8TH SEPTEMBER 2021 BULLETIN OF THE POLISH CHAMBER OF PHYSIOTHERAPISTS - Głos Fizjoterapeuty
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8TH SEPTEMBER 2021 BULLETIN OF THE POLISH CHAMBER OF PHYSIOTHERAPISTS
ISSN 2545-3637
INTRODUCTION COVID-19
3 There is no turning back from development. 27 Support for COVID-19 convalescents is
A foreword from KRF President Maciej necessary
Krawczyk, PhD
30 Learn how to work with patients who have
had COVID-19 - the number of convalescents
TOPIC OF THE ISSUE is a real challenge for physiotherapists
4 KIF cannot force an open door - Maciej
Krawczyk in a more private version FROM THE WORLD
Assessment of the five-year term: 31 Rehabilitation is not enough - Dr. Paloma
9 Development, department of digitalisation, Cuchi, a representative of the World Health
training - Ernest Wiśniewski Organisation in Poland
10 Promotion of the profession and private 35 This term of office is your great international
practices - Paweł Adamkiewicz win! Interview with Jonathon Kruger
11 Science and education - Zbigniew Wroński 37 We will study the availability of assistive
technologies in Poland - about the project
12 Regions, physical medicine, balneo- aimed at the improvement of the availability
climatology, health resort physiotherapy -
of assistive technologies
Jacek Koszela
39 World Physiotherapy Congress online - there
13 Guaranteed services - Tomasz Niewiadomski
is also a whole range of countries for which
15 We overcome the resistance of the matter - Poland and our regulations of the profession
Katarzyna Blicharczyk-Ożga, talks about the can be an inspiration
work of the Legal Department of the KIF.
SCIENCE
KIF'S ACTIVITIES
41 What are the modern guidelines on the
20 How important is physiotherapeutic practice - guidelines on clinical practice
prevention today? Physiotherapists
significantly contribute to preventing or
decreasing disability KIF'S ACTIVITIES
23 Medical records in the electronic form became 43 "Physiotherapy moves - literally and
mandatory figuratively" poster competition
24 Success of the Polish version of the WHO’s 47 Public physiotherapy – what has changed
guide over the last 5 years?
25 Famous actors promote recommendations 48 Private physiotherapy practices – what has
on post-COVID-19 rehabilitation changed over the last 5 years?
52 Support from the governing organisation,
or what is the KIF for?
Editorial team: “Voice of Physiotherapist”
Paweł Adamkiewicz, Wojciech Komosa, The Polish Chamber of Physiotherapists Bulletin
Weronika Krzepkowska, Dominika Kowalczyk Editorial office address:
Secretary to the editorial team: Pl. Stanisława Małachowskiego 2, 00-066 Warsaw
Aleksandra Mróz, aleksandra.mroz@kif.info.pl phone: +48 22 230 2380, redakcja@kif.info.pl
Editing: Agnieszka Gierczak-Cywińska Publisher: Krajowa Izba Fizjoterapeutów
Graphic design and typesetting: Katarzyna Dobrakowska ISNN 2545-3645
Cover: "Physiotherapy moves!" Wojciech Janicki
All rights reserved. Using any content from this periodical must first be approved by the Publisher.
The editorial team reserves the right to change or abridge the articles and letters it receives, as well as to give them titles.
We hereby inform that the Polish Chamber of Physiotherapists publishes statements which represent the Chamber’s positions and opinions exclusively on the kif.info.pl website,
in the “Voice of Physiotherapist” information bulletin, as well as on social media profiles (e.g. Facebook) belonging to KIF and ran by authorised persons. Please note that any
information regarding the actions of KIF which appears in places other than the ones mentioned above - e.g. on internet forums, online discussion groups, private social media
profiles or in comments - are published under the sole responsibility of their authors. KIF does not take responsibility for such information.
There is no turning
back from progress
am the president of the National Council of The biggest failure is the lack of full professional
Physiotherapists and I hope that as a human independence in Sanatoriums. This area requires
I have defined this function, and not otherwise. a thorough change and a new approach to bal-
In the jubilee issue of "The Voice of Physiothe- neology. I also consider not enough changes in
rapist”, which you now hold in your hands I al- salaries of physiotherapists in public health a fa-
lowed myself to share a little of my private life. ilure. Since I know how much we are skilled, I am
I wanted you to see me as a human, collegue, aware of how much we should earn. I have been
friend, co-worker. The sum of my previous pri- an employee of the public health care system
vate and professional experiences has defined for many years myself. It hurts me that the most
my presidency. talented and youngest physiotherapists are run-
ning away from it. However, I am convinced that
This first term of office was exceptional. Thank
the changes that occurred in the legal system
you to everyone who trusted me from the be-
strengthened our position to increase earnings.
ginning of this journey. It is a real honor for me,
but also a huge obligation. I had no examples, What's next? I've always believed that whoever
I had to work out the formula myself. I followed stands still, steps back, so we can't slow down
the example in other professions of public trust. now. Further elements of the rehabilitation re-
Unfortunately each profession has its own spe- form must be introduced. New competencies
cificity and not all practices could be duplicated. will be crucial here. In physiotherapy in the pu-
I became engaged in my new role and I can say blic health care system, I focus on a real esti-
that during this time I have submitted my pro- mate of individual therapy time. I do not see any
fessional life to it, and to a large extent also pri- turning back from development and in my opi-
vate life. I decided that the situation required it. nion, its pace is not slowing down either.
I can't be involved halfway.
I would like to pay my tribute to the community
My greatest success is strengthening our oc- for having this opportunity to create the Cham-
cupational independence. Despite introducing ber together.
our autonomy by the Act on the profession,
it still has to be enforced in thousands of legal
acts. Along with the sanctioning of independen-
ce, came the increase in prestige. We are treated
as partners, not subcontractors or assistants.
