OPEP-DV Report on physiotherapy and Domestic Violence
In the framework of the European OPEP DV project, an investigation and mapping of the field was carried out in order to describe the theoretical background and the educational programme that physiotherapists receive during their studies. An attempt was made to investigate both the curriculum and the training of physiotherapy students on potential issues of abuse and domestic violence. Below, we present a summary of the main findings according to the above-mentioned requests, as they were extracted from the research carried out by the European Project partners in their local areas. The results collected come from the countries: Cyprus, Estonia, Greece and Spain
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Content Α. Education & Training ........................................................................................................................ 4 Mapping of the field 4 Curriculum for physiotherapists 5 Academic studies 5 Curriculum programs / Identification ............................................................................................... 5 Curriculum programs/Communication: ............................................................................................ 6 Monitoring and evaluation ............................................................................................................... 6 Β. Procedures & Responsibilities........................................................................................................... 7 Protocols 7 Legislation 7 Law 8 Supervisory body .............................................................................................................................. 8 C. Practices............................................................................................................................................ 9 Treatments ....................................................................................................................................... 9 Difficulties 10 D. Further information 10
Mapping of the field How is the curriculum in physiotherapy schools structured? Are there differences among the different departments per university? Is there a distinction among private and public institutions? If so, are there different national processes in integrating the curriculum into compulsory and elective courses?
Studies in physiotherapy involve education at higher education, which has a minimum of 3 years of study and is mostly carried out by public educational institutions. Usually, university education is defined as 4 years of study, i.e., 8 academic semesters. During the period of study there is a variety of courses are offered to equip students with the required knowledge and skills This curriculum is offered according to national, European, and international standards, so that they become well-trained professionals who will cover professional positions and provide services as optimally and efficiently as possible. In Cyprus, physiotherapy studies are not offered by the state universities (University of Cyprus) but by 2 private universities. At the same time, in Greece and Spain, it is possible to study physiotherapy in both state and private educational institutions (minimum of 3-year study) which are recognized and accredited by the relevant ministry which is responsible for education and the national education system of each country. In all countries, it is stated that physiotherapy studies have theoretical and practical training. Upon completion of the theoretical part of the education and courses, students are required to proceed with practical training. It is worth mentioning that in Estonia, especially at the University of Tartu, there is an additional compulsory teaching practice, which requires physiotherapy students to work in a clinical environment. Furthermore, in all countries and highereducationinstitutions, itisstipulatedthat physiotherapystudentsneedtoprepareathesis to obtain the degree upon completion of the theoretical and practical part of the studies
In addition, in all countries, it is reported that the curriculum of physiotherapy is describedin a transversalway, from the bachelor's degree level topossibilitiesofspecialization through postgraduate programmes offered by higher education institutions, as well as doctoral programmes and studies for even more advanced training in the subject and academic training. In Greece, to practice physiotherapy, it is required to acquire a professional license which is awarded to graduates after receiving their degree from the services of the Ministry of HealthWelfare and Social Insurance and completing required procedure for its issuance in accordance with the specified qualifications and rights of the physiotherapist, as provided for under P. D. 90/1994 (Government Gazette 53/8-3-95/T.A.).
Finally, there are structured curricula offered in the field of physiotherapy in higher academic education in line with the guidelines set by each educational system and academic qualifications both at the national and European levels. Apart from theoretical education, students are provided with workshops, practical training, and thesis writing to enhance learning and enable transition to fieldwork/ the career path.
4 Α. Education & Training
Curriculum for physiotherapists Does the curriculum for physiotherapists includes courses (lectures or seminars) or workshops on forms of violence or ways of perpetrating violence (e.g. physical violence, covert violence, ambiguous signs of violence)? If so, by whom are these courses run? By a physiotherapist or by an expert in violence? If so, is the curriculum used in a one-year course or is it taught for all academic years in universities?
In Cyprus, Estonia, and Greece, there is no reference and specific course covering this subject in the curriculum Only in Spain where the seminars and courses do not focus exclusively on gender-based violence, a reference is made in the university curricula of physiotherapy. In this regard, universities offer elective or compulsory courses which aim to provide students with the knowledge of psychological and physical effects of gender-based violence, the recognition of signs of violence, and the investigation of suspected violence through asking appropriate questions to address and prevent cases of gender-based violence promptly.
Academic studies As part of the academic studies as physiotherapists, is there the provision of information or training regarding the recognition or signs of suspected physical (gender-based) violence?
