Rehabilitating Physiotherapy1 September 2005
Physiotherapy's place in the rehabilitation of disability through injury or illness makes it essential. Dagmar Pavlu, associate professor of Physiotherapy at Charles University, Prague, explains how the WCPT-ER are working to improve the standard of physiotherapy across Europe.
To this day, laymen and, to a great extent, health workers, still hold the belief that physiotherapy is a synonym for rehabilitation. Consequently, they also believe that rehabilitation is in fact physiotherapy or, indeed, appropriately chosen physical exercise or massage.
However, this is not the case, and the term rehabilitation must be understood in a much broader way. The WHO, for example, defines rehabilitation roughly as follows:
Rehabilitation comprises all measures taken with the aim of reducing influences and conditions responsible for health-related disability or handicap in order to make disabled or handicapped persons fit enough to become reintegrated in society. Simultaneously, rehabilitation strives not only to readapt individuals with such restrictions and injuries to conditions of their setting but also to facilitate their social integration by efficient intervention in society.
Rehabilitation then is a coordinated all-society system which, according to the WHO, seeks to restore self-reliant and adequate physical and psychic wellness to people after accidents or illness, or at least to mitigate chronic consequences of injury or disease for their life and work.
THE MULTIPLE FACETS OF REHABILITATION
The system of rehabilitation makes use of therapeutical, social, educational, occupational, technical and other means. Hence, rehabilitation is a multidisciplinary profession. Taking part in it are physicians who are specialists in the field of rehabilitation, such as physiotherapists, ergotherapists, speech therapists, psychologists, nurses, social workers, prostheticians and other technicians, special educationalists, vocational consultants, workers in culture and sports for disabled citizens, and sometimes also paramedics.
For those reasons, physiotherapy makes up a small part of overall rehabilitation, albeit a highly significant one. As a special field of healthcare, physiotherapy is centred mainly on the diagnosis, treatment and prevention of locomotor system dysfunction and other health disorders that are positively controllable by methods of physiotherapy. Concurrently with legal provisions, physiotherapy can only be practised by qualified physiotherapists, often working in conjunction with other specialists as members of a wider rehabilitation team.
The gradual advances in medical sciences coincide with growing demands on the scientific nature of physiotherapy and other healthcare professions involved in comprehensive rehabilitation. Taking physiotherapy as an example, this can be seen in the ever-higher degree of academisation in the training of physiotherapists. In a number of European countries today, physiotherapists benefit from university education holding BA or BSc degrees (after a course of three to four years) or a Master's degree (MA, MSc, after a course of four to five years).
Many institutions of higher learning enable students to work for a doctor's degree in Physiotherapy, mostly in the form of postgraduate training (PhD). Thanks to this, more scientific thinking is being introduced into physiotherapists' activities, thus enhancing research into the field of physiotherapy conducted by physiotherapists themselves.
Oddly enough, in Germany (to go by a Deutscher Verband für Physiotherapie communication) only 2% of physiotherapists in a class attain university-level training. There has also been a worldwide increase in the awareness of the need for lifelong education of physiotherapists and other workers in the field of rehabilitation, with a correspondingly growing offer of diverse courses and seminars run by universities and other organisations.
The growing number and, particularly, improving quality of physiotherapeutic and rehabilitation conferences, symposia and congresses arranged or supported – often at international level – by the respective specialist and professional organisations is encouraging.
This goes to show that increasing numbers of physiotherapists are capable of pursuing scientific research and its application in everyday practice.
Some countries, in Europe – for example, the UK – already practise direct access to physiotherapists. This means that the patient is free to seek the advice of a physiotherapist without medical recommendation, who can then establish, on the basis of their own examination, a diagnosis and decide what therapy or rehabilitation is needed.
As a rule, such physiotherapeutic interventions are defrayed from the patient's health insurance. There are many other countries where attempts at direct access to the physiotherapist have failed so far since decisions on the diagnosis and therapy continue being a medical prerogative. Nevertheless, there are signs of a trend toward direct access – in some countries this is tolerated with no claims on the health insurance system.
Another significant line of progress can be seen in that clinical practice in general, and physiotherapy and rehabilitation in particular, lay a great deal of emphasis on what is known as evidence-based practice. This leads to a major enhancement of the efficacy of the therapeutic and rehabilitation measures applied.
The purpose of evidence-based practice is to make any decision-making on diagnosis and treatment proceed from proven knowledge in the field concerned. In choosing the mode of intervention it is always necessary to ask the question, "How likely is this particular intervention to make a favourable effect on the natural course of the disease as well as rehabilitations?" This may curtail the inauspicious and costly consequences of ineffectual intervention.
Evidence-based practice is currently becoming a basic ethical stand in physiotherapy – and other fields of healthcare – as well as a strategy for lifelong education, a way of responding to the growing volume of expert knowledge with the offer of target oriented self-education focused on the problems in question. Discovering shortcomings in one's knowledge and their elimination by means of specific systematic research efforts is no sin – rather, it is a virtue.
In general terms, the method of such learning can be concisely described in five steps: accurate formulation of the given clinical problem, research into the problem, critical assessment of the research, integration of those results into clinical reasoning and assessment of the outcome of intervention.
In Europe, the physiotherapists' interests are handled by the European Region of the World Confederation for Physical Therapy (WCPT-ER). The WCPT-ER is a non-profit non-governmental organisation of professional associations of physiotherapists from 35 countries that are members of the WCPT.
The specific aims and objectives of the WCPT-ER are:
- To promote reciprocity of physiotherapy qualifications and improve the quality of physiotherapy education and practice in Europe
- To promote physiotherapy in Europe and to oversee all matters dealing with physiotherapy
- To facilitate free migration and the right of establishment of physiotherapists in Europe
- To encourage closer cooperation among the national physiotherapy associations across the region in the interest of improved general health of the population
- To cooperate with international organisations in Europe to promote the aims and objectives of the WCPT-ER
- To represent the interests of, and speak for, its member organisations
- To develop policies and declarations for proposition to the Executive Committee and General Meeting of the WCPT
- To represent the profession of physiotherapy on regional basis in consultation with the Executive Committee or as delegated by the Executive Committee of the WCPT
The WCPT-ER aims to achieve these objectives by:
- Encouraging international exchange of physiotherapy research, educational curricula, evidence based practice, articles, journals, teachers and students
- Monitoring demand and supply of physiotherapists in the region and informing governments and other appropriate bodies of over-and under-supply in relation to demographic needs
- Identifying and publicising postgraduate physiotherapy programmes recognised by the member organisations and encouraging international participation
- Establishing working groups to survey areas of physiotherapy
- Promoting and developing educational and professional congresses, seminars and conferences for the benefit of the physiotherapy profession
- Maintaining essential relations with European authorities, examining all matters concerned with EU Directives, regulations, projects and all other decisions or proposals which may affect physiotherapists
- Promoting the physiotherapy profession
- Encouraging the exchange of visits between member associations