I am also glad that patients more and more often Professor Maciej Krawczyk, PT, PhD
consciously direct their steps to us, and not to President of the Polish Chamber
other medical practitioners. of Physiotherapists
VOICE OF PHYSIOTHERAPIST 3
TOPIC OF THE ISSUE
KIF cannot force an open door
– External limitations imposed by people who do not understand what physiotherapy is represent
the biggest challenge for me – admits the President of the Polish Chamber of Physiotherapists
Prof. Maciej Krawczyk. In an interview to mark the fifth anniversary of the KIF, he talks about what
requests his colleagues can make to him, how many people a day he talks to on the phone and
why he likes walking barefoot.
What time did you get up today? a large amount of sleep so much. times until 11.00. I wouldn’t feel
Before 6 o’clock. I get up at that I feel that work is accumulating OK ignoring it, but I myself have a
time every day. This is proba- while I’m sleeping. Maybe, by sle- rule that I don’t call my colleagues
bly because for over thirty years eping less I try to prevent the time after 10.00 pm unless there is an
I have been working in a hospital from slipping away. emergency.
and arriving there before eight Your day starts with work? What do you like most about your
o’clock. My wife often gets angry
After a quick shower I have some work?
because of this habit, because
time to prepare coffee to take in Creating new things. I like having
I get up early also on holidays and
my car. The first phone calls I an- a vision of what is ahead of us and,
at weekends, when everybody at
swer are when I’m in the car, befo- before that, creating that vision. In
home is still asleep. Sometimes
re seven o’clock. the evening, when I finish work, my
I wish I could lie in, but I can’t help
power to create is depleted. This is
waking up in the morning. What time do work-related pho-
the effect of talks and discussions
ne calls stop?
Life made you get used to it? with my colleagues at the Cham-
I try to mute my phone after 10:30 ber and my work in the hospital.
Yes, as a young man I used to like
pm, but it rings regularly, some- I try to be there three, four times
lying in. Now, I don’t enjoy having
4 VOICE OF PHYSIOTHERAPIST
TOPIC OF THE ISSUE
a week. I am the head of a team Do you agree to that? which comprise physiotherapy,
of physiotherapists in the Institu- Yes, I always do. can be harmful when not used
te of Psychiatry and Neurology in properly. In my opinion, a phy-
Warsaw. There, I solve problems Some people may wonder what siotherapist is a coach of a human
related to patients, often not con- the Polish Chamber of Physiothe- being in an illness. Our task is to
nected with the Polish Chamber of rapists actually does. How would put a seriously ill person under
Physiotherapists. you explain that to a person who an appropriate pressure through
knows nothing about it? physical effort. There are already
Your work is mostly about co- a few multi-specialized hospitals
The Chamber makes sure that
nversations? in Poland that have a physiothe-
the quality of physiotherapeutic
I usually have fifty to a hundred services in Poland is the highest rapist available by phone who can
conversations during one day. possible so that we can provide ef- come to a patient who has had a li-
I must be kind and understanding fective protection to patients. We ver or heart transplantation within
towards people, I cannot let my want to prevent people who are four hours of the completion of
emotions take control over me. not physiotherapists, do not have the surgery. This mechanism is in
Of course, I do have emotions, required qualification, from prac- place all week round. A physiothe-
and my nearest and dearest and tising this profession. Our priority rapist has to be there, because the
friends know that. for the nearest future is spreading complications that can occur in
information among Poles about the ill without a physiotherapy are
Have you got a tried and te-
who a physiotherapist is. very serious, including transplant
sted way of being in control of
rejection. Spending a few hundred
emotions instead of simply bla- So, who is a physiotherapist? or a few thousand Polish zlotys on
sting them?
It is a person who brings you back physiotherapy can save somebo-
My personality allows me to tune to your life before the illness when dy’s life. Unfortunately, the high
out. For many years I have had it occurs. At the same time, he mortality rate in Poland during the
to switch between various roles. or she prevents new disorders: third wave of the pandemic is also
I change my hospital uniform to both in a primary and seconda- a result of the lack of proper phy-
a suit, and then to jeans. I talk with ry way. This means reducing the siotherapy in most covid wards.
patients, then with students, and risk of developing an illness for A large group of patients who did
then with politicians and colle- the second, third or fourth time. not receive an appropriate dose of
agues. I interact with new people We want to show that treating physiotherapy at the appropriate
all the time. By switching my con- a patient does not have to involve stage need ventilators.
centration and attention I have le- a surgical intervention or phar-
arnt to turn off my stress. The fact macotherapy. The World Health When is this stage?
that I don’t live near my workplace Organisation reports that 63 per When patients suffer from short-
helped me, because I have time to cent of all disorders worldwi- ness of breath, a noninvasive oxy-
listen to music in my car. Howe- de, including cancers, are caused gen therapy is used and that is
ver, recently this happens less and by lack of sufficient amount of the moment when a physiothera-
less, because I spend most of the exercise. Half of the rural inhabi- pist should come in. Although it
ride talking on the phone, using tants in Poland do not know what is often not talked about, a phy-
a hands-free set, of course. a physiotherapist is. However, it is siotherapist is often the only per-
a physiotherapist that could solve son that the patient sees in covid
What problems can your colle-
many of their health-related pro- wards. Thanks to that the patients
agues or members of the Cham-
blems. If only they knew that such do not need a ventilator.
ber report to you?
a profession exists and what it is
Any. Sometimes, I feel that for the Has the pandemic been the big-
concerned with.
last five years physiotherapists gest challenge so far in your
have called me with every possible Is then physiotherapy a cure? work at the Polish Chamber of
issue. Very often, they ask me for Yes, it is. As with every cure, it Physiotherapists?
medical help for their nearest and should be used in a deliberate way. Actually, the biggest challenge
dearest. Movement and physical stimuli, was something else. A pandemic
VOICE OF PHYSIOTHERAPIST 5
TOPIC OF THE ISSUE
is a situation when we use our na- the legislative power has ack- do. I cannot overcome this flaw.
