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European Physical and Rehabilitation Medicine Bodies Alliance Challenges and perspectives for the future of PRM 4. Promote Standards of Ambulatory Rehabilita- cine. The plan followed was to a large extent the same tion. as the one described above for Russia. E.  Permanent working group on Balneology: Contribution to policy planning 1. Collect all papers for EBM Balneology Ser- vices PRM specialty should be a major contributor to the 2. Publish a position paper on Balneology. establishment of modern health policies due to its spe- cific focus on functioning and the entire person, in- Another example on how to face the future harmo- stead on single diseases. The binomial health/disease nization is the opening of dialogue and relations in relation is still more focused on “pathogenesis” (ap- 2014 for PRM specialty with physicians from Rus- proach focusing on factors that cause disease) rather sia, practicing a part of Rehabilitation Medicine or of than in “salutogenesis” (approach focusing on fac- Physical Medicine. They wished to collaborate with tors that support human health and well-being). This the UEMS PRM Section and Board to transform the paradigm however is slowly changing. Nevertheless, way of their practice according to the model of the there isn’t yet sufficient awareness of the population Western Europe and eventually create the specialty and of the politicians for the relevance of Functioning of Physical and Rehabilitation Medicine in Russia. A in what it really represents to health (in its holistic plan was set up in cooperation with the Russian As- sense) and to the socioeconomic consequences of dis- sociation called ARUR (All Russian Union Rehabili- ability. It is a fact that statistical reports and political tators). Four Seminars were organized of one week attention goes more to the figures of childhood mor- each and were attended by 35 Russian colleagues, tality rate, diseases incidence and prevalence or life consultants of several Russian Rehabilitation depart- expectancy rather than on functional scales such as ments. The first seminar was organized in Vilnius health quality of life, functional independence mea- in December 2014, the second in Moscow in March sure, healthy life expectancy (HALE) or disability- 2015, the third in Kazan in June 2015 and the fourth adjusted life-years (DALYs). It is of course an ethical in December 2015. The lectures presented covered all principle to make all our efforts to make people sur- the fields of PRM specialty as they are described in vive; also, it is normal that it was the most important our curriculum. Since September 2015 a pilot project focus in Europe before the progresses of medicine started in thirteen Regions of Russia for comparing in the last centuries. Nevertheless, it does not seem the old system of Rehabilitation with the new system. logical that with better chances of survival, patients The project lasted for one year and the Section was are not given the necessary support to achieve a good asked for reviewing the process of this project. Sever- life. Moreover, it is quite absurd measuring “health” al Professors accepted to contribute their knowledge by scales of mortality or evaluating our life by sta- and experience. They travelled all the 13 Regions of tistics of death. We all know that, while reaching the the project, from Moscow to St. Petersburg to Kazan, excellent figures of such a low rate in childhood mor- to Vladivostok, to Siberia to Urals, to Samara etc. The tality rate, we find ourselves with a significant num- attendants of the seminars carried out the project suc- ber of severely disabled children, who also ethically cessfully with enthusiasm and they have started teach- deserve all our dedication. The same could be said ing other younger physicians in Russia to become with people that survive after very severe traumatic PRM physicians in their own country for the benefit injuries, serious diseases or either live much longer of their patients. The collaboration of ARUR with the under chronic and disabling conditions. They all de- Section and Board will continue in the long run and serve the needed rehabilitation care. While PRM fo- delegates from ARUR participate as observers to the cused its attention on all these aspects, this is not yet meetings of the Section and Board and of the Europe- clear to politicians and the general population. ICF an Society as well. In 2016, the UEMS PRM Section has been developed by the World Health Organization was asked by the newly found Ukrainian Society of and taken up by PRM as its reference framework. This PRM, to help for transforms in the country concerning is not yet true at a more general level, even if there the practice of Rehabilitation and implementing the EU standards for Physical and Rehabilitation Medi- 318 European Journal of Physical and Rehabilitation Medicine April 2018

Challenges and perspectives for the future of PRM European Physical and Rehabilitation Medicine Bodies Alliance are examples of applications not only in education, lic or private) should take into account the possible but even in fields like engineering and architecture. need of Rehabilitation interventions after a trauma, an The contribution in the next years of PRM in shifting acute illness or within a chronic condition that may the focus from mortality and morbidity only to health appear along our lives. In policy making, rehabilita- and functioning is crucial. Another issue is the health tion systems have to be developed continuously con- resources distribution between services for acute and sidering the following principles: long-term health conditions, including disability and disabling health conditions. We see today the well- —— rehabilitation following injury or illness and in established enormous effort in providing acute care, chronic conditions is a basic human right; with the noble goal of saving the greater number of lives possible. Conversely, there are no comparable —— equitable and easy access to all aspects of reha- investments on the immediate or subsequent care for bilitation including specialist rehabilitation medicine, the best recovery and to reach the maximal functional assistive technology and social support for the entire