Midical rehabilitation: Policy-making in the English health service

Disablement and the social context of daily activity

This paper presents a discussion of current approaches to assessment of disablement in the light of findings from a study of people with rheumatoid arthritis. It begins with a critical evaluation of the assumptions underlying assessment of activities of daily living and notes recent attempts to broaden these to incorporate some understanding of social roles. Material from an in-depth study of people with rheumatoid arthritis is then used to illustrate the dynamics of social role relationships and their reciprocal relationship to disablement. Particular attention is given to gender differences in role responsibilities and the way in which these affect the expectations that are placed upon people with chronic illness.

Medical dominance and the development of professional autonomy in physiotherapy

Has medical dominance declined as a result of the increasing autonomy of developing health professions? The paper argues that to answer this question it is first necessary to define medical dominance and professional autonomy. The paper outlines a categorisation of different types of professional autonomy, which correspond to different types of medical dominance. This categorisation is used to identify the particular aspects of professional autonomy in physiotherapy which have developed over recent years. It is concluded that whilst these changes correspond to a decline in aspects of medical dominance, there is no evidence of a significant decline in medical dominance in health services or that the changes which have taken place are solely a result of developing health professions' struggle for autonomy.