SECTION 3 Preventive medicine and public health Teach and support self-help strategies and ability to by statute. If the disability is job-related, the person is par obtain effective social support. ially reimbursed for lost wages and fully reimbursed for the a Provide vocational counseling in case of work-related stress. costs of medical care from the state workers' compensation Expected outcome: Absence of clinically significant psy- fund(see Chapters 18 and 24) chosocial problems and acquisition of stress manage In the United States a person with a permanent disability ment skills ay be reimbursed at a fixed rate for the rest of life or for defined period. The rate varies from state to state(as stipu Cardiac rehabilitation has been shown to be one of the lated by law), but it is based on the type of disability and most cost-effective interventions in preventing progression degree of function lost( as determined by a clinician ing self-management by disadvantaged patients. Rehabili tation usually involves the following four stages V SUMMARY 1. Enrollment of patients while they are in the hospi 2. Reconvalescence at home The goal of tertiary prevention is to limit the physical and 3. Supervised group programs social consequences of an injury or disease after it has 4. Lifelong maintenance occurred or become symptomatic. The two major categories f tertiary prevention are disability limitation and rehabilita tion. Whereas disease and disability describe objective diag C. Rehabilitation for Other Diseases noses and impairments, illness also encompasses patients PULMONARY REHABILITATION perceptions,assumptions,and expectations about their disease. These illness perceptions strongly predict disease Evidence of the positive impact of pulmonary rehabilitation outcomes and patient first came from a landmark study on lung reduction surgery' ethods of disability limitation include therapy, which and was later confirmed in systematic reviews. Since then, seeks to undo or reduce the threat or damage from an exist- the indications for pulmonary rehabilitation have been ing disease, and symptomatic stage prevention, which broadened beyond COPD, and rehabilitation programs are attempts to halt or limit progression of disease. The strate now used for many chronic respiratory diseases gies of symptomatic stage prevention are taken from primary prevention(modification of diet, behavior, and environ- CANCER REHABILITATION omplications, treatment for complications). The effective More and more patients experience cancer not as an acute management of chronic diseases, such as coronary artery lethal illness but rather as a chronic disease. This trend has disease, dyslipidemia, hypertension, and diabetes mellitus, engendered an increased interest in the role of cancer reha requires a combination of therapy and symptoma ilitation. In contrast to patients with most other diseases, prevention. This approach also can be used in the cancer patients often suffer as much from complications of ment of many other diseases, including stroke, therapy as from the disease itself. obstructive pulmonary disease, arthritis, and some cancers and infectious diseases D. Categories of Disability Rehabilitation should begin in the early stages of ment. Depending on the needs of the patient, the rel Disability is a socially defined concept but has tion team may include a rehabilitation counselor; ph implications for financia support. Most states therapist; speech therapist; occupational therapist; and psy- everal categories for reimbursement of workers chiatric, emotional, or spiritual counselor. Under most stat ob-related injuries or illnesses covered under a laws governing workers' compensation, several categories of job-related illnesses or injuries are recognized permanent a Permanent total disability (e. g, loss of two limbs or loss total disability of vis disability, temporary partial disability, and death. The goal a Permanent partial disability (e-g, loss of one limb or of rehabilitation for workers, whether their impairment is loss of vision in one eye) temporary or permanent, is to minimize the social and occu a Temporary total disability (e.g, fractured arm in truck pational consequences of the impairment Ithough it might seem that the opportunity for preven- Temporary partial disability (e. fractured arm in ele- tion is lost when a disease appears or an injury occurs,this is often not the case. The appearance of symptoms or the ■ DeatH threat of severe complications may lead patients to take an active interest in their health status, seek the health care that death) according to a fixed schedule. Less well-defined nesses and injuries, such as repetitive motion or back inju References ries, are usually compensated by a mixture of financial and 1. Petrie K), Jago LA, Devcich DA: The role of illness perceptions benefit training, and even job placement. 20:163-167,2007 A disability is considered"temporary"if it is expected that 2. Giri P, Poole I, Nightingale P, et al: Perceptions of illness and a person will return to his or her job within a time defined their impact on sickness absence. Occup Med 59: 550-555, 2009