This issue of the Journal launches a series of articles on rehabilitation medicine aimed at general practitioners and other doctors who have not specialised in this field. We, and our co-authors, hope to demonstrate that rehabilitation is a dynamic and critical component of the therapeutic continuum, and one that is essential if patients are to regain good quality of life after serious illness or injury.

Rehabilitation has been defined by the World Health Organization (WHO) as "a process aimed at enabling persons with disabilities to reach and maintain their optimal . . . functional levels . . . ."1 However, this definition will require some revision, as, in May 2001, WHO adopted the International Classification of Functioning, Disability and Health.2 The new classification has modified the concept of disability to recognise that personal and environmental factors directly influence the experience of people with disability, and the term "handicap" has been dropped because of its negative connotations. With the new terminology, rehabilitation is seen as a coordinated process that enhances "activity" and "participation" (Box 1).

Rehabilitation medicine was recognised as a principal specialty in Australia in 1978 and as a Faculty of the Royal Australasian College of Physicians in 1991. The early development of the specialty was largely in response to the need to manage disabilities resulting from wars, and occupational and road trauma. There has traditionally been a focus on physical medicine, but increasingly rehabilitation is acknowledging the patient's social context.3

Topics for this MJA Practice Essentials – Rehabilitation Medicine series have been selected partly on the basis of the prevalence of the impairment or condition, and partly because of the impact they have on individuals. Stroke, musculoskeletal injuries, brain injury and rehabilitation in the context of older people will be examined, beginning with "Rehabilitation and older people" on page 387.

There are many reasons why rehabilitation is of such importance in the new millennium. Firstly, populations are ageing rapidly, and the incidence and prevalence of common disabling conditions (such as stroke and fractured femur) increase markedly in older people (Box 2).4 Secondly, curative and perioperative medicine has greatly improved in recent years. Frail elderly people undergo major surgery, and trauma victims who in previous years would have died now survive. However, this may be at the cost of significant impairment and disability. Finally, the past few decades have seen the development of new chronically disabling conditions such as AIDS.

These changes have had an enormous impact on the medical workforce, as a substantial cadre of highly qualified, committed medical specialists is needed to work in the rehabilitation field (the number of such specialists currently falls far short of agreed standards5), while other doctors need to be educated to refer appropriately and manage disability within their field of practice. The rehabilitation medicine physician is part of an interdisciplinary team the members of which have complementary roles. Allied health professionals and nurses are essential members of this team, whose input is determined by the patient's specific rehabilitation goals.

Where does the general practitioner fit into these highly specialised areas? The GP's role in rehabilitation is primary care of people with disability, tertiary prevention of disability, coordination of maintenance care, and identification of situations requiring involvement of specialist rehabilitation services. There are also substantial opportunities for GPs to assist in the primary prevention of disability related to musculoskeletal injuries, particularly those occurring in the context of compensable road trauma or work injury. Additionally, patients will benefit if GPs have direct interaction with specialised rehabilitation services operating in inpatient or ambulatory care settings or in patients' homes. Effective interaction may be encouraged by the use of case conferencing and care planning, using the structure of the Enhanced Primary Care initiative.6

Finally, it is no longer sufficient to adopt a particular therapeutic approach because it "feels right"; an evidence base is just as important in rehabilitation medicine as it is in any other specialised field. Despite the relatively low use of expensive technology or drugs in rehabilitation, the high staff-to-patient ratio makes it an expensive commodity, and if we are to persuade private and public purchasers to commit to rehabilitation we need to provide data to support its value.7 Although rehabilitation is a relatively new research field, the last few years have seen a great increase in high quality publications, including systematic reviews from the Cochrane Collaboration,8,9 and clinical practice guidelines.10 Each article in this MJA series will review the research that backs up the aspects discussed, or point to the need for research where only consensus recommendations are available. Evidence-based recommendations will be graded according to the system of the National Health and Medical Research Council (Box 3).11

The rehabilitation paradigm differs from the curative one in many ways. It is an individualised, patient-oriented activity focused on disability rather than disease. Rehabilitation moves from impairment towards helping the patient find "ability" in the presence of obvious disability.