inactivity. No patient-level factors were associated with receiving a physician referral. Following referral, 8% (n = 13) utilized cancer rehabilitation medicine services. Patient-level and clinical factors may predict qualification for physical activity referrals; however, they don't appear to predict referral completion to cancer rehabilitation medicine. Future research should focus on potential provider- and organization-level factors that interact and influence access to cancer rehabilitation medicine services.

Demographic Characteristics of Spinal Cord Injury Patients Referred for Rehabilitation in Miri Hospital

Background and aim: Miri is the second-largest city in Sarawak, and Miri hospital is the main referral hospital in Northern Sarawak that serves other hospitals such as Bintulu, Marudi, Limbang and Lawas hospitals. The rehabilitation medicine service in Miri hospital started on 14th February 2019. This study aims to explore the demographic characteristics among the referrals for the spinal cord injury populations. Methods: This is a retrospective descriptive study among inpatient referrals to the rehabilitation department taken from the patient’s registry record from 15th February 2019 to 13th April 2021. The descriptive statistical analysis described the demographic characteristics of the spinal cord injury patients. Results: A total of 70 patients were analysed in the study. Non-traumatic spinal cord injury comprises 2/3 of the total cases, with 65% being of infective origin. Most (77.1%) of the patients were referred to rehabilitation within the first 2 weeks of admission, with the average days from admission to the referral of 10 ± 10 days. The duration for co-management of the rehabilitation team with the primary team during inpatient stay was short, with an average of 6 ± 8 days. Rehabilitation management for most of the patients (67.1%) had to be carried out within a week of admission, whereas another 24.3% of the patients were given additional stay up to 2 weeks. From the functional aspect, the mean SCIM scored 29 ± 14, and the mean MBI scored 30 ± 20, indicating a high dependency level among the patients. Conclusion: Due to bed limitations in the hospital setting, the spinal cord injury patients at the high level of dependency were given early supported discharge plans. Identifying the demographic characteristics of the spinal cord population in Miri enables the ongoing development of spinal cord rehabilitation service that meets the need of the local population.

Continuing Care through Telerehabilitation for Patients in a COVID-19 Referral Center in the Philippines: A Case Series

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.

Function-based Rehabilitation Model: An Initial Step towards Universal Health Coverage

Objective. As part of the thrust towards Universal Health Care, the Philippines has enhanced health insurance coverage for rehabilitation with recent introductions of benefits for disabilities in children, prostheses, and orthoses. The project aimed to develop a functionality-based framework to guide comprehensive benefits for rehabilitation services for adult Filipinos.
 Methods. Scoping review was conducted to identify common rehabilitation conditions, frameworks for clinical assessment, and essential services for rehabilitation. Key informant interviews and focus group discussions were conducted with targeted rehabilitation service providers and experts to validate the information collected. A unified pathway of care and essential services for the provision of rehabilitation medicine services was developed through triangulation. The study was conducted from October 2018 to September 2019, with activities done in Metro Manila.
 Results. The results summarized treatment pathways for four major disease categories: neurologic, musculoskeletal, chronic pain, and activities of daily living/ cardiopulmonary. Impairments were identified reflecting the principles from the International Classification of Function. Disabilities were categorized based on function: mobility, self-care, cognitive-behavioral, and communication. A unified care pathway was developed to harmonize rehabilitation assessment, management, and care. A framework to simplify financial coverage was likewise provided. The extent of management (e.g., duration of therapy) depends on the severity of the disability classified as mild, moderate, or severe. Based on this classification, essential management modalities included physiatry interventions, medications, and rehabilitation sessions, supported by outcomes evaluation.
 Conclusion. A framework is proposed to guide the design and implementation of benefits and health insurance coverage. Awareness and application of this approach among rehabilitation practitioners and health facilities are essential steps for successful uptake and implementation of the upcoming expansion in PhilHealth coverage.

The outbreak of the SARS-CoV-2 Omicron variant make imperative the adoption of telerehabilitation in the Bulgarian health care system.

The rapid spread of the highly contagious Omicron variant of SARS-CoV-2 globally will challenge the accessibility and the delivery of physical and rehabilitation medicine (PRM) services. Many health care systems throughout the world performed effective reforms such as the transition to telerehabilitation (TR). In Bulgaria, TR is still not regulated by law, and terms such as teleconsultation and tele-education have not yet been introduced. The adoption of TR in the Bulgarian health care system will undoubtedly increase the accessibility to rehabilitation treatment for a larger group of Bulgarian patients with various neurological, cardiorespiratory, musculoskeletal, and oncological conditions and will significantly contribute to the PRM services modernization in Bulgaria.

