Rob Smeets, professor of Rehabilitation Medicine:
“We really need to put the patient centre stage”
“As far as I’m concerned, the patient forms the most important link”, says Rob Smeets, professor of Rehabilitation Medicine at CAPHRI. Smeets will deliver his inaugural lecture – ‘Revalideren is goed schakelen’, on the importance of rehabilitation as a link in the care chain – on Friday 13 May. “We really need to put the patient centre stage and take his wishes and needs as our starting point.”
In Smeets’s view, practitioners need to start seeing patients more as people within their personal and social context, and to involve them in the treatment plan much more than is presently the case. “By formulating the treatment goals together with the patient, the chance that the treatment actually works increases.”
Smeets has worked at CAPHRI’s Department of Rehabilitation Medicine since June 2009. He was seconded from the Adelante in Hoensbroek for the appointment, and chose deliberately to postpone his inaugural lecture. “I first wanted to lay a solid basis, so that I can really clarify what it is that we stand for.”
In today’s rapidly ageing society, rehabilitation medicine is becoming increasingly important, and forms a crucial link in the care chain. Smeets: “Rehabilitation is essential for the patient’s recovery at a number of places in this care chain. What’s more, by starting rehabilitation early we can reduce the overall care costs.”
Prehabilitation
Rehabilitation medicine is developing rapidly as a medical specialism, and is also playing an increasing key role in preventing physical problems. This is known as prehabilitation. “We’re using this now in oncology patients, for example, but would like to expand it to other patient groups.”
Smeets gives the example of an obese woman who urgently needs a hip replacement, but whose weight prevents her from being operated on. “We have the knowledge and skills to get this patient to exercise, so that she loses enough weight to allow for the operation.”
Acute medical rehabilitation is also undergoing rapid development, Smeets explains. “With patients who end up in intensive care with serious complications, we’d like to mobilise them as much as possible within 24 hours. We can do this by finding out immediately what the patient is still able to do, but also by checking how he is lying in bed in order to prevent new complications. Research from Germany has shown that patients who receive rehabilitation treatment at this very early stage leave intensive care faster, are rehabilitated quicker, and function better later. It would mean more costs for hospitals, but this would lead to returns on a macro-economic level.”
In his lecture, Smeets points out that other colleagues in care, too, form an important link. A good example is the collaboration with GPs in the region: rehabilitation specialists are now holding a regular, joint consultation hour together with two teams of GPs.
Research
Naturally, the effectivity of rehabilitation and new interventions are a key topic of research. Within CAPHRI, the research team focuses on the arm and-hand function of children and adults, traumatology, and chronic musculoskeletal pain. “This research is always aiming to serve the clinical practice of diagnostics, treatment and aftercare. It has to contribute to better and more effective care.”
For instance, an important research theme is the arm-hand function of people who have had a stroke and who are being rehabilitated in Hoensbroek. “We follow these patients until one year after their discharge from the rehabilitation centre.”
Another good example is the research into the functioning of hospital patients with complex traumatology, who are sent from the hospital directly to Hoensbroek for rehabilitation within five days after being medically stable. In the study, their functioning is compared with that of patients who stayed in hospital longer (until medical treatment was not necessary anymore) before receiving rehabilitation treatment. The differences in costeffectiveness are also registered. “We now want to set up a study like this for early rehabilitation in intensive care (IC). The aim is to compare our patients, who start rehabilitation early, with patients in ICs where that doesn’t happen.”
Finally, Smeets emphasises that the possibilities brought about by new technologies are also being researched. For instance, computer-supported treatment programmes are continually growing in importance, certainly in a society that is ageing rapidly and making greater demands on care. “But in this, too, we always want to consider which treatment suits which type of patient best. To this end we’re working closely with the Eindhoven University of Technology and other institutes.”