tural reserves of helping patients. nowledged that physiotherapy is But now I want to tell my colleagu-
External limitations imposed by an important part of treating pa- es, among whom are five deputy
people who do not understand tients. In the countries where the chairmen, as well as many people
what physiotherapy is represent autonomy of the profession of a from Poland, my colleagues phy-
the biggest challenge for me. Un- physiotherapist is the biggest, the siotherapists, who will certainly
fortunately, many officials, even quality of the healthcare system is know that these words are ad-
at the highest levels, do not know regarded as the best. In countries dressed to them, that without you
and do not want to know what such as Australia, Ireland, Norway, I would have achieved nothing. To
exactly we do. Because of that Sweden or the Great Britain, a pa- me, they are like a shelf that sup-
physiotherapy is still treated as a tient may go to a physiotherapist ports me. Without them I would
luxury addition rather than as an without a referral. It is probably have done nothing. I have my vi-
integral part of treating serious one of the reasons why the health sions, I can fight for what I care,
civilisation diseases. care is at a very high level there. I have a huge trust in the power
The internal limitations that exist I wish more members of my pro- of my profession. But without my
within our professional group are fessional group believed that phy- colleagues I would have been hel-
also a difficult thing for me. Many siotherapy could be better, bring pless in all that like a child.
of my colleagues physiotherapists even more money and earn even
bigger trust in patients. Will you choose one more num-
do not notice the increasing chan-
ber and one more question? Nine
ges abroad and globally. I hear sta-
So, how would you finish the sen- is already taken.
tements along these lines „I be-
tence: „I wouldn’t like the Polish So, I go for three.
have this way because I follow the
Chamber of Physiotherapists to
practice I have known for twenty Have you got your guilty pleasu-
be associated with?”
or thirty years.” We as the Polish res that until now you have not
Chamber of Physiotherapists can- Only caring about the interests of
physiotherapists. Also, I wouldn’t talked about loud and publicly?
not force an open door. Most of the
like the Polish Chamber of Phy- These are mundane things. I like
doors have already been opened
siotherapists to be associated with fin-de-siècle dishes. Indecently
by others, that is the physiothe-
the classical, sometimes pejorati- unhealthy.
rapists in other countries where
ve, understanding of the concept
Fast food?
of “professional corporation”.
No, it is rather comfort food. I so-
In front of me, there are ten metimes like eating a doorstep
envelopes. Inside each is a dif- with lard or home-made fried li-
ferent question. Please, choose a ver. I’m not sure whether this will
number from one to ten. be included in the interview...
I choose nine.
It will. Some readers probably
Tell me why nine. like such dishes as well. Pork
Because this is the day of my bir- chop with cabbage?
thday. I was born on the ninth of I would go even further. Stewed
January. cabbage. Sometimes, I have to
make it by myself if I want to eat
The question inside envelope it. Another guilty pleasure is wat-
nine reads: Is there anything you ching a classical cycle race on TV,
have never told your employees, when for an hour and a half no-
but you are ready to use this oc- body disturbs me. That’s how I
casion to admit now? watched the Paris-Roubaix race.
There is one such thing. One of my Ideally, neither my wife nor my
many flaws is that I do not praise daughter comment on what I’m
people often enough for what they doing. I love having a good wine.
Private photo M. Krawczyk
6 VOICE OF PHYSIOTHERAPIST
TOPIC OF THE ISSUE
Private photos M. Krawczyk
I drink wine from March, April till What about one more, last qu- I don’t want to keep you any lon-
October, then my craving for this estion. Pick the number. ger. Have a good trip. And I wish
drink diminishes. My acquaintan- I’ll have ten. you many occasions to walk bare-
ces are often surprised that I can foot.
distinguish types of wine. It gives This is an alternative. What do
me pleasure to treat people to a you prefer: bonfire in the forest Interviewed by
good wine and food. I also love or flames in a fireplace? Michał Dobrołowicz
talking about politics with people If I answer flames in a fireplace,
who have views similar to mine. this will mean that I’m getting old.
However, I only know a few such I think I would rather have a bon-
people. This pleasure is not very fire in the forest. I am a traveller. I
creative, because we don’t have an have lit a fire hundreds of times in
impact on big politics, but I enjoy my life time. Those who know me
that. I would like to dress well, but I know that I am good at doing that,
fail. I have to change clothes all the even when it is wet.
time, and for five years I have had a
wardrobe in my car. There is a long weekend ahead of
us. Are you going to get up before
In the boot or in the back seat? six o’clock on Saturday?
In the back seat. I often have a total No, I’m going to get up around 6:30
mess there. In my car, I have five to am. I have to get ready for a family
ten hangers with clothes, I change dinner, I’m going to go to the ba-
my clothes several times a day. The zaar, do the shopping. I also have a
Sejm, ministry, Chamber, hospital. plan to go on a three-hour bicycle
A different outfit in each of these trip.
places. I sometimes wish I did not
have to change clothes so often Three hours. How many kilome-
every day. There is another pleasu- tres is that?
re connected with clothes. I like I’m prepared for 60-70 kilometres.
walking barefoot. I sometimes do
Where can we find you cycling?
so in the hospital. I feel very at ease
then. This may be connected with I live in south-west Mazovia region.
my stay in Australia in 1990. I saw I will probably go to Tarczyn thro-
many Australians walking barefoot. ugh Żabia Wola.
VOICE OF PHYSIOTHERAPIST 7
TOPIC OF THE ISSUE
Assessment of the five-year term
The tasks set for the first years of the operation of the governing organisation
of physiotherapists include, among other things, building the foundations of the Polish
Chamber of Physiotherapists and patiently raising awareness of the role
of physiotherapists among officials, politicians, but above all – patients. A lot has been
achieved over these five years. Sceptics would say that it could have been more.
But, as the deputy chairmen of the Chamber conclude, the failures or defeats of this term
will be a signpost for the future. And a challenge that needs to be tackled. We ventured an
assessment. We asked each of the deputy president of the KIF the same questions grouped
into the following categories: successes, failures and challenges.
This is how they sum up their activity in the first term.
