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Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 143-147

7.4 The organizations of physical and rehabilitation medicine in the world: Physical and rehabilitation medicine in Europe

European University Cyprus – School of Sciences, Nicosia; Limassol Center of Physical and Rehabilitation Medicine, Limassol, Cyprus

Date of Web Publication11-Jun-2019

Correspondence Address:
Prof. Nicolas Christodoulou
Limassol Centre of Physical and Rehabilitation Medicine, Limassol; Medical School, European University Cyprus, Nicosia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisprm.jisprm_33_19

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How to cite this article:
Christodoulou N. 7.4 The organizations of physical and rehabilitation medicine in the world: Physical and rehabilitation medicine in Europe. J Int Soc Phys Rehabil Med 2019;2, Suppl S1:143-7

How to cite this URL:
Christodoulou N. 7.4 The organizations of physical and rehabilitation medicine in the world: Physical and rehabilitation medicine in Europe. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2019 Aug 20];2, Suppl S1:143-7. Available from: http://www.jisprm.org/text.asp?2019/2/2/143/259359

  Introduction Top

The use of physical agents in ancient time for the treatment of several problems of the human body is well known not only both by written descriptions of physicians, like Hippocrates, Galen, and others[1] but also by findings in ancient tombs of physicians. For example, in Paphos of Cyprus, some decades ago, the archeologists found in the tomb of a physician, a series of terracotta hot water bottles with the shape of several parts of the human body. These were made during the Roman period and designed to treat specific body parts (local thermotherapy)[2] [Figure 1]. During the medieval period, we have also several descriptions (Avicenna, and Averroes) for the use of physical agents for the treatment of health problems.[3]
Figure 1: Terra-Cota Hot Water “Bottles” of the Hellenic-Roman Period. Archaeological Museum of Paphos-Cyprus

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In 1938, in the United States, Dr. Frank H. Krusen introduced Physical Medicine as one of the medical specialties. Following the second World War and the effects of the worldwide poliomyelitis epidemic, Dr. Howard A. Rusk introduced Rehabilitation Medicine in 1947 as a comprehensive approach for the health problems leading to disability. The aim was to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. Finally, the specialty of Physical Medicine and Rehabilitation (PMR) was introduced in 1949 and was gradually adopted in Europe and in other countries of the world.[4],[5],[6]

In 1950 in London, the International Federation of Physical and Rehabilitation Medicine (PRM) was founded with the aim to bring together specialists in PMR from various countries around the world. The first international congress of the medical specialty was organized also in London in 1952.[7] The specialty in Europe was officially recognized in 1968 when in Geneva (Switzerland), the World Health Organization's Expert Committee on Medical Rehabilitation announced the new medical discipline: PMR.[8]

In Europe, several professional and academic bodies oversee and work together for the benefit of the specialty at the European, regional and national levels. Several recognized the name of the specialty as (PRM and not PMR). We will describe these entities below.

  European Federation of Physical Medicine and Rehabilitation Top

It is the first European organization created in the 1950s but officially registered in 1963 in Brussels. Its aims were to implement processes for promoting the autonomy of the specialty based on its specific structure and methodology, the harmonization of the specialty education programs among the European countries, the theoretical defense of the profession's general interests, and the promotion of the creation of national PMR societies. The European Federation of PMR operated officially for ≥40 years (1963–2003) in the continent and contributed greatly to the foundation and the homogeneous development of our medical specialty. It started with five foundation member societies and increased to 20 member societies including Austria, Belgium, Bulgaria, Croatia, Cyprus, France, Germany, Greece, Italy, Latvia, Lithuania, the Netherlands, Portugal, Romania, Serbia, Slovenia, Spain, Switzerland, Turkey, and United Kingdom. It was dissolved in 2003, not due to any conflict but perhaps to make way for the creation of the European Society of PRM (ESPRM).[7],[9]

  European Society of Physical and Rehabilitation Medicine Top

The ESPRM accepts both individual members specialized in PRM and National PRM Societies from Europe. Its mission is to improve awareness of PRM's fundamental role in implementing social changes to fulfil the rights of disabled people, to promote scientific research and education in PRM at a European level, to harmonize the way of understanding rehabilitation in different countries at a European level, to diffuse the European knowledge in the International bodies, and to contribute to the enrichment of contents and awareness of PRM at any level and in any matter.

