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 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 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).

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.