The British Society of Rehabilitation Medicine, the BSRM, is the primary UK organisation for doctors interested in rehabilitation, especially but not exclusively doctors trained in Rehabilitation Medicine. It also welcomes other people from other professions as associate members. Although most members are doctors, the Society has produced many reports and documents concerning rehabilitation in general, for example, here. This page outlines the history of rehabilitation in the UK and how the current Society developed. It then describes the Society before reviewing how it can contribute to a National Rehabilitation Community. It ends by suggesting that it could become a leading organisation within the Community with a slight change in its membership rules.

Preface – history

The explicit use of exercise, massage and similar physical treatments for health reasons started in the mid-nineteenth century. (here) The First World War precipitated a much greater interest in reducing disability after injuries, with a continuing focus on exercise and activity with additional electrotherapy. (here)

After the Great War, interest in rehabilitation continued and grew. It was known as ‘physical medicine’, and the early articles were published in the Journal of Radiology because radiation had become another therapy. That journal evolved into the Archives of Physical Medicine and Rehabilitation.

The first specialist society formed was probably the American Society of Physical Therapy Physicians, founded in 1938. It became the American Society of Physical Medicine and Rehabilitation in 1951.

Physical Medicine only covers some disabling problems because the treatments involved (exercise and physical, hands-on therapies) cannot resolve a proportion of the difficulties faced by people with disabilities, for example, urinary incontinence or forgetfulness. Rehabilitation has a much broader scope and was first practised in the UK by a physician caring for the elderly, Marjorie Warren. (here) However, this branch of rehabilitation focused on older patients, culminating in the speciality of geriatrics, represented by the British Geriatrics Society. Nevertheless, rehabilitation expertise is a significant proportion of the expertise of a geriatrician. (here)

The first specialist Society for rehabilitation formed in the UK was the British Association of Physical Medicine, founded in 1943. (here) The founding members had developed their practice and ideas following the First World War. The Association was “founded as the professional body to promote and firmly establish the specialty of Physical Medicine amongst physicians.” The membership was restricted to doctors, in part to distinguish it from physiotherapy. (also see here)

The British Association of Physical Medicine held its first meeting outside London in 1956. (here) In 1968 it had a meeting at King’s College Hospital, London. The talks included (see here):

• report on a double-blind controlled trial of physiotherapy exercises for people with backache (Dr P Hume Kendall)
• an estimate of the prevalence of disability, from Dr George Cochrane
• a discussion on rehabilitation for people with severe mental health problems
• a talk from Dr J C Brocklehurst, a well-known geriatrician on rehabilitation in the elderly
• a talk from Dame Cicely Saunders who made two notable statements. Terminal care is care of “the state that commences when somebody else said that there was nothing further to be done.” and that “patients should die peacefully but, until that time, they should live fully.”

In 1970 the Association added rheumatology to its name, becoming the British Association for Physical Medicine and Rheumatology, registered as a charity in 1972. It later changed its name to the British Association for Rheumatology and Rehabilitation (BARR).

Then, in 1983, the British Association for Rheumatology and Rehabilitation. The rheumatology half merged with the Heberden Society to become the British Society for Rheumatology. The rehabilitation half formed the Medical Disability Society, founded in 1984. After a few years, it changed its name to the British Society of Rehabilitation Medicine. The speciality of Rehabilitation Medicine initially started with a limited scope, but the latest 2021 curriculum has revived the broad range of conditions covered in 1968.

Comment on history

This overview highlights some interesting and relevant points.

Most notably, when the Society was British Association of Physical Medicine, it had a comprehensive and inclusive view of rehabilitation. It included psychiatric rehabilitation, palliative care, and rehabilitation of frail older people as important matters. The only significant area missing is paediatrics.

Equally, research was necessary. The trial reported to the Association in 1968 must be one of the first rehabilitation trials undertaken. There was also an interest in epidemiology and the services needed.

For the first 40 years, the specialist group, first an Association, then a Society, is closely associated with the term ‘physical’ and latterly with rheumatology.

Last, from the outset in the 1850s, exercise has been a consistent form of therapy. As has been well-established, exercise is an effective activity for reducing problems and increasing function across an extensive range of disorders and conditions.