To achieve the above goals, ESPRM organizes a Biennial Scientific Congress in different countries in Europe and participates in the European Union (EU)-funded research projects. Furthermore, it has established the following Special Interest Scientific Committees (SISC) focusing on specific fields of PRM competence: Public Health, Orthotics and Prosthetics, Guidelines, Persons with Pain and Disability, Persons with Parkinson/Movement disorders, Persons with Traumatic Brain Injury, Persons with Musculoskeletal Disorders, Sports Affairs, Robotics in Rehabilitation, PRM in Aging Persons, Evidence-Based Medicine, Persons with Spinal Cord Injury, Persons with Stroke, Ultrasound in PRM, and Persons with Peripheral Nerve Disorders.

As an initiative of the SISC on evidence-based medicine, under the leadership of Prof. Stefano Negrini and with the approval and support of the other European PRM bodies and the International Society of PRM (ISPRM); the Cochrane Rehabilitation field has been created and it was launched in December 2016. The aim of this initiative is to contribute to the strengthening of the scientific evidence in our specialty, to improve rehabilitation research methodology, and to create new clinical practice guidelines as well as other benefits for rehabilitation.

In 2017, the SISC on robotics in rehabilitation started in Italy, the “Robotic Rehabilitation Summer School” under the leadership of Prof. Alessandro Giustini. This school accepts 12-PRM trainees from European countries with free registration and accommodation. It is supported not only by the ESPRM but also by the Union of European Medical Specialists (UEMS) PRM Section and Board as well. The trainees receive theoretical knowledge with an evidence-based approach in the area of the assistive technologies in rehabilitation.[8],[9]

  European Academy of Rehabilitation Medicine Top

The European Academy of Rehabilitation Medicine (EARM) was created in Geneva in 1969 by eight founding members under the French title of “Académie Européenne de Médecine de Réadaptation,” but the registered seat of the Academy is in Brussels. Its logo is “Societatis vir origo ac finis” (Man is both the source and the goal of society).

Its mission is to improve all aspects of rehabilitation for persons with disabilities, to introduce and defend the concept of rehabilitation, to engage in moral and ethical debates, to be one of the reference points in the scientific educational and humanitarian aspects of PRM, to exchange information defining the field of rehabilitation and its terminology, to ensure that education in rehabilitation is part of the curriculum vitae, to support and help improve research in rehabilitation, and to facilitate the exchange of PRM trainees and doctors among different countries.

The academy can have up to 50 individual members from several countries of Europe. Some of the work of the EARM in the area of ethics include:

  1. The ethical problems posed by the longer survival of a greater number of people who are entirely dependent and conscious
  2. Revealing the prognosis to a paralyzed adult
  3. Ethical problems posed by sexuality for persons with disabilities living in institutional establishments
  4. Violence and handicap
  5. Rehabilitation medicine for aging people: Human challenges.

The academy, in order to encourage new researchers, has created an annual prize for a publication in the PRM field. The prize is officially awarded at the European Congress of PRM.[7],[8],[9]

  Union of European Medical Specialists Section of Physical and Rehabilitation Medicine Top

In 1963, the UEMS approved the creation of the Section of physiotherapie/physiotherapy. This Section was inactive for several years, and in 1971, UEMS accepted the name of PRM. After some years of reorganization of the specialty, the Section started its official operation in 1974.

For ≥30 years, the Section had to solve the following main problems: To establish a definition of the specialty, exact and official, to give the same name to this specialty in all of the countries of the European Community, to develop guidelines for the harmonization of education in PRM, to define the role of the doctor specialized in the discipline, to establish a convenient and reasonable relation between the specialty and the other health professions in rehabilitation, and to examine how and what continuing medical education (CME) was in the specialty in each country.

In 2001, the Section was reorganized and divided the work in three committees for better functionality. The Board (for Educational Affairs), the Professional Practice Committee (for the Field of Competence), and the Clinical Affairs Committee (for the quality of clinical programs). An Executive Committee elected for a 4 years term is responsible for the coordination of the work of the three committees, the implementation of decisions, the development of the action plan, and the external relations with other professional bodies. The Section accepts delegates from the EU States, as well as from Associate Countries and other Countries interested in participating as observers. Today, our Section has about 70 delegates from 40 countries, and consequently, it represents ≥23,000 physicians.