8 VOICE OF PHYSIOTHERAPIST
TOPIC OF THE ISSUE
Ernest Wiśniewski
Development, department of digitalisation, training
courses, international contacts, financial management
Successes:
> A huge success for me is the building of the orga- bably one of the first countries in Europe to intro-
nisational structures of the governing organisation. duce the ICF into the regulations related to medical
We started from the scratch, without any financial records.
resources. We quickly established the Register of
> We have created a training department which can
Physiotherapists, and started to grant licences to
boast over 20 thousand trained physiotherapists. It
practice the profession of a physiotherapist – al-
allowed us to teach keeping medical records. Now,
most 10 thousand in the first year of our activity,
partly due to the changes caused by the pandemic,
and almost 50 thousand in the first months of the
we are introducing, much faster than originally
year 2018;
planned, new models of online training courses,
> Membership fees enabled us to set up the office webinars, and a dedicated e-learning platform will
of the KIF PChP, hire first employees. At present, be launched soon;
there are over 100 of them: computer programmers,
> The department of digitalisation has been deve-
lawyers, managers, specialists in marketing, mana-
loping dynamically from the very beginning. The
gement and finances. Those people work for the de-
work began with creating the National Register of
velopment of the organisation and for the benefit of
Physiotherapists, then we established: Portal of
all Polish physiotherapists;
Physiotherapist, Znajdź Fizjoterapeutę (Find a Phy-
> A huge task was to develop a rehabilitation reform siotherapist) and last but not least our newest baby
programme in Poland. One of its pillars is change in and success with capital S, i.e. Finezjo. I am perso-
the valuation of refundable services, moving away nally attached to this project, because I developed
from “point-based” valuation to valuation based on many of its features myself;
a physiotherapist’s working time. All of this is con-
> Thanks to careful management, we have never
nected with the assessment of functioning (ICF)
lost financial liquidity, not even in the first, most
and monitoring of therapy effectiveness;
difficult year. We have managed to build a reserve
> By implementing the ICF, we managed to assign which allowed us to earmark additional PLN 1 mil-
to physiotherapists a unique competence of exami- lion during the pandemic as financial aid for phy-
ning and measuring the patient’s functioning. This siotherapists in need. Apart from that, every year
ability sets us apart from other medical professions. we earmark 10 per cent of the paid membership
In order to achieve that, it was necessary to incor- fees for financial support in the form of allowance
porate ICF into clinical practice and introduce “me- and exemption on the payment of membership fees;
asurement tools” into medical records. The deve-
> Our international activities are so extensive that
loped guidelines included both, i.e. instructions on
the five people at the Department for Internatio-
using the difficult and technical ICF classification
nal Cooperation have their hands full. We have
during examination and functioning measurement
developed cooperation with most important orga-
tests. We have just completed a study programme
nisations worldwide from the perspective of phy-
of tests validation, which lasted a year and a half,
siotherapists, i.e. WHO and World Physiotherapy
and complemented the guidelines with the popula-
(formerly WCPT), which more and more apprecia-
tion test WHODAS 2.0. Our idea of including the ICF
te our competences and engage in new activities.
into medical records proved to be in line with the
An example is translation and distribution of over a
WHO’s agenda: Rehabilitation 2030. We were pro-
hundred thousand brochures for patients who had
VOICE OF PHYSIOTHERAPIST 9
TOPIC OF THE ISSUE
COVID-19, based on which we also made a series of that it can be available to patients, and physiothera-
instructional videos (available in the Polish, English, pists can be well-paid for their work.
Ukrainian and Russian languages). We also partici-
> Allowing individual practices and small entities
pate in an international research project concer-
to conclude contracts with the NFZ (National He-
ning assistive technologies. Such activities of the
alth Fund). Although in my opinion, contracting of
governing organisation build prestige of Polish phy-
services should be abolished. Every insured person
siotherapists worldwide.
should be able to use practices or establishments
of their choice. We only need to establish the prin-
Failures:
ciples of the settlement of the costs of services;
> We still have not persuaded the decision ma- > Continuous extension of the competences of phy-
kers from the Ministry of Health and the National siotherapists, e.g. to include prescribing r imaging
Fund of Health to implement further elements of tests, prescribing and administering some medici-
the rehabilitation reform programme. Ready-made nes, issuing sick leaves. However, in order to achie-
solutions, i.e. allowing physiotherapy practices to ve that we have to implement the plan of major-o-
conclude contracts with the NFZ (National Health riented specialisations.
Fund), are not implemented, even in the form of a
pilot project;
> Our post-COVID rehabilitation programme has
been approved only partially, and is not what it was Ernest Wiśniewski
originally.
vice-president of the Polish
Challenges: Chamber of Physiotherapists
for development, international
> To complete the reform and make rehabilitation contacts and financial
a key point in the development of health policy. So management
Paweł Adamkiewicz
Promotion of the profession and private practices
Successes:
> Amendment to the act as a result of which a phy- > Together with the team for International Co-
siotherapist who carries on economic activity can operation we prepared for and participated in the
register not only a healthcare entity, but also an WCTP’s World Physiotherapy Congress in Geneva.
individual and group physiotherapy practice. This During the event, we talked about the modern hi-
resulted in over 13 thousand registered practices story of the governing organisation and how the ef-
and legalisation of economic activity in the form of forts of physiotherapists resulted in the adoption of
physiotherapy practices; the act on the profession of physiotherapist. Also,
> We registered physiotherapy practices, but in our pavilion won in the “competition” for the best
so doing we were obliged to appoint the so-called stand. Our participation in the congress resulted in
controllers. This is the requirement of the Ministry submitting application forms and joining the struc-
of Health. We developed a training project culmi- tures of the international organisation (WCPT, cur-
nating in examination. As a result, 86 people were rently: World Physiotherapy;
appointed as controllers under the KIF;
10 VOICE OF PHYSIOTHERAPISTTOPIC OF THE ISSUE
> We prepared a webinar for members of the go- practices (solidarity fund programmes are an ex-
verning organisation from all over Poland. Over 6 ception);
thousand people got acquainted with the changes
in care health resulting from the regulation of the Challenges:
profession of a physiotherapist. We also presented
> We want physiotherapeutic practices to be able to
our programme of post-COVID rehabilitation and
implement health policy programmes;
physiotherapeutic prevention programmes that are
being developed by a team appointed by the Cham- > Our aim is for individual physiotherapeutic prac-
ber tices to be allowed to hire employees carrying out
medical activity;
> Development of our bulletin – “Voice of Physiothe-
rapist.” Now, it is a regular periodical and presents > We intend to apply for EU funding to further equip
various faces of the Polish physiotherapy; physiotherapeutic practices with computer devices
as was the case of doctors working for a primary
> Several social campaigns with the motto “Phy- health care provider;
siotherapy moves” – they allowed us to reach mil-
lions of Polish patients, and raise awareness of our > We will continue our efforts to promote the pro-
profession in a significant way. The campaigns were fession – we want every Pole to know what phy-
conducted on the Internet as well as in the traditio- siotherapy involves and how it can help them.
