Initiatives in rehabilitation research.

Federal funding of rehabilitation research depends on how much that research is valued, both within the physical therapy profession and among the external groups and individuals who have a stake in the research outcomes. To help advance rehabilitation research, the American Physical Therapy Association (APTA) forges partnerships, coalitions, and collaborations for advocacy, awareness, and legislative action; promotes the appointment of physical therapists to federal panels; and fosters infrastructure and research capacity building. To further cement the physical therapy profession's relationship with policymakers, APTA also is identifying health policy questions.

Partnerships, Coalitions, and Collaborations for Legislative Action: Advocating the Independence of NCMRR

Last autholized in 1993, the National Institutes of Health (NIH) do not require reauthorization to function. In the absence of a bill to reauthorize, however, appropriators in Congress typically include authorizing language in yearly spending bills for NIH (and other agencies). In an attempt to reassert authority over NIH, the House of Representatives Committee on Energy and Commerce has circulated a draft reauthorization bill, which was discussed at a hearing on July 19, 2005. Dr Elias Zerhouni, NIH Director, was the only witness at this hearing.

The draft bill divides NIH agencies and centers into 2 broad categories. Missionspecific centers or institutes are associated with a specific disease, organ, or life stage; science-enabling centers or institutes conduct basic science and training activities and handle emerging disciplines, crosscutting (collaborative research across disciplines and professions), and clinical and translational activities. The proposed bill limits the number of institutes or centers to the current 24 and contains a number of provisions outlining procedures for creating, reorganizing, or abolishing them.

In collaboration with other rehabilitation stakeholders, APTA has embarked on an initiative to elevate the National Center for Medical Rehabilitation Research (NCMRR) to independent status. NCMRR was created by Congress in 1990 (PL 101-613) and placed within the National Institute for Child Health and Human Development (NICHD). Earlier versions of legislation had called for the creation of a rehabilitation institute at NIH, but this plan was abandoned for a number of reasons.

Many factors have led to APTA's decision to lobby for independent status for NCMRR:

* Since 1990, the field of rehabilitation science has matured to a point at which independence is appropriate. The number of scientists who can be competitive in the grants process has increased substantially.

* Support for an independent institute exists beyond the immediate rehabilitation community. In 1997, a congressionally sanctioned Institute of Medicine (IOM) Blue Ribbon Expert Panel recommended independent status for the Center, and former NIH Director Bernadine Healy concurred with this recommendation.

* The impact of physical disability on society is significant. The 1997 IOM report titled Enabling America (1) presented some sobering statistics. Between 25 and 30 million Americans have impairments that limit their ability to perform activities of daily living. The statistics are especially stark among older populations. Despite these numbers, however, it is estimated that NIH will allocate only $300 million for rehabilitation research in 2005, with only $65 million included in NCMRR's research budget. In comparison with the $7.1 billion estimated in spending for disease prevention--which NIH defines as including both "cure and treatment"--the proportion of the budget that goes to rehabilitation is very small.

* NICHD may be faced with additional budget constraints. It is possible that the Institute may have to dedicate funds to the National Children's Study (NCS). Requested by Congress in 2000, the study is projected to have a total cost of $30 billion over a 30-year period. NICHD has been designated as one of the primary sponsors of the study as well as the primary administrator. To stay on schedule, NCS will require a budget of $140 million in 2005. Because no money has been specifically appropriated by Congress, this study could potentially siphon funding from other lines of the NICHD budget.

One of 4 lead organizations among approximately 20 rehabilitation stakeholder groups that include both providers and consumers, APTA is playing a vital role in the effort to make NCMRR independent. This coalition will be very visible in highlighting and increasing the focus on rehabilitation as NIH continues to go through its reauthorization process. The task is somewhat daunting as NIH is facing budget constraints across all its institutes.

Despite the obstacles, APTA staff and other members of the coalition are mounting an effort to increase awareness of the importance of rehabilitation research. More than 20 visits to members of Congress have been either completed or scheduled. The response to the visits has been favorable. Perhaps even more important within the context of the draft reauthorization bill, a letter has been sent to Zerhouni to request a meeting to discuss the impact of rehabilitation research on the health of the nation and to emphasize the importance of agency independence.

At a minimum, the coalition will achieve the positive outcome of increasing awareness of the value of rehabilitation research among policymakers--which is likely to result in more funding for physical therapist scientists. Although APTA currently is concentrating efforts on the NCMRR, it also continues to devote attention to other relevant funding agencies within and outside of NIH.

Questions about APTA's initiatives in rehabilitation research may be directed to [e-mail].

References

(1) Brand EN Jr, Pope AM, eds; Institute of Medicine. Enabling America: Assessing the Role of Rehabilitation Science and Engineering. Washington, DC: National Academy Press; 1997.

Partnerships, Coalitions, Collaborations

Legislative Action

Appointments to Federal Panels

Health Services Research Agenda

Infrastructure, Research Capacity Building

Advocacy, Awareness

Note: table made from pie chart.