The European board of PRM has the task of harmonizing specialist training across Europe working in collaboration with other professional bodies. It is responsible for the following:

  • European examination for recognition of specialist training leading to a fellowship
  • CME and professional development (used for 10-yearly revalidation of fellowship)
  • Recognition of European trainers and training units through site visits
  • Accreditation of Learning Educational Events and E-Learning programs.

In 1994 with the support of the Section and Board, the European Academy and the Timone University Hospital, the European School of Marseille was established. This School, under the current leadership of Prof. Alain Delarque, accepts every year PRM residents and young PRM specialists for 2 weeks of training in the field of motor disabilities, posture and movement analysis, rehabilitation and neurophysiology.

Recently, an important resource, a free e-book, was published by the Board under the title “PRM for Medical Students.” In April 2018, the European Training Requirements of PRM were approved by the UEMS Council. This validation is very important because the training requirements have been accepted unanimously by all the Sections of the other European medical specialties and by all the national medical associations of the EU. In addition, these requirements will be part of the EU legislation concerning training in PRM and the free movement of the specialists in all European countries.

The Professional Practice Committee has the task of improving the general setup of PRM practice in the EU, harmonizing the professional practice in the EU, improving the relations with other medical specialties, and other PRM-team members and of describing and developing the “Field of Competence of PRM.”

It played a very important role in preparing and publishing the second (2007) and third (2018) edition of the White Book of PRM in Europe, which was translated into many languages. In addition, it has published a series of position and role articles concerning the competencies of the PRM physicians and outlining recommendations for best practice. Two free e-books including all these articles have been published under the title “The Field of Competence of PRM Physicians Part I in 2014 and Part II in 2018.”

The Clinical Affairs Committee has the task of establishing and further developing the European Accreditation System for the quality of care programs, for defining Harmonized Guidelines of PRM Services at the European level, assessing tools used in rehabilitation, and promoting the Standards of Ambulatory Rehabilitation.[8],[9]

  European College of Physical Medicine and Rehabilitation (Served by Union of European Medical Specialists Physical and Rehabilitation Medicine Board) Top

The European College of PRM was created in 1991 and registered in the Hague, the Netherlands. Its task was to harmonize the training of medical specialists in PMR. Its function was closely connected with the UEMS PMR Board. The work of the College was supported with a donation by Antoine Macouin, president of the West France Group of doctors specializing in Reeducation and Rehabilitation.

The pioneers of the College, among them Prof. Andre Bardot, Carlo Bertolini, Jan Ekholm, and Alex Chantraine, set up an executive committee and a committee of teachers. They worked very hard and in <2 years, they had established the first training curriculum for PMR specialists' trainees in Europe, the methods of practical training, and the corresponding English–French bilingual logbook.

The College/Board of PRM was active with this organizational structure until 2014 and organized Examinations for the Diploma of the European Board of PRM. In 2014, the college transferred all its activities to the UEMS PRM Board in response to the UEMS regulations.[7],[10]

  Regional FORA Top

The Mediterranean Forum of PRM (MFPRM) was founded in 2000 in Athens during the 3rd Mediterranean PRM congress. This decision followed a meeting of pioneers from several Mediterranean countries during the 1st Mediterranean PRM congress in 1996 in Herzliya, Israel organized by Prof. Haim Ring under the moto “Rehabilitation without frontiers.” Under the presidency of Prof. Nicolas Christodoulou (2000–2010), the MFPRM increased its individual members from 20 to 530, and every 2 years organized a congress during which the Interim Meetings of the ISPRM took place.