In Cyprus, Estonia, and Greece, there does not seem to be a structured learning and training programme in the academic physiotherapy curriculum on how to recognize and report the suspected physical injury, gender-based violence, and/or abuse. Information and education on the subject depend on the personal interest of each student and the professional. In Spain, following the revision of the Spanish Health System Review (2010), a specific strategy for the prevention and treatment of gender-based violence is foreseen. Through this strategy, physiotherapists must report to the authorities their suspicions regarding situations of domestic violence and abuse against children, elderly or disabled people.
Curriculum programs / Identification Are there any curriculum programs, trainings or seminars on the identification and treatment of abuse with a target group of physiotherapists? If so, what are they?
In Cyprus andGreece, there do not seem to be any programmes, trainings, and seminars related to the recognition and treatment of violence and abuse that are addressed to physiotherapists. In Estonia, from time to time, there are crisis psychology courses for physiotherapists so that they are trained to deal with crises, but this training does not put emphasis on (mental) violence. Also in Spain, the Ministry of Education and Health offers special curricula, with training and seminars, to recognize and deal with violence and abuse.
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Curriculum programs/Communication: Are there any curriculum programs, training or seminars to improve the communication and development of physiotherapistbeneficiary relationships?
In physiotherapy curricula in Estonia, Greece, and Spain there are courses on psychology, patient treatment and approach, rehabilitation psychology, communication psychology, crisis psychology, and counseling techniques, which also aim at familiarizing physiotherapists with the most appropriate way to approach patients and beneficiaries. In addition, through learning the code of ethics of the physiotherapy profession, the basic principles of the physiotherapist-patient-beneficiary relationship are defined, in a relationship of safety, trust, and intimacy.
Monitoring and evaluation Is there any monitoring and evaluation for the physiotherapist training system? How is it implemented, by whom and how is it carried out? If this monitoring and evaluation physiotherapist training system is active at the moment, what are the results of these actions exploited?
In Estonia, the curriculum for physiotherapists is assessed by the Estonian Quality Agency for Higher and Vocational Education. Higher Education Institutions accept both institutional and curricular assessments to ensure the improvement of the quality of education and the achievement of high-quality education for students. In Greece, Higher Educational Institutions (HEI) are legal entities under public law and fully self-governed, which constitutes an independent and autonomous service of the Ministry of Education and Religious Affairs. Their supervision by the state is exercised by the Ministry of Education, Research and Religious Affairs under the provisions of Article 16 of the Constitution and the provisions in force. In Cyprus, physiotherapy curricula are only supervised for the recognition of higher education qualifications by the Council of Recognition of Higher Qualifications (KYSATS) while the Spanish higher education system, including physiotherapy studies, is supervised and evaluated by the National Agency for Quality Assessment and Accreditation of Spain (ANECA) established under Act 15/2014 and the Statutes of ANECA (Royal Decree 1112/2015).
According to the above-given information, it can be reasonably concluded that there is no single supervisory body according to international and European standards, but the supervision and evaluation of the education and training of physiotherapists, along with the entire constitution of the educational programme of physiotherapists, are carried out by different supervisory bodies in local regions and respective countries.
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Β. Procedures & Responsibilities
Protocols What are the specific protocols for the practice of physiotherapy? Is there a code of ethics/conduct for the profession? If so, who is it and what does it say? Is there specific provision to reflect the responsibilities of the physiotherapist in relation to the performance of their services and the potential for abuse and violence?
In the code of ethics for physiotherapists, it is explicitly stated that physiotherapists should follow theprinciplesofethics, provide theirserviceswithrespect,courtesy, andhonesty to the beneficiary – patient by always acting in their interest and providing them with all the necessary information for the proper participation of patients in the procedures of physiotherapy.
