Functional status and its uses in rehabilitation medicine

Over the past decade and a half, rehabilitation medicine has developed and implemented standardized measures of functional status. Standardized measures of functional status are important for four reasons: (1) clinicians need them to determine whether interventions produce the expected outcomes; (2) managed care companies use them to decide which rehabilitation services and equipment will be paid for; (3) accreditation bodies such as the Commission on the Accreditation of Rehabilitation Facilities (CARF) require empirical functional status and functional outcome measures; and (4) public policy is moving toward a case-based payment system derived from patient need, and type and severity of impairment.

Review of the literature.

While researchers, clinicians, managed care, accrediting bodies, and federal regulation have each influenced rehabilitation as conceptualized, measured, and practiced, lack of coordination among these groups has hampered agreement on appropriate tools for functional assessment and outcome. Rehabilitation providers, however, will be increasingly accountable to government regulations and managed care companies.