Name of our specialty in member countries of the European Society for Physical and Rehabilitation Medicine – does different names implicate different philosophy?

In Europe, while most of the other medical specialties have existed for a long time under the same names in the different countries (Cardiology, Neurology, Radiology, etc.…), it is of interest to observe that Physical and Rehabilitation Medicine (PRM) began to be organized during the years of laborious birth of the great political European organizations, Council of Europe in 1949, and then European Community in 1957. The chronological ancestor of the European Society for PRM was the European Federation of Physical Medicine and Rehabilitation, founded in 1963. On 2003 the European Society for Physical and Rehabilitation Medicine (ESPRM) was founded, whose membership is open also to individual members specialized in PRM, although the participation of National Societies remains its central element. Furthermore, the role of the Society is strengthened with regards to its cooperation with other bodies (i.e. UEMS PRM Section and Board and European Academy of Rehabilitation Medicine) which work at European level in the Physical and Rehabilitation Medicine field, as well at International level with the International Society for Physical and Rehabilitation medicine (ISPRM).

The mission of ESPRM is 1) to be the leading scientific European Society for physicians in the field of physical and rehabilitation medicine; 2) to improve the knowledge of fundamentals and the management of activities, participation and contextual factors of people with a disability and c) to improve and maintain a strong connection between research and clinical practice in PRM. These scopes are pursued by many activities, such as disseminating information on rehabilitation-related funds, multicenter trials, national and European projects, meetings and conferences; providing resources to facilitate research activities and improve communication; organizing a biennial Congress and providing information to local, national and European authorities on the content and scientific evidence-based effectiveness and efficiency of Physical and Rehabilitation Medicine.

The theoretical background, principle, practice and organization of the discipline are extensively described in the ‘White Book on Physical and Rehabilitation Medicine in Europe’ realized with the contribution of all European PRM bodies.¹

ESPRM is current umbrella organization for 38 member countries and one observing country (Jordan) with population of 812 millions and with the total PRM manpower of 27,192 specialists (12,400 are members of their national PRM Societies) and 4681 PRM residents (2869 are members of their national PRM Societies) in 37 countries,² since Physical and Rehabilitation medicine is not a specialization recognized in Denmark.

An overview of the list of National Societies of our specialization³ reveals pretty non-uniform official titles of Societies across the continent. In 20 countries, the name of the specialty in the title of national Society is ‘Physical and Rehabilitation Medicine’ in 10 countries is ‘Physical Medicine and Rehabilitation’ in two countries ‘Rehabilitation Medicine’ (Romania and Poland), as well names of specialty are ‘Rehabilitation’ (Hungary), ‘Physiatry, balneology and Medical Rehabilitation’ (Slovakia), ‘Rehabilitation and Physical Medicine’ (Czechia) and ‘Physical Therapy’ (Georgia). This current real field data differs from the official data published by the European Physical and Rehabilitation Medicine Bodies Alliance,⁴ which again reflects the rather strange situation in the specialization.

Among the reasons for non-uniformity of the title of specialty Society are tradition, specialty background, single country natural resources as well needs of the different European regions and even political will and perspective.

The terms ‘Physical’ and ‘Rehabilitation’ are basic adjectives that describe our specialization, but sometimes there seems to be an academic debate which of those terms are more attributed to ‘medicine’ – one (which one?) or maybe both of them. Since term “Rehabilitation” has a meaning as an essential part of universal health coverage along with promotion of good health, prevention of disease, treatment and palliative care through a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment,⁵ it is very clear that just the term Rehabilitation is just too general and too wide for the description of the activities of the physicians working in the field of rehabilitation. Therefore, our opinion is that the term Rehabilitation Medicine reflects the activity of doctors, practicing medicine in the frame of their specialization. The adjective ‘Physical’ could be understood differently from different geographical angles and therefore is worth of additional discussion. We can understand the term ‘Physical’ as description of something ‘relating to the body of a person instead of the mind,’⁶ which would be a very unfortunate description of our holistic specialty, but on the other side this is the first thing that layperson would think of, when hearing about Physical medicine. A wider concept of ‘Physical’ should be adopted, focused on health-related interactions between the person and the world, according to the so-called biopsychosocial model of medicine.⁷

Of course there could be historical and linguistical debates around the meaning of ‘physical’, but our opinion is to maintain the name of specialization without doubts of the meaning, that can be understood by the medical and non-medical subjects. Last but not least, there is one very straight meaning of ‘physical’ in the eastern European countries speaking languages of Slavic roots. Historically in those countries (as well many others) in diagnosis and therapy, as well as in preventive treatment, various agents are used, so there are natural (water, air, sun, movement, use of mineral waters, healing mud) and artificial (physical) agents (light waves, electrical electricity, but also various other forms of energy obtained artificially). As described for example by online edition of Croatian encyclopedia - Miroslav Krleža Lexicographic Institute, 2021:⁸ physical medicine (according to Greek φυσıϰός: natural + medicine): a branch of medical science that uses different forms of physical energy (e.g. mechanical, thermal, etc.) in diagnosis, treatment, rehabilitation and prophylaxis. Its roots go back to the distant past, but it developed intensively only in the 20th century and became the basis of medical rehabilitation.

Our opinion is, that the term ‘Physical and Rehabilitation Medicine’ is inevitably the name of our specialty. The exact meaning and origin of adjective ‘Physical’ is obviously yet to be determined, but necessary in the way that would not cause uncertainties or double meaning for the medical and nonmedical population. Therefore we call for the joint efforts of Physical and Rehabilitation Medicine Bodies Alliance, with the aim to achieve a broad consensus on this issue including the efforts to unanimously unify the name of our specialty across Europe, which would help to strengthen reputation of specialty and ease the communication among professionals as well as non-professionals.