Croatian Society of PRM and UEMS PRM Section and Board agreement

1 Introduction

Croatia is a country connecting Mediterranean, Central Europe and South-Eastern Europe with 4.4 million inhabitants, extending as an arc over Adriatic sea and reaching Danube river in the east, with total area of 87,661 km ²(total land area 56,594 km ²). The Croatian Adriatic coast is one of the most indented in the world: it has 1246 islands and islets with a total coastline of 4058 km, the total length of the mainland coast being 1777 km. Besides, its diverse landscape comprises lowlands and mountainous area separating them from its coastal part. Croatia has BDP, which is at 64% of European Union average but higher than in seven EU member countries and a number of other non-EU European countries. Sixteen percent of Croatian population is older than 65 years, and with actual low birth rate (approx. 9‰, while mortality rate is 10–12‰) Croatia expects reduction of its population by approximately 20% in 2051, even with planned immigration policy . In geographically diversified landscape, old population represents even more burden to health care system, and particularly to our specialty of PRM. More than 12,000 practising physicians in 43 different specialties in public health system organized by the Ministry of Health and Social Welfare and under the payment system of Croatian Institute for Health Insurance take care of Croatian population, including 350 PRM specialists and 40 trainees, giving a ratio of 6,8 PRM doctors/100,000 inhabitants, second highest in European Union of Medical Specialists (UEMS) member countries . Three thousand physiotherapists and occupational therapists work in the PRM system, with a number of psychologists, speech therapists, social workers and others. Croatian Medical Association (CroMA) was formed in 1874, at that time one of only eight physicians’ associations in Europe. CroMA has the mission to promote healthcare, professional and scientific work of medical doctors, fostering of ethical issues and protection of physicians’ interests. First two sections, those of Surgery and Internal medicine evolved in 1911, followed by others. Section of Rheumatology, Physical Medicine and Balneoclimatology appeared in 1947, and divided into PRM Section and Rheumatology Section in 1966. Croatian Medical Association nowadays has more than 100 societies, Croatian Society of PRM (CSPRM) being one of the largest and most active. PRM specialty was established in 1960, while even before some hospital wards were dedicated to inpatients in PRM, for instance in hospital of Varazdinske Toplice in 1957.

2 Undergraduate PRM training

Nowadays, undergraduate education in PRM consists of 45 hours of training (2 weeks in PRM department), at all of four university Medical Schools. This curriculum has 15 hours of theoretical courses and 30 hours in practical sessions. Content, agreed by Croatian PRM professors and proposed to the Board in its effort to harmonize undergraduate training in PRM include: history, role and importance of PRM; prevalence, diagnosis and evaluation of disability; methods and organizing of rehabilitation, social aspects of disability (2 hours); propedeutics and diseases of musculoskeletal system (2 hours); planning of rehabilitation and rehabilitation interventions; individuality of medicamentous and physical treatment; use of electrotherapy, thermotherapy, phototherapy, criotherapy, kinesiotherapy; modulation of pain (2 hours); diagnostics, treatment and rehabilitation in rheumatic inflammatory and degenerative diseases (1 hour); rehabilitation of patients with amputation (1 hour); rehabilitation of patients with spinal cord lesion (1 hour); rehabilitation of patients with traumatic brain injury and children with cerebral palsy (1 hour); rehabilitation of patients with trauma of musculoskeletal system or arthrophlasty (1 hour); rehabilitation/orthotic aids–orthoses and prostheses (1 hour); balneology and thermo-mineral waters (1 hour); rehabilitation of patients with cardio-pulmonary dysfunction (1 hour); sport in disabled persons (1 hour). Teaching of practical skills with common levels of competences include: history taking and clinical evaluation of patients with emphasis on functional limitations; developing of rehabilitation strategy for the patient; communication skills with patients, family members and other members of rehabilitation team; VAS for pain, measurement of joints and spine range of motion, manual muscle test; measurements in PRM and evaluation of outcome indicators in PRM–FIM, SF-36, Barthel’s, WOMAC, HAQ, BASFI. Practical exercises include: use of kinesiotherapy, occupational therapy, hydrotherapy, electrotherapy, phototherapy, ultrasound, electro-stimulation, teamwork in rehabilitation; application of orthoses and prostheses; assessment of ambulation, self-care and use of aids following stroke; assessment of children with cerebral palsy; assessment of patient with spinal cord lesion; assessment of patient with brain injury; assessment of patient with acute and/or chronic rheumatic disease; gait and posture analysis; range of motion measurement: spine, shoulder, elbow, wrist, hip, knee, ankle; hand grip and strength; MMT, including MMT for quadriceps, assessment of atrophy; measurement of leg circumference and leg length; assessment of swollen joint; assessment of joint pain on pressure; palpation of distal arteries; neurological tests: Lasegue, reflexes; VAS; FIM; HAQ; proposal of rehabilitation diagnose: impairment, limitation, restriction; application of ultrasound, TENS, interference current, criotherapy; isometric and isotonic exercises.