The main institution that determines the protocol and guidelines for the practice of the profession of physiotherapy and follows the Code of Ethics of physiotherapists is the World Confederation of Physiotherapy of Europe (WCPT). In Greece, the application comes as a consequence with the implementation of the Code of Ethics of Physiotherapists, as published by Ministerial Decision Y7g/GP/oik.107359 /2010 in Government Gazette 1396/B/6-9-2010
Moreover, in Estonia the implementation of the principles follows on the recommendations and good practices recommended by the Estonian Association of Physiotherapists for the organization of the work of physiotherapists. At the same time the Code of Ethics, published by the Cyprus Physiotherapists and Physiotherapy Establishments Registration Council in Cyprus clarifies the definition of the objectives of physiotherapy and the way physiotherapists practice their profession, as well as their obligations towards patients. All of the above individual country implementation elements are s always defined in accordance with the Code of Ethics of physiotherapists is the World Confederation of Physiotherapy of Europe (WCPT). However, it is worth noting that this code is worded in a male-centric language without any reference to equality, diversity, and equal inclusion in public health, in line with the prescribed principlesoftheWorldConfederationofPhysicalTherapy(WCPT).Inaddition,inSpain,main bodies responsible for ensuring compliance with the code of conduct are the Spanish Ministry of Education and Health and the Europe Region World Physiotherapy (ERWCPT)
Legislation Are physiotherapists aware of the legislation that exists regarding abuse and violence? Is there a statutory way in which physiotherapists are made aware of legislative procedures regarding domestic violence and abuse? Is there an institutionalized protocol and plan regarding this or are they subject to the physiotherapist's personal will and awareness on an individual basis?
In most of the project countries (Cyprus, Estonia, Greece), there seems to be no institutionalized protocol or specialized training programme for physiotherapists' knowledge and information on legislative procedures on domestic violence, abuse, and gender-based violence.In Cyprus, despite legislative and policy development in the field of violence against women there are no institutionalised protocols for the physiotherapist’s profession. More specifically, this highlights the need to have some policies and proposals to ensure the implementation of a law to prevent and combat violence against women and domestic violence
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specifically focused on the field of physiotherapy and the exercise of the professional role of physiotherapists More specifically, this refers to the fact that For example, the national laws deriving from the transposition of the Council of Europe Convention on the Prevention and PreventionofViolenceagainstWomenandDomesticViolence(IstanbulConvention)covering Domestic Violence, Stalking, and other. Similarly, the Estonian Ministry of Justice is is responsible for ensuring the implementation of Istanbul Convention’s. In contrast to all the above, it seems that only in Spain, there are specific regulations for physiotherapists to deal with gender violence, abuse, and domestic violence. More specifically, Spanish law stresses the need to train physiotherapists in gender-based violence and abuse in order to intervene and deal with such phenomena appropriately. In addition, the National Health System Portfolio of Common Services (regulated by Royal Decree 1030/2006, Official Bulletin of the State, 2006) refers to the obligations of physiotherapists to provide support and assistance to victims of violence to stand against gender-based violence as a responsibility of physiotherapists. Thus, the 2007 Standard Protocol on Gender-Based Violence for Health Professionals has been put into practice by the country These practices are critical interventions for the identification, prevention, and treatment of gender-based violence, abuse, and domestic violence.
Finally, it is important to point out that, in addition to recommendations and exhortations, there is a need for institutionalized prevention and support measures in cases of gender and domestic violence in the context of physiotherapy.
Law What does the law provide for the physiotherapist's actions if he or she becomes aware of possible violence or brings evidence of violence?
In Cyprus, Estonia, and Greece, there is no specific reference in the law regarding the obligations of physiotherapists in cases of violence and abuse, apart from the existing legislation on the prevention and treatment of gender-based violence and domestic violence, which refers to the general ways of dealing with it by citizens and/or all private and public sector service providers involved, or how to ensure the rights of women victims of violence and their protection. However, in Spain, it is the legal obligation of physiotherapists to report a violent act or any act of violence to the judicial authorities and the police, as established by the Common Protocol for a Healthcare Response to Gender Violence (2012) and Royal Decree 1030/2006, which structures the National Health System Common Services Portfolio.
In line with the above, it is important to structure a statutory protocol and legislative framework, which will ensure obvious measures for support, prevention, recognition, and treatment in cases of domestic violence in physiotherapy
Supervisory body Is there a supervisory body for physiotherapists e.g. a statutory association of physiotherapists as an independent and universal body?
Concerning the supervisory bodies for physiotherapists, it is seen that there are different bodies in each country. However, it is worth mentioning that the country-specific physiotherapist regulatory bodies are active members of the World Confederation of Physiotherapists (WCPT) and subject to the principles set out by the WCPT and the Europe Region World Physiotherapy (ERWCPT). It also seems that other relevant bodies frequently
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collaborate with these entities at the international level. More specifically, in Cyprus, the Cyprus Physiotherapists and Physiotherapy Establishments Registration Council is the supervisory body responsible for the registration, supervision, and licensing of physiotherapists. Additionally, the Pancyprian Association of Physiotherapists is the supervisory body responsible for educational materials and general information on the profession of physiotherapy. In Greece, the Panhellenic Association of Physiotherapists (P.S.F.) is a Legal Entity under Public Law that deals with the subject of the Science of Physiotherapy and is a Founding Member of the European Region of WCPT. Also in Spain, specific protocols for the practice and supervision of physiotherapy are defined by the white book published by the National Agency for Quality Assessment and Accreditation (ANECA).