nal media. During the ongoing pandemic we produ-
ced films: “Active senior at home” and “Active break
at work.” The last film production was about post-
-COVID rehabilitation;
> We have a constant presence in the media – every
month sees several hundred publications contribu-
ted by our KIF experts or inspired by us. Paweł Adamkiewicz
Failures: vice-president of The Polish
Chamber of Physiotherapists
> We did not manage to make contracts with the for promotion of the profession
National Health Fund cover physiotherapeutic and private practices
Zbigniew Wroński
Science and education
Successes:
> Undoubtedly, a success is the introduction of long- Education and ultimately by the Ministry of Health.
-cycle studies (5 years) in physiotherapy as part of The standard came into force in 2019;
undergraduate education; > One of our achievement is the introduction of a
> We are also happy that physiotherapy as a field state physiotherapy exam following five years of
of study in the 5-year system was included in the studies. This means better quality of education and
Law on Higher Education and science (Ustawa 2.0). higher prestige of the profession. The first students
We managed to bring together a group of people will take this exam in 2022. Its guidelines were de-
– KIF experts (lecturers, professors, educators, cli- veloped by a group of KIF experts. From our per-
nicians) – who developed an educational standard spective, this is a significant change, because the
approved by the Ministry of Science and Higher aim of the exam is to control the effects of educa-
VOICE OF PHYSIOTHERAPIST 11TOPIC OF THE ISSUE
tion. After all, patients should feel assured that phy- > For four years we have been working with the na-
siotherapists are well-prepared for their profession; tional consultant on a new programme of the spe-
> We have succeeded in developing first few guide- cialisation. The new programme has not been im-
lines on hydrotherapy, laser therapy, needle thera- plemented yet, although it is almost finished.
py;
Challenges:
> We have launched an English-language scientific
journal – the quarterly “Physiotherapy Review”. Our > We plan to establish a research facility that can
aim is for the periodical to be included in indexing conduct independent research, support resear-
databases, its citation rates to increase, and for it chers, hold contests, and facilitate the development
to be included on the Ministry’s list of scientific jo- of the profession. Our ultimate aim is for physiothe-
urnals. rapy to become a field of science (knowledge plus
practice supported by relevant research).
Failures:
> We have failed in the regulation of postgraduate
education. Our plan was to put the issue of training
courses in order, as there is still chaos in that area
and the act on our profession needs to be amended.
Zbigniew Wroński
The project we have prepared got stuck in the Mi-
nistry of Health and the epidemiological situation vice-president of the Polish
prevented us from processing it; Chamber of Physiotherapists for
science and education
Jacek Koszela
Regions, physical medicine, balneo-climatology,
health resort physiotherapy
Successes:
> Establishing regional offices of the Polish Cham- > Joint work on creating a positive image of a phy-
ber of Physiotherapists. Such offices have already siotherapist in the eyes of a patient – promoting
been created in Szczecin, Krakov, Lublin and Rze- a therapeutic path so that instead of going to the
szów; soon there will be one in Wrocław, and we doctor for a dressing or ointment the patient knew
plan to open one in Poznań. By that, we want to be that he/she can receive professional help from a
closer to the different regions so that our activities physiotherapist;
are more effective and transparent; > During this term, we trained 120 physiotherapists
> Bottom-up promotion of the profession of phy- to be expert witnesses, who can be called at trials
siotherapist and making local decision makers related to our work. This way, we can feel safe sho-
more sensitive to our presence bring effects. As a uld we need defence and can count on an expert
result, we are included in a range of activities, local opinion;
initiatives. We meet with presidents of cities, mar- > We successfully organise training courses in re-
shals, voivodes. This gives us fuel to strengthen our gions (in the area of physiotherapeutic prevention,
position; among the things) and legal advice for physiothe-
rapists;
12 VOICE OF PHYSIOTHERAPISTTOPIC OF THE ISSUE
> We are happy to have a good cooperation with > A failure was, sadly, the shutdown of health re-
trade unions; sorts during the pandemic despite our appeals to
> On the initiative of Robert Włodarczyk, member the Minister of Health to allow them to operate with
of the National Register of Physiotherapists, we sanitary precautions. That way patients could have
have managed to establish a social committee that avoided several-month delays in rehabilitation;
provides aid for physiotherapists. Especially for > The Act on Health Resort Medical Care does not
those who lost their livelihood due to the pandemic. mention physiotherapists, although our work is key
The Chamber earmarked a million Polish zlotys for to sanatorium treatments. The government hasn’t
that purpose; got an idea for the functioning of sanatoria. Un-
> We provide social support to the families and fortunately, we did not succeed in bringing up this
children of the physiotherapists who have lost their issue.
family members due to coronavirus;
Wyzwania:
> Interventions by the representatives of the KIF in
several medical facilities all over the country that > Access to legal advice in all voivodeships, a lawyer
faced shutdown or mass dismissals of physiothera- on duty in every regional office;
pists. > Opening offices in the other regions;
Failures: > Organising and initiating thematic webinars and
training courses in the region so that everyone can
> We are still unable to break through with some attend them not far away from their workplace or
projects. We did not manage to persuade decision place of residence;
makers to allow physiotherapy practices that have > Starting discussion on the reform of the act on
contracts with the National Health Care to operate health resort treatment.