Spinal Cord Dysfunction Secondary to a Sports/Exercise Event

Purpose: The objective of this paper is to present two young patients with SCDys after participation in a sports/exercise event. The authors aim to raise awareness of these unusual causes with potentially fatal results. The authors want to review literature regarding the diagnosis and treatment and particular rehabilitation issues of SCDys. Methods: Two cases of young patients with a history of SCDys consulted the pediatric rehabilitation medicine service. Results: Physical examination revealed incomplete paraparesis and neurogenic bladder. Both final diagnoses were confirmed by magnetic resonance imaging or computerized tomography scan. Treatment was aimed at avoiding further/permanent neurological complications in both cases, taking into consideration their respective etiologies. Conclusion: SCDys is a nontraumatic spinal cord injury that has different etiologies. This paper presents a SCDys due to an unusual etiology.

Impact of the COVID-19 Pandemic on Physical and Rehabilitation Medicine in Morocco

Background: The World Health Organization declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on physical and rehabilitation medicine (PRM) services is unknown. In Morocco, the spread of the COVID-19 pandemic has worried the entire healthcare system. The present study intended to assess the global impact of COVID-19 on PRM patient care and training across Morocco. Setting: We conducted a web-based anonymous survey from April 15, 2020, to May 15, 2020. A 9-item questionnaire was developed to investigate the impact of COVID-19 PRM services. Participants: Practicing PRM physicians and PRM trainees. Results: About 57.5% of PRM physicians consented to participate in the survey. They are mostly based in Casablanca and Rabat. The type of activity indicates that 36% of the respondents are associated with a public institution, 43% with private institutions, 12% with a university hospital, 3% with the military hospital, and 3% with Foundations and Associations. The impact of COVID-19 over activities and the results indicate that a majority of the activities are reduced (79%) because of the prevailing pandemic, 29% is devoted toward participating in COVID-19 patient care, 25% converted to COVID-19 department. The measures undertaken for the continuity of training indicates that several ways were used to carry on training sessions of the staff. Conclusion: Considering beyond the pandemic, rehabilitation and physical medicine should be at the forefront of discussions, carriers to infrastructure, financing as well as implementing care through telehealth along with other approaches needs to end.

COVID–19 and NeuroRehabilitation

COVID–19 pandemic has huge impact on rehabilitation medicine and rehabilitation services. The impact is sorted to two types. One is neuromuscular disease newly caused by COVID–19 and the other is an adverse effect on people with pre–existing neuromuscular diseases. COVID–19 is ACE–2 receptors where SARS–COV–2 virus sticks and invades are distributed vascular endothelial cells. Multi–organ failure by COVID–19 result may result in encephalopathy, thrombotic condition may induces Stroke. Encephalitis may be occurred from direct invasion of SARS–COV–2 virus. Cases with Guillain–Barre syndrome are reported by immune reaction to this virus. Rhabdomyolysis during COVID–19 is also reported, but the mechanism is not known. The approaches and methods of rehabilitation to these diseases are common with those to neuromuscular diseases by other etiologies. Neurorehabilitation has to be planned early phase of disorders, but we should be careful to prevent infection of COVID–19 to medical doctors and medical stuffs. The impact of COVID–19 pandemic is enormous to the people with pre–existing neuromuscular diseases. Voluntary restraint of outgoing is requested by Japanese government more than one month. Fear to be infected is inflated by mass media. Times to visit hospitals and opportunity to have rehabilitation service were markedly decrease during COVID–19 pandemic. The decreased activity brought physical and mental hypofunction. Neurorehabilitation service should be reconstructed to prevent more deterioration. During pandemic of COVID–19, telerehabilitation is good candidate to provide rehabilitation service safely.

Rehabilitation strategies after 2004 Aceh earthquake and tsunami disaster in Indonesia: Case report