British Society of Rehabilitation Medicine

The British Society of Rehabilitation Medicine has, as its objects (purpose):

1. to promote the development of the understanding and management of acute and chronic disabling diseases and injuries, and their consequences for the individual patient, their carers, their medical and other attendants, and society at large.
2. to promote the specialty of Rehabilitation Medicine, being defined as the application of medical skill to the diagnosis and management of disabling disease and injury of whatever cause and affecting any system of the body.
3. to advance the education of health and other professionals and the general public in the area of disability.
4. to develop and promote standards for clinical care and professional working in the specialty and mechanisms for audit, appraisal and review to ensure that those standards are maintained.
5. to promote and facilitate research in the field of rehabilitation to support the evidence base which underpins good clinical practice in the specialty.

Membership is now open to any healthcare professional and medical trainees, and students.

The membership class and charges are:

• Full: Any doctor working in Rehabilitation Medicine or any other specialty in a non-training post full or part-time. £235.00pa
• Trainee: Working in a recognised specialty training post full or part-time. £75.00pa
• Associate: Senior AHPs and Nurses (Band 7 or above) with experience of working in rehabilitation and medical practitioners in allied specialties who are members of their specialty society. £80.00pa
• Affiliate/Overseas Member: For Rehabilitation Medicine doctors resident and working overseas and Non-consultant career grade doctors working in Rehabilitation Medicine. £80.00pa
• Student: Medical Students (registered with UK Med School), Foundation Year and pre-specialty training doctors with GMC registration, £00.00pa

The Society has a significant interest in the education and training of doctors, both trainees and consultants and all career grade doctors. It has an education subcommittee focused on these activities. This committee has two trainee representatives, and there is a close relationship with the Specialist Advisory Committee for Rehabilitation Medicine. The committee currently plays a significant role in organising the Annual one-day conference. There are regional groups, but these are, at present, weak.

The Society also has a research and clinical standards subcommittee, which, as the name suggests, supports research by members of the Society and is responsible for producing documents detailing clinical standards. The papers are accessible here. They are used, including by commissioners, to improve services. A working group, which usually has several invited members from outside the Society and other professions, will produce the document. The committee reviews it to ensure its quality.

The Society has recently set up a third subcommittee, the communication subcommittee, to improve communication within the Society and between the Society and others.

There are also Special Interest Groups. These are open to any members who are interested in the specific topic. New groups are formed as needed and according to the interests of members. For example, a group interested in Prolonged Disorders of Consciousness has recently started. They also are disbanded when no longer needed or attracting interest. They are often responsible for the work behind a clinical standards document. Some, but not all, groups are listed here.

Contribution to rehabilitation community

The BSRM, like many other organisations, has a range of contacts in various relevant governmental organisations, and it has different connections. In particular, it has a formal relationship with the Royal College of Physicians, which has much more significant influence. The association also leads to an increased awareness of rehabilitation among other physicians.

In contrast to most other societies, rehabilitation is the BSRM’s leading and only interest. As the membership categories illustrate, there is a residual ambiguity about whether its focus is on Rehabilitation Medicine, meaning (I think) an emphasis on doctors who have undergone the specific training recognised by the General Medical Council, or whether its focus is on Rehabilitation Medicine. The content of the standards documents suggests the main interest is in rehabilitation.

However, many other specialities and organisations have an equally strong commitment to rehabilitation. For example, the analysis of the curriculum for geriatric medicine shows this. (here)

The BSRM also has experience in setting standards for rehabilitation by multidisciplinary teams. The standards are not restricted to the roles of a doctor or any other profession. The standards are downloaded in large numbers, suggesting they are considered valuable.

Conclusion

The BSRM is the only national organisation with rehabilitation as its primary interest, and it has demonstrated its commitment to multi-professional rehabilitation standards. On the other hand, its membership is mainly medical. Although other professions may join, they cannot be full members. The BSRM could be a leading member of the Rehabilitation Community, but, in my view, this could only occur if the BSRM were to become open to full membership of people from any profession interested in rehabilitation.