in small cities and towns as well, so that patients
could have access to the aid they are entitled to in
their place of residence; Jacek Koszela
> Some members of the community do not under- vice-president of the Polish
stand that the Chamber is not a political institution. Chamber of Physiotherapists
We want to cooperate with all the trade unions. The for physical medicine, balneo-
Polish Chamber of Physiotherapists is all of us, not climatology, health resort
the political ambitions of some of our colleagues; physiotherapy
Tomasz Niewiadomski
Guaranteed services
Successes:
> The biggest achievement of this term is undoub- > Creating a platform for improvement of compe-
tedly the fact that there is more talk about guaran- tencies – under a training project financed by EU
teed rehabilitation services; funds we trained 500 physiotherapists in four are-
> Increased awareness of physiotherapy among as: medical documentation including ICF, ortho-
general public. Only a few years ago, we were re- paedics, neurology and pulmonary cardiology. We
garded as massage therapists, executors of medical have secured further EU funds to improve profes-
orders. Now, the patients see what we are and our sional competencies of two thousand physiothera-
competencies; pists (including those working outside of the Natio-
VOICE OF PHYSIOTHERAPIST 13TOPIC OF THE ISSUE
nal Health Fund). The enrolment will start in June > Inclusion of rehabilitation services in the list of
2021; services for which one can be placed on a waiting
> Continuous strengthening of the legal status and list in the “so called” AP-KOLCE application. Thanks
professional autonomy of physiotherapists. The to that, a patient can no longer register a few refer-
changes we managed to introduce in various legal rals to the same service;
acts regulate our work; > Increasing the competencies of a physiotherapist,
> Seeking dialogue with the entire medical commu- who can, among others prescribe medical devices;
nity. We are a partner to other medical professions. > We participate in the talks in the Council of So-
We talk and cooperate with each other at various cial Dialogue and the Trilateral Commission on the
levels; income and emoluments of physiotherapist, among
> We make politicians, health care organisations other things.
and decision makers aware that the quality of he-
alth services also depends on us, physiotherapists; Failures:
> We established a network of observers in the NHF > At the beginning of our activity, we crashed with
boards. The observers sit on provincial boards of the brutal bureaucratic machine. For the first two
the National Health Fund, where they present their years, it was very difficult to talk with politicians,
objections and demands. We also have a represen- although we realise that changes should be intro-
tative in the headquarter of the NHF; duced faster;
> We appointed a team responsible for guaranteed > The post-covid programme, which was ready
services, which works on a rehabilitation services already in December 2020, was processed by the
package, among other things; decision makers too long. We are also not happy
> Since the start of the term, we have been working with the proposed valuations. The NHF will pay two
with the Agency for Health Technology Assessment thirds less than our calculations consulted with
and Tariff System (AOTMiT) on a rehabilitation re- AOTMiT. We are aware that it is impossible to deli-
form. The agency finished its report and although ver good quality services for such a rate. We will try
we do not know what steps will be taken at the next to change this situation.
stage, we opt for gradual changes. We do not want
patients to be suddenly deprived of the aid of phy- Challenges:
siotherapists;
> We demand that an appropriate number of phy-
> Direct access, as part of the Solidarity Fund, to a siotherapists is hired in individual hospital wards;
physiotherapist (without a referral) for people with
> Change in the valuation of rehabilitation services;
a certificate of mild or moderate disability;
we have been fighting for that for several months;
> Changes in the package of guaranteed services > Complete reform of rehabilitation.
in the therapeutic rehabilitation type; first adjust-
ments to statutory competencies of a physiothera-
pist were introduced in the area of therapy plan-
ning based on the assessment of a patient’s state of
functioning;
> Post-covid rehabilitation services, which were
substantively developed by the PChP, are already
delivered by the NHF. The KIF experts prepared a
physiotherapy programme for those who have been
infected with the coronavirus. It was submitted to
the Ministry of Health as an example of universal Tomasz Niewiadomski
care of those infected with COVID-19. Local autho- vice-president of the Polish
rities also showed interest in the adaptation of the Chamber of Physiotherapists
programme; for guaranteed services
14 GŁOS FIZJOTERAPEUTYTOPIC OF THE ISSUE
We overcome the resistance
of the matter
The lion’s share of our work is the fight with officials for the position of a physiotherapist
in the system. It can be frustrating. We are overcoming this resistance of the matter
slowly, but I am convinced that with time we will be able to achieve more and more –
Katarzyna Blicharczyk-Ożga, talks about the work of the Legal Department of the KIF.
VOICE OF PHYSIOTHERAPIST 15TOPIC OF THE ISSUE
Busy time behind you? ce since 1 January 2019. It gave a physiotherapist new
competencies in the area of functional diagnostic of
It has been very busy since I started working at the
a patient and planning of physiotherapeutic proce-
Office of the KIF, i.e. since March 2018. At that time,
dure as part of health services financed by the NHF.
the Office was being established and we had to build
This was a breakthrough decision, because it allowed
certain structures, including the legal department,
a physiotherapist to be independent from a doctor in
implement procedures required by law, define the
ordering physiotherapeutic services.
internal legal framework to ensure the operation of
the Chamber in many areas so that it could fulfil the Of importance for physiotherapists was also the re-
tasks specified in the act. All of that requires legal gulation of 6 April 2020 on medical records. The act
interventions. What’s more, our activity is governed on the profession of physiotherapies stated that a
by regulations that often do not provide us clear an- physiotherapist is obliged to keep medical records,
swers and require settling very complicated legal but it did not specify what documents he/she should
issues and deciding certain actions. Legal support is fill in and with what information. The regulation fil-
necessary in almost every area of the activity of the led that gap, indicating medical records to be kept in
PChP, from legal servicing of ongoing administrati- physiotherapy practices as well as in medical entities,
ve proceedings (granting a licence to practice the including hospitals. What’s more, even a hospital di-
profession, recognising professional qualifications), scharge summary report includes information about
providing legal services to the Polish Chamber of physiotherapeutic procedure. As a result, physiothe-
Physiotherapists, in particular the National Council rapists can feel more independent and treated equally
of Physiotherapists. So far, the KIF has passed almost with other medical professions.