December 26, 2004 an earthquake with a magnitude of 8,9 SR US followed by tsunami has hit the west and north coast of Nangroe Aceh Darussalam (NAD) province and North Sumatra region in Indonesia. Hundreds of thousands has been dead, many more have been injured, it also caused damaged to almost every infrastructures including health services. Health problem related to earthquake and tsunami other than respiratory problems are multiple bone fractures, peripheral nerve injuries, severe infected wounds, gangrenes that often lead to amputation of the injured limbs. The only rehabilitation centre in Aceh province at Zainoel Abidin hospital in Banda Aceh, have been damaged seriously including all equipments for mobility and the prosthesis-orthosis workshop. Many limb amputee persons, has great need for prosthesis so they can walk and do their daily living activity. Prosthesis manufactures need special skill and are individually design. After early assessment, a special rehabilitation medicine team together with an international NGO, work for relief after disaster, made and distribute free prosthetic-orthotics. From April 24, 2005 till March 29, 2006 the rehabilitation medicine team and prosthetic-orthotic technicians has made seven visits to Banda Aceh and approximately for three to four days on each visit. The team made and give one hundred fifty (150) free prosthesis-orthosis appliances for 134 amputee. All these prosthetic-orthotic appliances was made at the orthotic-prosthetic laboratory. Department of Rehabilitation Medicine, Cipto Mangunkusumo teaching hospitals in Jakarta. There is a great need to rebuilt rehabilitation medicine services in Aceh with its infrastructures, equipments and specialized trained person such as rehabilitation medicine specialist and prosthetic-orthotic technician. Long-term plan from rehabilitation medicine view are to develop a mobile limb workshop for rehabilitation medicine services, so an outreach program can be done more effectively.

The Challenge of Chronic Pain Management by PM&R Specialist

According to the definition from international association for the study of pain (IASP), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Besides, there are many term of unpleasant sensory that complaint by patient as a pain, such as allodynia, hyperalgesia, and hyperesthesia. The pain is one of the most cases that came to seeking a doctor. The data from Indonesian National Health Insurance (JKN) from 2014-2017 have revealed that pain cases were the most frequent in Rehabilitation Medicine Services, i.e. low back pain, knee pain, and shoulder pain. The prevalence of pain is increasing along with ageing, sedentary life style, obesity and chronic diseases.

Peripheral nervous system injury after high-dose single-fraction image-guided stereotactic radiosurgery for spine tumors.

OBJECTIVE The object of this study was to determine the percentage of high-dose (1800-2600 cGy) single-fraction stereotactic radiosurgery (SF-SRS) treatments to the spine that result in peripheral nervous system (PNS) injury. METHODS All patients treated with SF-SRS for primary or metastatic spine tumors between January 2004 and May 2013 and referred to the Rehabilitation Medicine Service for evaluation and treatment of neuromuscular, musculoskeletal, or functional impairments or pain were retrospectively identified. RESULTS Five hundred fifty-seven SF-SRS treatments in 447 patients resulted in 14 PNS injuries in 13 patients. All injures resulted from SF-SRS delivered to the cervical or lumbosacral spine at 2400 cGy. The overall percentage of SF-SRS treatments resulting in PNS injury was 2.5%, increasing to 4.5% when the thoracic spine was excluded from analysis. The median time to symptom onset following SF-SRS was 10 months (range 4-32 months). The plexus (cervical, brachial, and/or lumbosacral) was affected clinically and/or electrophysiologically in 12 (86%) of 14 cases, the nerve root in 2 (14%) of 14, and both in 6 (43%) of 14 cases. All patients experienced pain and most (93%) developed weakness. Peripheral nervous system injuries were CTCAE Grade 1 in 14% of cases, 2 in 64%, and 3 in 21%. No dose relationship between SF-SRS dose and PNS injury was detected. CONCLUSIONS Single-fraction SRS to the spine can result in PNS injury with major implications for function and quality of life.

Considerations Regarding The Quality Of Rehabilitation And Physical Medicine Services From Patients Perspective

Abstract The research study aims to assess the quality of physical medicine and rehabilitation (MFR) services offered to the population by specialized sanatoriums and hospitals in Dobrogea, in order to identify some appropriate measures to improve the quality of such services. The target group (593 respondents) consisted of 6 independent batches, different in number, selected from 6 medical units. The patients responded to a specific questionnaire regarding the quality of MFR services and the collected data were analyzed statistically. According to the patients′ answers, the medical staff meets their expectations in terms of the information provided at the time of admission, promptitude, kindness, availability, which reflects just one segment of the quality of medical rehabilitation services. As regards the entity recommending the medical rehabilitation physician, of the total answers, the lowest ratio in the study is held by the answer “family doctor / another doctor”. It thus highlights the poor knowledge of family doctors or other doctors on the therapy benefits specific to medical rehabilitation and therefore the access to such services is not facilitated, a disservice to the patients′ life quality. There is a dependence relation between the level of education and the reason of admission. We see that is not prevention taking the first position, but the pain, which reflects a deficient education for health in all social levels. Assessing the patient’s satisfaction regarding the mobility facilities in the sanatorium / hospital a percentage of 6.6% patient responded that they are not satisfied. It results that all the 6 partner institutions in the study must evolve to provide decent conditions ensuring the mobility independence to the patients.