The tasks of the MFPRM are to be the scientific Mediterranean body for PRM physicians working in three continents such as Europe, Asia, and Africa, around or with close vicinity with the Mediterranean Sea, to facilitate Mediterranean exchange regarding different aspects of rehabilitation research, multicenter trials, national and Mediterranean projects, meetings and congresses, to organize a biennial Mediterranean congress of PRM in one of the countries with active members in the Forum, to influence national governments, in close cooperation with the national societies of PRM and to support initiatives and cooperation in the field of teaching, development of services, and research in PRM. In addition, the MFPRM aims to provide information to national governments about the contents and evidence-based efficacy of PRM. In 2005, the MFPRM started the annual Euro-Mediterranean PRM School in Syracuse, Sicily (Italy) under the leadership of Dr. Franco Cirillo. Later, the name of the late Prof. Haim Ring was added to the name of the School. About 40 residents and young trainees from several Mediterranean countries meet in Syracuse for 1 week and they have theoretical and practical presentations of PRM topics of current interest. Most of the expenses are covered by a local consortium, the UEMS PRM Board, the ESPRM, the MFPRM, and the Italian PRM Society (SIMFER).[11] All these tasks have continued successfully under the presidencies of Pr. Jorge Lains (2010–2014) and Prof. Gulseren Akyuz (2015–2019).[8]

The Baltic and North Sea Forum of PRM (BNF-PRM) was founded in 2007 in Riga by individual members. The present organization has an executive board, an advisory board, and four committees. There are two main reasons for the existence of BNF-PRM. The first one is that the Baltic and North Sea is a region with 16 countries with different languages and traditions, as well as different health systems that result in differences in approach and strategy for rehabilitation. The second reason is the political history of the region. A few decades ago, the region was divided by the so-called “Iron Curtain,” and almost no personal contact between colleagues living in different sides of the border was possible. This resulted in very little if any scientific communication and exchange.

The tasks of the BNFPRM are to communicate and exchange knowledge in the field of PRM, to create and evaluate concepts for PRM activities and discuss best practice, to stimulate the creation of networks for scientific projects regarding different aspects of rehabilitation research, to support education and training in the field of PRM, and facilitate exchange of young doctors and scientists, to influence national governments and promote the incorporation of issues of rehabilitation into national health strategies, and to have a collaboration and a good cooperation with National and International scientific PRM societies. Furthermore, they organize a biennial regional congress of PRM.[12]

  National Physical and Rehabilitation Medicine Societies Top

The national societies play the most significant role in the development of PRM at the national level. The European PRM Bodies support the National Societies in their task of developing PRM within their own country's health system, professional organizations, and academic institutions. All the national societies of the member countries appoint delegates to the PRM Section and Board of UEMS and participate in the regular general assemblies that are organized twice per year. During the same week of the assembly, there is the meeting of the delegates of ESPRM. Most of the national societies of PRM are members of the ESPRM. ESPRM includes not only national societies of member states of the EU but also from almost all the European countries.

The main tasks of the National PRM societies are to promote the development of PRM, to ensure good rehabilitation care for persons with disability and other disabling conditions, to promote the specialty of PRM and the profession of PRM, and to develop the rehabilitation services at the national level. Some of the national societies have mainly scientific and educational goals, related to the professional development of the specialists, while others are engaged in defending the professional interests of PRM doctors, defining the competences of PRM doctors, their relations with the other members of the rehabilitation team, with the other medical physicians and other professionals. These focus on creating clinical guidelines and clinical standards of good practice. There are societies that attend to all these areas as well. The national PRM societies organize regular scientific events in PRM (conferences and congresses) and are responsible for the CME. Several national societies publish their own scientific journal, and others use European PRM Journals as their national journal.[8]

  Journals of Physical and Rehabilitation Medicine Based in Europe Top

A European PRM Journals Network was founded in 2010 with the main goal of creating the widest possible readership of the articles published in the European Journals. The scientific journals play a key role for PRM in Europe, because they serve for the development of science and research in our field and disseminate knowledge to an international audience.[13],[14],[15] These journals, European and national, are the following:[8]