600 resolutions that were prepared or verified by the
Another change was introduction of physiotherapy
legal department.
practices.
The scope of tasks of the Legal Department of the
KIF include issuing opinions on legislative proposals This is probably the most important amendment to
(laws, regulations). There have been over 350 such the law we successfully demanded. Initially, the 2015
proposals so far, and we submitted our objections act stated that physiotherapists can run medical acti-
to 120 of them, asserting the position of physiothe- vity but only as part of medical entities. The require-
rapists. ments for medical entities are relatively high, and in
We should also not forget about the advisory service order to fulfil them, substantial financial resources
we provide to physiotherapists. We have issued aro- are needed. With a large number of small physiothe-
und 8500 opinions, either by e-mail or as part of legal rapy practices, running medical activity was not re-
assistance. These are only some of the areas of our asonable. Thanks to the regulation, it is no longer
activity. necessary to meet stringent sanitary requirements,
It was quickly apparent that the legal department requirements with respect to the premises, equip-
required expansion. Currently, it consists of three ment or the sum insured in order to be able to legally
legal advisers with many years of experience gained run a physiotherapeutic medical activity.
in institutions specialising in medical law, a lawyer’s An important achievement was also the possibility of
trainee and a fifth-year law student. With some mat- providing telerehabilitation as part of NHF services.
ters, such as dealing with disciplinary courts, sup- Thanks to that change, during the pandemic patients
porting the disciplinary ombudsman or in tax-rela- were still under the care of physiotherapists.
ted issues, we are helped by specialised law firms.
And how did the pandemic affect the work of the
What regulations facilitating the work of phy- legal department?
siotherapists have been successfully implemented
We definitely had more work to do. It was mainly due
over these years?
to the legal inflation we faced at the beginning of the
The solutions that have been introduced strengthe- pandemic. The legal situation was changing over-
ned the professional autonomy of physiotherapists. night. We had to update physiotherapists about re-
After the act on the profession of physiotherapist levant regulations, including the so-called “shields”.
came into force, another milestone was the regula- At the beginning, rehabilitation was practically shut
tion changing the regulation on guaranteed services down. We argued that this decision should be chan-
in therapeutic rehabilitation, which has been in for- ged, considering patients’ health needs in particular.
16 VOICE OF PHYSIOTHERAPISTTOPIC OF THE ISSUE
We encourage physiotherapists to contact us if they
have any legal problems connected with practising
350 their profession. Currently, assistance is provided by
stating position in a case, but also in the form of a me-
legal acts on which opinions
were issued (including around
eting with a legal adviser or lawyer. We will improve
120 submitted comments) that assistance. We want physiotherapists to receive
professional help as quickly as possible. We also want
legal support to be available in the other regions of
8500
Poland, not only centrally.
around
Nurses and paramedics have been raising aware-
opinions – legal assistance
ness of the problem of aggressive patients for seve-
to physiotherapists
ral years. Do physiotherapists report similar issu-
es?
Unfortunately, they do. We had several such cases. If
a patient is aggressive, we recommend reporting it to
We managed to achieve that more quickly than we the police or the prosecutor’s office. A physiothera-
assumed. The situation was very dynamic. One day pist who feels under threat while delivering rehabi-
something functioned, the next day – it didn’t. We litation services, has to consider refusing to provi-
worked under the pressure of time, at nights, during de them, but do so very cautiously. Sadly, the act on
weekends. The regulations introducing restrictions the profession of physiotherapist does not explicitly
connected with the epidemic were usually published grant the right to refuse to provide a service, even in
on Fridays in the evening. I remember regulation from the case of the loss of trust. We are appealing to the
October, from the beginning of the second wave. Ear- Minister of Health for change in that regard.
lier, re-closure of health resorts was indicated at the
But I also remember a different case, when a phy-
press conference. On Friday night, it turned out that
siotherapist had problems with providing services
the provision of the regulation is so constructed that
because the patient was obese. Rehabilitation of such
it actually closes entire rehabilitation. And it was to
a person is problematic because he/she needs to be
happen next day! We had to urgently explain that and
lifted, mobilised, and there was no appropriate equip-
indicate physiotherapist what to do.
ment in this patient’s house. These are also the issues
What problems do physiotherapists report to the we deal with.
legal department?
Do patients write to you as well?
A lot of questions we receive concern actions outside
Such situations happen. Usually, these are issues and
of strictly medical activity. Examples include prac-
reports concerning irregularities during a therapy.
tising the profession of a physiotherapist in nursing
We refer them to the disciplinary ombudsman.
home cares, schools, sports clubs, spas. There are
certain differences that have to be taken into account At present, the legal department only provides legal
when providing physiotherapeutic services there, e.g. assistance to physiotherapists.
with respect to keeping records. A lot of questions You still face a lot of challenges. What are the spe-
concern a break in practising the profession and how cific goals?