2 Undergraduate PRM training

Nowadays, undergraduate education in PRM consists of 45 hours of training (2 weeks in PRM department), at all of four university Medical Schools. This curriculum has 15 hours of theoretical courses and 30 hours in practical sessions. Content, agreed by Croatian PRM professors and proposed to the Board in its effort to harmonize undergraduate training in PRM include: history, role and importance of PRM; prevalence, diagnosis and evaluation of disability; methods and organizing of rehabilitation, social aspects of disability (2 hours); propedeutics and diseases of musculoskeletal system (2 hours); planning of rehabilitation and rehabilitation interventions; individuality of medicamentous and physical treatment; use of electrotherapy, thermotherapy, phototherapy, criotherapy, kinesiotherapy; modulation of pain (2 hours); diagnostics, treatment and rehabilitation in rheumatic inflammatory and degenerative diseases (1 hour); rehabilitation of patients with amputation (1 hour); rehabilitation of patients with spinal cord lesion (1 hour); rehabilitation of patients with traumatic brain injury and children with cerebral palsy (1 hour); rehabilitation of patients with trauma of musculoskeletal system or arthrophlasty (1 hour); rehabilitation/orthotic aids–orthoses and prostheses (1 hour); balneology and thermo-mineral waters (1 hour); rehabilitation of patients with cardio-pulmonary dysfunction (1 hour); sport in disabled persons (1 hour). Teaching of practical skills with common levels of competences include: history taking and clinical evaluation of patients with emphasis on functional limitations; developing of rehabilitation strategy for the patient; communication skills with patients, family members and other members of rehabilitation team; VAS for pain, measurement of joints and spine range of motion, manual muscle test; measurements in PRM and evaluation of outcome indicators in PRM–FIM, SF-36, Barthel’s, WOMAC, HAQ, BASFI. Practical exercises include: use of kinesiotherapy, occupational therapy, hydrotherapy, electrotherapy, phototherapy, ultrasound, electro-stimulation, teamwork in rehabilitation; application of orthoses and prostheses; assessment of ambulation, self-care and use of aids following stroke; assessment of children with cerebral palsy; assessment of patient with spinal cord lesion; assessment of patient with brain injury; assessment of patient with acute and/or chronic rheumatic disease; gait and posture analysis; range of motion measurement: spine, shoulder, elbow, wrist, hip, knee, ankle; hand grip and strength; MMT, including MMT for quadriceps, assessment of atrophy; measurement of leg circumference and leg length; assessment of swollen joint; assessment of joint pain on pressure; palpation of distal arteries; neurological tests: Lasegue, reflexes; VAS; FIM; HAQ; proposal of rehabilitation diagnose: impairment, limitation, restriction; application of ultrasound, TENS, interference current, criotherapy; isometric and isotonic exercises.

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