RTMS in Alleviating Mild TBI Related Headaches – A Case Series

Headache is one of the most common debilitating chronic pain conditions in patients with mild traumatic brain injury. Conventional pharmacological treatments have not been shown to be effective in alleviating debilitating mild traumatic brain injury related headaches (MTBI-HA). Therefore, the development of an innovative non-invasive therapy in managing MTBI-HA is needed in the field of pain management. Repetitive transcranial magnetic stimulation (rTMS) utilizes a basic electromagnetic coupling principle in which a rapid discharge of electrical current is converted into dynamic magnetic flux, allowing the induction of a localized current in the brain for neuromodulation. The treatment is currently FDA approved for treating depression in the United States. Recent meta-analysis studies have implicated its usage in chronic pain management. The objective of the prospective case series is to assess the potential application of rTMS in alleviating MTBI-HA. A prospective evaluation was conducted in patients with established diagnoses of MTBI-HA and treated with neuronavigational guided rTMS. The study was conducted at the Veteran Administration San Diego Healthcare System where over 400 patients with MTBI were being evaluated annually by the Rehabilitation Medicine Service. A fraction of this patient population was referred and evaluated in the Anesthesia Pain Clinic for the consideration of rTMS for their headaches. A prospective case series was conducted with human subject protection committee approval. Patients with established diagnoses of MTBI and constant headaches rated at = 4 on a 0 - 10 Numerical Rating Pain Scale (NRPS), and on stable headache medication regimens were selected to receive the treatment. Four sessions of rTMS were delivered to specific areas of cortices over a 2-month period. Patients' average intensities of lingering constant headaches (defined as duration of headache lasting more than 48 hours), and the average frequency (number of severe headache episodes per day), intensity (NRPS), and duration (hours) of headache exacerbations were assessed before and after the rTMS treatment protocol. Six men (average age of 50) with MTBI-HA received the rTMS treatment protocol. Average pre and post-rTMS constant headache scores (± SD) on the NRPS were 5.50 (± 1.38) and 2.67 (± 1.75), respectively, with an average post-rTMS headache intensity reduction of 53.05% (± 19.90). The average headache exacerbation frequency (episodes per week) was reduced by 78.97% (±19.88) with 2 patients reporting complete cessation of severe headache episodes. For those (N = 4) with persistent headache exacerbations, the average duration and intensity of these exacerbations were reduced by 50.0% and 31.7%, respectively. This prospective evaluation provides the initial insight that rTMS may be beneficial in alleviating a debilitating chronic pain condition in patients with MTBI-HA. More controlled randomized studies should be conducted to validate its efficacy. Other co-existing cognitive and mood dysfunction should be assessed as well. rTMS offers a non-invasive treatment option for MTBI-HA. The tested treatment protocol was well tolerated by the patients and can be adopted for future randomized controlled studies in further validating the treatment efficacy.

Concepts and Models of Physical and Rehabilitation Medicine Services

Concepts and Models of Physical and Rehabilitation Medicine Services

Do Patients with cancer benefit from rehabilitation medicine services?

ABSTRACT Background: The role of rehabilitation medicine services in the management of cancer patients has not yet gained popularity despite the evidences supporting its use. Aim of the study: To identify the extent of gains made by cancer patients in a multidisciplinary rehabilitation setting Design, subjects and setting: Retrospective case series review of cancer patients undergoing inpatients multidisciplinary rehabilitation for functional impairment at a rehabilitation department Method: Clinical notes over 56 months period were reviewed. Information on FIM scores, length of hospital stay, psychological complications, discharge destination were collected Results: 35 patients (19:16 M: F) were identified. The mean hospital stay was 54 days. 32 (91.4%) patients were admitted from hospital or hospice; while only 3(8.6%) were admitted from home. 26 (74%) were discharged home following rehabilitation. Median FIM improved from 85 (41-118) on admission to 109 (58-125) on discharge. Goal planning was carried out for 29 (82.85%) patients. 20 (57%) patients fully achieved their rehabilitation goals and 9 (43%) patients partially achieved their rehabilitation goals. The remaining 6 patients did not engage in goal planning exercise; 4 patients were transferred to acute medical settings and 2 patients did not cooperate with any therapy input because of severe psychological comorbidities.

