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Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.

On 2 December 2020 the World Health Organization (WHO) announced key findings from the newly released “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019” published in The Lancet (1), promoting the upcoming WHO Rehabilitation Need Estimator aligned with these global estimate data. Using data from the 2019 Global Burden of Disease, Injuries, and Risk Factors Study (2), the estimates were based on the prevalence and years of life lived with disability (YLDs) of 25 diseases and impairments selected as amenable to rehabilitation. The Lancet paper presents the headline number that, globally, 2.41 billion individuals live with conditions who could benefit from rehabilitation. Musculoskeletal disorders contributed the most to this total, with a prevalence of 1.71 billion people. The Lancet paper discusses implications for the field of rehabilitation and for country-level rehabilitation priority-setting and decisions on programmes to address rehabilitation needs. The objective of this paper is to put this milestone study of global estimates of rehabilitation need into an historical perspective, and, in particular, to reflect on its implications for the WHO’s broader agenda, “Rehabilitation 2030: A Call for Action”, and for Physical and Rehabilitation Medicine more generally. This paper also briefly elaborates the opportunities for the European Academy of Rehabilitation Medicine (EARM) to contribute to the WHO’s Call for Action., EARM members EARM members collaborating in this paper (in alphabetical order): Jari Arokoski (University of Helsinki, Helsinki, Finland), Mercè Avellanet (Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra), Kristian Borg (Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden), Helena Burger (University Rehabilitation Institute, Ljubljana, Slovenia), Maria Gabriella Ceravolo (“Politecnica delle Marche” University, Ancona, Italy), Joaquim Chaler (EUSES, Universitat de Girona-Universitat de Barcelona, Barcelona, Spain), Anne Chamberlain (University of Leeds Faculty of Medicine, Leeds, UK), Richard Crevenna (Medical University of Vienna, Vienna, Austria), Thierry Deltombe (CHU UCL Namur site Godinne, Yvoir, Belgium), Jean-Pierre Didier (Université de Bourgogne, Dijon, France), Gabor Fazekas (National Institute for Medical Rehabilitation, Budapest, Hungary), Joan García Alsina (Hospital Universitario de Bellvitge. Barcelona, Spain), Christoph Gutenbrunner (Hannover Medical School, Hannover, Germany), Elena Ilieva (Medical University of Plovdiv, Bulgaria), Alvydas Juocevicius (Klaipeda University, Klaipeda, Lithuania), Jaro Karppinen (Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland), Jolanta Ewa Kujawa (Medical University of Lodz, Lodz, Poland), Jorge Lains (Rehabilitation Medicine Center for the Central Region, Rovisco Pais, Tocha, Portugal), Antti Malmivaara (National Institute for Health and Welfare, Helsinki, Finland), Angela McNamara (National Rehabilitation Hospital, Dublin, Ireland), Xanthi Michail (University of West Attica, Athens, Greece), Rory J. O’Connor (University of Leeds, Leeds, UK), Jean Paysant (Regional Rehabilitation Institute, Nancy, France), Brigitte Perrouin-Verbe (University of Nantes, France), E. Diane Playford (University of Warwick, Coventry, UK), Konstantina Petropoulou (National Rehabilitation Center, Athens, Greece), Hans Rietman (University of Twente, Enschede, The

In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with the fundamentals of PRM from a physiological perspective, looking at the human mechanisms both physical and behavioral which are at the base of PRM physicians' work. After a discussion on the development and evolution of PRM that leads to its unique and specific approach, the mechanisms considered include: - repairing processes (and potential of recovery evaluation): repairing processes are mainly related to the quantity and natural history of diseases and impairments, while potential of recovery is also linked to the individual and environmental factors; PRM physicians work on impairments to favor healing or recovery, and propose rehabilitation if there is a potential of recovery: this is related to the prognostic role of PRM physicians; - learning processes: PRM is the specialty of teaching new physical ways and behavioral approaches to make patients participate at best through improvement of impairments and modification of activities; in this perspective, during repair and rehabilitation processes, PRM physicians and the rehabilitation team are teachers of new motor and behavioral strategies; - compensatory processes (adaptation/habilitation/rehabilitation): PRM physicians teach patients how to adapt to the new (acquired) health condition using compensatory mechanisms based on other body structures/functions, behavioral changes and/or assistive devices (or technical aids) (prosthesis and orthosis); during growth PRM physicians aim at allowing a complete (and compensatory) development of the intact function, not to be impaired by the original disease; compensatory processes are related to activities; - management skills: PRM physicians are managers of people and resources; they manage patients and their caregivers, to teach and allow them to reach the best possible participation, also focusing on maintenance; they lead the team, with the aim to make it f