Rehabilitation Case Management and Case Study
The Rehabilitation Case Management and Case Study domain tests end-to-end management: intake, examination, diagnosis, prognosis, treatment planning, documentation, medical necessity, impairment and disability determination, return-to-work coordination, and closure. Questions often use a vignette and ask what to do next or what is missing.
Core rules and concepts
- Case management cycle: referral → assessment → problem list → SMART goals → plan → implementation → monitoring → evaluation → closure. Goals must be Specific, Measurable, Achievable, Relevant, and Time-bound.
- Documentation: SOAP format; each visit should show objective functional data, response to care, and medical necessity - care that is reasonable, necessary, specific, and effective. Avoid cloned notes.
- ICF model: impairment (body structure or function), activity limitation, and participation restriction. Do not equate impairment with disability.
- AMA Guides: the 5th edition uses range-of-motion and diagnosis-related estimates; the 6th edition is diagnosis-based with grade modifiers. Assign impairment at maximum medical improvement (MMI), not before.
- Return to work: job demands analysis, functional capacity evaluation (FCE), work conditioning or work hardening, restrictions, and employer communication.
- Red flags: fracture, infection, tumor, cauda equina, and progressive neurologic deficit require immediate referral.
Worked example
A 52-year-old warehouse worker is 8 weeks post L4–L5 microdiscectomy with residual radicular symptoms. The job requires 50-lb lifting. You request an FCE, obtain the job demands analysis, and start work conditioning with a 20-lb lift restriction, progressing by tolerance. Communicate with the surgeon before clearing lifting. At MMI, assign impairment using the applicable AMA Guides edition and document the diagnosis and modifiers; keep the impairment rating separate from the return-to-work restriction.
Traps that cost marks
- Declaring MMI before functional plateau and adequate healing time.
- Equating a permanent impairment rating with work disability.
- Missing red flags or failing to refer.
- Writing non-specific progress notes that do not support medical necessity.
- Ignoring psychosocial or workplace barriers to return to work.