Referrals to a Regional Rehabilitation Clinic in South Western New South Wales, Australia

An outreach fly-in fly-out rehabilitation medicine service has been established at a regional centre in south western, New South Wales, Australia to support local practitioners. This service includes an outpatient clinic, and an inpatients case conference and consultations. This study examined new referrals to the regional rehabilitation clinic over a 12 month period. There were 94 new patients with the median age of 57.5 years. The main reason for referral was noncancer pain assessment and management (60 patients, 63.8%); followed by post hospital discharge follow up (26 patients, 27.7%). The majority of patients with pain were already on opioid therapy at the time of initial consultation. 18 patients were found to be on a high dose of opioids (>100 mg/day of oral morphine or equivalent) with no recent pain specialist input. Risks of opioid related problems were assessed and identified in those patients with a high dose of opioid therapy. Reasons and barriers influencing opioid therapy for non-cancer chronic pain in the regional area are discussed. Further study is required to establish specialist rehabilitation medicine needs from local general practitioners perspective in regional areas.

Beyond the body image: a qualitative study on how adults experience lower limb amputation

Objective: To explore adults’ experiences of lower limb amputation, focusing on the changes in self-identity related to the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Interviews were transcribed, coded and analysed by two independent researchers. Setting: A rehabilitation medicine service from a general public hospital. Participants: A convenience sample of 42 patients with lower limb amputation performed after the age of 18 and followed up in the physical medicine and rehabilitation department of a general hospital. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of amputation; the adjustment process; and the relation with the external resources. Results: Eight themes emerged from interviews: reactions and feelings about becoming amputee; changes in own life; problems in well-being; relation with the prosthesis; self-perceptions; aims related to the rehabilitation and future plans; relation with the rehabilitation; and perceived social support. These results supported a theoretical model for the self-identity changes related to limb loss. Conclusions: The self-identity changes after a lower limb amputation appear beyond the patient’s body image and functioning, affecting the patient’s awareness of the impairment, biographical self and any future projections.

Clinical Telerehabilitation: Applications for Physiatrists

Telemedicine offers an innovative approach to increase access to rehabilitation medicine services for patients who live in areas where physiatrists are scarce or absent. This article reviews the current status of telerehabilitation services delivered through real-time videoconferencing to provide support, assessment, and interventions to individuals with impairments or disabilities. A literature review demonstrates various uses of telerehabilitation by physical therapists, occupational therapists, speech and language pathologists, audiologists, recreational therapists, neuropsychologists, nurses, other physician specialists, and physiatrists. We also provide more in-depth examples of 2 current programs that involve physiatrists: One furnishes telerehabilitation services to adult stroke survivors, and the other addresses the special health care needs of children with developmental disabilities. We discuss the benefits of using telemedicine via real-time videoconferencing to care for individuals with disabilities, outline the challenges of successfully implementing a physiatric telerehabilitation program, and finish with a list of potential applications for physiatrists interested in incorporating telemedicine into their practice. Further investigation of the use of telehealth technologies to deliver physiatric services, care coordination, and education is needed. We recommend that our professional societies develop and publish guidelines to facilitate development and use of telerehabilitation technologies to increase access to physiatric services.

Work‐related carpal tunnel syndrome in Washington State workers' compensation: Utilization of surgery and the duration of lost work

Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability. This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n = 8,224) filed during 1990-1994 (followed through 2000) and receiving lost-work compensation. Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P < 0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery. There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution.

Employment Status Six Months after Discharge from Inpatient Rehabilitation for a Mild-to-moderate Physical Disability

Physical disability presents unique challenges to the individual, family and community. One of these challenges is returning the individual to work. The current study looks at individuals with a mild-to-moderate physical disability 6 months post-discharge from inpatient rehabilitation and their employment status and perceived barriers to returning to work. Prospective study of consecutive Singaporean patients, aged 21 to 65 years, discharged from the acute inpatient Rehabilitation Medicine Service at Changi General Hospital with a mild-to-moderate physical disability, as determined by discharge Modified Barthel Index score, and their employment status 6 months after discharge. There were 68 patients who met the study criteria; of these, 31 (45.6%) were successfully employed by 6 months post-discharge from inpatient rehabilitation. There was a statistically significant difference (P = 0.0004) between the 2 groups based on gender, with more males likely not to return to work as compared to their female counterparts. In this small prospective study, males were more likely not to return to work than females. Those of slightly younger age with more advanced education were more likely to return to work and fear of worsening of physical disability was the most common reason cited for not returning to work after a mild-to-moderate physical disability.