performance. Nevertheless, these investments would population in Europe; allow not only benefits for life quality and wellbeing of the patients, but also less expenses in future care. —— uniformly high standards of care in rehabilita- In the same line is all the hurry and priority to drive tion, including quality assurance and treatments based a patient to acute emergency units, while rehabilita- on scientific evidence; tion is frequently neglected or delayed. Assistance on acute states should be made comparable to support —— a scientific basis to develop rehabilitation models on the recovery process. In this endeavor, PRM is the and standards of care to guide clinical practice. Guide- medical specialty able to provide Governments with lines, pathways and recommendations should be imple- the necessary expertise in planning rehabilitation pol- mented with the participation of PRM. icies according to the population needs. PRM is able to help the planning of efficient Rehabilitation Care —— In order to reach these the following measures are Networks; to give its expertise to develop facilities, required: equipment and human resources; to build the more desirable operative models. Another growing issue, is —— to improve the general understanding and aware- the concern about chronic patients continuously mov- ness of the needs of people with disabilities; ing from one facility to another without a specific or- ganizational model. While General Practitioners can —— to publicize the benefits of rehabilitation. This offer the adequate competence in front of new mor- will lead to a culture in which access to adequate reha- bidities, the patients disabled or with disabling health bilitation is seen as a basic human right; conditions or with chronic conditions facing relapses or requiring continuous care and maintenance, need a —— to deepen the understanding and cooperation be- harmonization of their care creating a continuum of tween non-governmental organizations of people with care throughout the actually existing “silos” of the and the specialty of PRM; National Health Systems in Europe. Chronic patients and disabled people move from acute to post-acute to —— to establish comprehensive rehabilitation facili- long-term to outpatients to home care in various mo- ties across Europe with specialized and well-trained ments during their personal clinical history: this re- rehabilitation multi-professional teams led by PRM quires coordination. National Health Services should physicians and well-resourced rehabilitation facilities. have specialized departments concerning Rehabilita- Additionally, community based rehabilitation structures tion Care, and PRM should raise the knowledge about should be in place for the management of chronic dis- this need. The legislation should take into consider- abling diseases; ation the right to Rehabilitation Care by the popula- tion. This means that all the health insurances (pub- —— to set up systems to ensure that Physical and Re- habilitation Medicine has sufficiently well-trained and competent PRM physicians available in all European countries; —— to establish common high standards of care on the basis of current evidence. These should take into ac- count quality control and access to assistive technology; —— to incorporate new technical developments into PRM practice. This has a great deal to offer in assisting rehabilitation to produce better outcomes. Increasingly technology should contribute significantly to indepen- Vol. 54 - No. 2 European Journal of Physical and Rehabilitation Medicine 319

European Physical and Rehabilitation Medicine Bodies Alliance Challenges and perspectives for the future of PRM dent living and quality of life of people with disabilities description and development of our field of competence. Eur J Phys in Europe; Rehabil Med. 2009 Jun;45(2):275-80. 16. Gutenbrunner C, Neumann V, Lemoine F, Delarque A. Describing —— to promote scientific activities and research in the and developing the field of competence in Physical and Rehabilita- field of rehabilitation with adequate funding to improve tion Medicine (PRM) in Europe - preface to a series of papers pub- the outcomes for those experiencing disabilities; lished by the Professional Practice Committee of the PRM section of the Union of European Medical Specialists (UEMS). Ann Phys —— to support an environment where people with dis- Rehabil Med. 2010 Dec;53(10):593-7. abilities can fully participate in society. The PRM phy- 17. Ward AB, Gutenbrunner C, Damjan H, Giustini A, Delarque A. 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Challenges and perspectives for the future of PRM European Physical and Rehabilitation Medicine Bodies Alliance et al. Shoulder pain management. The role of physical and rehabilita- et al. Musculoskeletal perioperative problems. The role of physical tion medicine physicians. The European perspective based on the best and rehabilitation medicine physicians. The European perspective evidence. A paper by the UEMS-PRM Section Professional Practice based on the best evidence. A paper by the UEMS-PRM Section Committee. Eur J Phys Rehabil Med. 2013 Oct;49(5):743-51. Professional Practice Committee. Eur J Phys Rehabil Med. 2013 31. Varela E, Oral A, Ilieva E, Küçükdeveci AA, Valero R, Berteanu M, Oct;49(5):753-9. For this paper, the collective authorship name of European PRM Bodies Alliance includes: • European Academy of Rehabilitation Medicine (EARM) • European Society of Physical and Rehabilitation Medicine (ESPRM) • European Union of Medical Specialists PRM section (UEMS-PRM section) • European College of Physical and Rehabilitation Medicine (ECPRM) – served by the UEMS-PRM Board • the Editors of the 3rd edition of the White Book of Physical and Rehabilitation Medicine in Europe: Stefano Negrini, Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner, Carlotte Kiekens, Saša Moslavac, Enrique Varela-Donoso, Anthony B. Ward, Mauro Zampolini • the contributors: Maria Gabriella Ceravolo, Nicolas Christodoulou, Christoph Gutenbrunner, Stefano Negrini, Nikolaos Barotsis, Pedro Cantista, Calogero Foti, Slavica Dj. Jandrić, Črt Marinček, Xanthi Michail, Daniel Wever, Jerome Bickenbach, Kristian Borg, Leonard Li, Marta Imamura, Simon F. Tang Vol. 54 - No. 2 European Journal of Physical and Rehabilitation Medicine 321