  • European Journal of PRM (JPRM) (Italy)
  • Journal of Rehabilitation Medicine (JRM) (Sweden)
  • Clinical Rehabilitation (United Kingdom)
  • International Journal of Rehabilitation Research (Journal of European Forum for research in Rehabilitation)
  • Annals of PRM (France)
  • Physikalische Medisin–Rehabilitationsmedisin–Kurortmedisin-JPRM (Germany and Austria)
  • Rehabilitación (Madr.) (RM) (Spain)
  • Fisikalna Medisina. Rehabilitasia. Sdrave (Bulgaria)
  • Fizikalna i rehabilitacijska medicina (Croatia)
  • Revista da Sociedade Portuguesa MFR (eng. Journal of the Portuguese Society of PMR) (Portugal)
  • Rehabilitace a Fysikalni Lekarstvi (Czech Rep.)
  • Rehabilitáció (Hungary)
  • Nederlands Tijdschrift Revalidatiegeneeskunde (Netherlands)
  • Postępy Rehabilitacji (eng. Advances in Rehabilitation) (Poland)
  • Romanian JRM (Romania)
  • Herald of Regenerative medicine (Russia)
  • Balneoclimatology (Serbia)
  • Rehabilitácia (Slovakia)
  • Rehabilitacija (Slovenia)
  • Turkish Journal of PMR (Turkey)
  • Journal of PMR Sciences (Turkey)
  • Physical rehabilitation and sports medicine (Ukraine).

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Conflicts of interest

There are no conflicts of interest.

  References Top

Conti AA. Western medical rehabilitation through time: A historical and epistemological review. ScientificWorldJournal 2014;2014:432506.  Back to cited text no. 1
Archaeological Museum of Paphos: Terra-Cota Hot Water Bottles – Hellenic-Roman Period – Cyprus. Available from: https://www.pinterest.com/pin/421086633881079471/.  Back to cited text no. 2
Conti AA. Reconstructing medical history: Historiographical features, approaches and challenges. Clin Ter 2011;162:133-6.  Back to cited text no. 3
Verville R. War, Politics, and Philanthropy the History of Rehabilitation Medicine. Lanham, Maryland: University Press of America; 2009.  Back to cited text no. 4
Dillingham TR. Physiatry, physical medicine, and rehabilitation: Historical development and military roles. Phys Med Rehabil Clin N Am 2002;13:1-16, v.  Back to cited text no. 5
Lee PK. Defining physiatry and future scope of rehabilitation medicine. Ann Rehabil Med 2011;35:445-9.  Back to cited text no. 6
Bardot A, Tonazzi A. European physical and rehabilitation medicine organisms – Origins and developments. Eura Medicophys 2007;43:185-94.  Back to cited text no. 7
European Physical and Rehabilitation Medicine Bodies Alliance. White book on physical and rehabilitation medicine (PRM) in Europe. Chapter 5. The PRM organizations in Europe: Structure and activities. Eur J Phys Rehabil Med 2018;54:198-213.  Back to cited text no. 8
European Physical and Rehabilitation Medicine Bodies Alliance. White book on physical and rehabilitation medicine (PRM) in Europe. Chapter 4. History of the specialty: Where PRM comes from. Eur J Phys Rehabil Med 2018;54:186-97.  Back to cited text no. 9
European Physical and Rehabilitation Medicine Bodies Alliance. White book on physical and rehabilitation medicine in Europe. Introductions, executive summary, and methodology. Eur J Phys Rehabil Med 2018;54:125-55.  Back to cited text no. 10
EMRSS. The Euro Mediterranean Rehabilitation Summer School. Available from: http://www.emrss.it/ENG/index.html. [Lasta accessed on 2019 Mar 27].  Back to cited text no. 11
Gutenbrunner C, Borg K, Joucevicius A, Tuulik-Leisi VR, Vetra A, Ward AB. The Idea of the Baltic and North Sea Forum on Physical and Rehabilitation Medicine (BNF-PRM); 2016.  Back to cited text no. 12
Negrini S, Stucki G, Giustini A. Developing the European physical and rehabilitation medicine journal's network. Eur J Phys Rehabil Med 2009;45:1-5.  Back to cited text no. 13
Negrini S, Ilieva E, Moslavac S, Zampolini M, Giustini A. The European physical and rehabilitation medicine journal network: Historical notes on national journals. Eur J Phys Rehabil Med 2010;46:291-6.  Back to cited text no. 14
Franchignoni F, Ozçakar L, Michail X, Vanderstraeten G, Christodoulou N, Frischknecht R, et al. Publishing in physical and rehabilitation medicine. An update on the European point of view. Eur J Phys Rehabil Med 2013;49:711-4.  Back to cited text no. 15


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