C. Practices
Treatments What are the most common reasons for referral to physiotherapists for treatment? Could some of these conditions be caused by violence or chronic abuse? If so, how, if at all, could this be identified and how could the most appropriate approach be taken?
In order to provide answers to the above question, data were drawn from both research data and personal professional experiences of qualified physiotherapists in the field of physiotherapy.However, acorrectandcertainanswertothisquestionremains difficulttoapply as it is subject to a variety of additional parameters.
In the search for this specific information, there does not appear to be any research that focuses on or sets a specific goal of answering the above question as formulated in the existing report. Therefore, the responses attributed to country information raise reservations and may prompt broader research and collection of ideas on the specific topic.
Common reasons for referral to physiotherapy may include the following: immobilization, injuries, hip fractures, cerebrovascular accident, brain injury and rehabilitation, post-traumatic rehabilitation of knee or hip prostheses, chronic obstructive pulmonary disease, Alzheimer's disease, palliative care procedures, chronic conditions, shoulder pain, back pain, cervical syndromes, strains or tendinitis.
However, despite the reasons for referral and initiation of physiotherapy, there are no findings to support the association of these reasons for referral and illness with gender-based violence and violence against women. Appropriate information and knowledge of physiotherapists, along with teamwork and multi-agency collaboration and cooperation for cases (professionals of common or different specialties working together) together with the right approach to patients and observation of signs that may indicate underlying violence and abuse, can help to uncover existing violence and provide support and assistance to victims of violence.
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Difficulties What are the most common difficulties that physiotherapists encounter in performing their duties in cases that may be directly or indirectly identify or suspect any form of violence and abuse? How do they respond to these difficulties and how do they overcome existing obstacles?
In none of thecountries conducting the fieldinvestigation, were found resources available to respond to the aforementioned question.
In conclusion of what has been mentioned in this report, it can be concluded that physiotherapists have not received any specialized training during their studies on how to recognize andrespond toincidentsofviolenceor suspectedviolenceofanykindand, therefore, it may be more difficult for them both to recognize signs that may indicate covert violence and to know how to apply a gender-sensitive, victim-centered approach when providing support and assistance.Therefore, only possible proposals that may be helpful can be listed, such as the existence of specialized work programmes aimed at physiotherapists, combined with meetings, seminars, and training sessions that can be held among the various professionals involved (physiotherapists, doctors, nurses, workers in services for victims of violence, psychologists, social workers, etc.) and training, information and awareness-raising activities for physiotherapists.
D. Further information
For further information follow the links below:
• https://www.e-nomothesia.gr/kat-ygeia/ya-y7ggpoik-107359-2010.html
• https://www.psf.org.gr/
• https://physio.upatras.gr/
• https://msc.physio.uth.gr/
• http://www.phys.uniwa.gr/courses/programma-spoydon/
• https://www.ihu.gr/tmimata/fysikotherapias
• https://physio.uth.gr/studies/bsc/%CF%80%CF%81%CF%8C%CE%B3%CF %81%CE%B1%CE%BC%CE%BC%CE%B1%CF%83%CF%80%CE%BF%CF%85%CE%B4%CF%8E%CE%BD/
• http://www.gsae.edu.gr/attachments/article/1427/%CE%92%CE%9F%CE%97 %CE%98%CE%9F%CE%A3%20%CE%A6%CE%A5%CE%A3%CE%99 %CE%9A%CE%9F%CE%98%CE%95%CE%A1%CE%91%CE%A0%CE %95%CE%99%CE%91%CE%A3.pdf
• https://medicinaycienciasdelasalud.uah.es/facultad/documentos/libroblancofisioterapia.pdf
• https://www.boe.es/buscar/pdf/2006/BOE-A-2006-16212-consolidado.pdf
• https://www.boe.es/boe/dias/2004/12/29/pdfs/A42166-42197.pdf
• https://aefi.net/wp-content/uploads/2021/09/ESTATUTOS.pdf
• http://www.aneca.es/Documentos-y-publicaciones/Memoria
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