to calculate the length of the period of inactivity or
the minimum wage. When rehabilitation was closed, It is still organic work. Other organisations governing
many questions concerned the forms of government medical professions, e.g. nurses and midwives, have
aid or KIF’s social assistance. Now, when physiothe- over 30 years of activity. We are trying to quickly
rapists were granted powers to qualify for and give catch up. The most important thing is to make sure
vaccines against COVID-19, they ask about issues re- physiotherapists are not overlooked in legal solutions
lated to that, e.g. whether liability insurance covers pertaining to health care. We always call for including
their additional competencies. The issues vary a lot. physiotherapy in the process of a patient treatment,
Some concern a physiotherapist’s individual situation in various opinion-giving and advisory bodies in the
in a medical entity and mobbing or limitation of pro- area of health care, and in the powers granted to
fessional autonomy. medical professions. But decision makers still forget
VOICE OF PHYSIOTHERAPIST 17TOPIC OF THE ISSUE
about physiotherapists. Apparently, physiotherapist right. This was the case with inclusion of physiothe-
as a medical profession is still not firmly rooted in the rapists in the operation of various advisory bodies,
consciousness of officials. e.g. those dealing with rare diseases, public health
From the very beginning, we point out the necessi- council. We stress that these bodies are concerned
ty of increasing the salaries of physiotherapists. This with health and the presence of physiotherapists in
may sound bombastically and someone could ask them is necessary. Sometimes, our remarks, although
what the legal department has to do with that? A lot obvious from our point of view, are simply not taken
of issues concerning remuneration result from legal into consideration and we do not receive any explana-
regulations. We always demanded that physiothera- tion for why this happened or the explanation is very
pists are included as beneficiaries of the funding pro- evasive. This was the case with the law concerning
vided by the National Health Fund for salary increases the minimum salary. We argued that the rate should
on principles analogous to those applied to nurses, depend on the education of a physiotherapist instead
midwives or paramedics. Therefore, we addressed a of the education required at a given position. In this
request to the Constitutional Tribunal to declare the- situation, medical entities will level down and state
se provisions unconstitutional. We are waiting for the that it is enough to have a degree of technician or Ba-
date for the hearing to be set. chelor at the post held by a person with a Master’s
degree in physiotherapy and this will be translated
The issue of salaries is connected with the need for to lower remuneration. Situations like that are really
higher valuation of physiotherapeutic services. numerous. We are overcoming this resistance of the
Yes, and the present one is definitely not satisfacto- matter slowly, but I am convinced that with time we
ry. We will request that physiotherapy practices are will be able to achieve more and more.
allowed to sign contracts with the NHF. We achieved And if you caught a golden fish, what job-related
a partial success with respect to the Solidarity Fund, wish would you ask it to grant on behalf of your
but excessive and illegitimate requirements regarding team?
the delivery of services, in particular with respect to
equipment and medical devices are concerned, still I would wish myself effectiveness. I’d like our efforts
pose an obstacle. to be reflected in legal regulations and make phy-
siotherapists’ work easier. I would ask the golden
We also still grapple with the NHF requirements to
fish for stabilisation of the legal environment so that
obtain a patient’s signature confirming the service
we don’t have to inform physiotherapists about new
delivered. There is no such requirement for other he-
changes and bureaucratic obligations. This is burden-
alth services delivered by persons practising medical
some for physiotherapists in particular, but for us as
professions. This indicates lack of trust in one pro-
well. First, there was a lot of organisational work, then
fessional group and is very unfair. Secondly, it is not
the pandemic came, other problems showed up and
clear how this can be solved in the case of keeping
many things could not be achieved. Now, elections
medical records in an electronic form. Thirdly, some-
are coming. It is a very busy time, so a calm period
times a patient is unable to put a signature on his/her
would be good so that we can focus on implementing
own and it is put by someone who e.g. shouldn’t have
the goals set by the governing organisation, which are
access to the patient’s medical records.
most important from the perspective of physiothera-
So the lion’s share of your work is fighting with of- pists.
ficials?
Interviewed by Agnieszka Lewanowicz
That’s true. I have fought for the position of a phy-
siotherapist in the system. It can be frustrating. We
write comments on various projects and every time
we read that although they are sound they are not ta-
ken into consideration because they do not pertain to
the scope of the regulations. Or that they will be con-
sidered in the next amendment. But when the next
amendment is adopted, they forget about us, altho-
ugh after the fact the officials usually admit we were
18 VOICE OF PHYSIOTHERAPISTHow does KIF support their physiotherapists
kif.info.pl - KIF’s official service, which provides you with the most up-to-date
information about physiotherapy in Poland and worldwide
pomoc.kif.info.pl - Help Centre where you can find answers to many questions
concerning the exercise of the profession and useful model documents
portal.kif.info.pl - physiotherapist’s e-office where many important matters can be
settled: legal advice, signing up for training, data updating, checking the balance etc.
znajdzfizjoterapeute.pl - search engine to find physiotherapists from all over Poland,
where each of us can set up a free online business card
finezjo.pl - free programme for keeping medical records in a physiotherapy practice
and medical entity
pomoc.finezjo.pl - support for Finezjo application users
fizjoterapiaporusza.pl - service that promotes KIF’s social campaigns,
you can use it to educate patients
glosfizjoterapeuty.pl - website with the KIF’s monthly bulletin
along with an archive, which covers the most important issues
related to physiotherapy
ogloszenia.glosfizjoterapeuty.pl - service with job ads
for physiotherapists
kif.info.pl/biblioteka/ - e-library, where you will find
various KIF’s publications, such as scientific publishers,
guidelines, etc.
kif.info.pl/wydawnictwo-naukowe/ -
scientific bulletin Physiotherapy Review
You can follow our activities on Facebook,
YouTube, Instagram, Twitter, LinkedIn.
VOICE OF PHYSIOTHERAPIST 19KIF’S ACTIVITIES
How important is physiotherapeutic prevention today?
Physiotherapists significantly contribute to preventing or decreasing disability and improving
the physical capacity of people of different ages by shaping and sustaining their fitness.
When the act on the profession of physiothera- refore when creating the definition of physiothera-
pist came into force, physiotherapeutic prevention peutic prevention and its division, we assumed at our
became our formal obligation. Until that moment, Prophylactic Physiotherapy Team that it should fit
physiotherapists did engage in physiotherapeutic within the divisions already existing in the public ad-
prevention activities to a significant extent without ministration and also be in line with the distinctions
caring about giving formal names to certain acti- present in other areas of medicine. Thus, following
vities they performed – after all this is what the po- the discussion among the Team members and the
pularisation of healthy life style, so characteristic of members of the National Council of Physiotherapists,
our work, is. We significantly contribute to preven- the definition of physiotherapeutic prevention and its
ting or decreasing disability and improving the phy- division as laid out in the resolution of 16 May 2019
sical capacity of people of different ages by shaping (see page 6) was adopted.
and sustaining their fitness. Provisions to that effect
were included in the act, which stressed that enga- Tasks of the Prophylactic Physiotherapy Team
ging in physiotherapeutic prevention is one of health The main aim of the appointed Prophylactic Phy-
services to be delivered by physiotherapists. siotherapy Team was to create a definition and
Definition adjusted to the reality develop the division and scope of the delivery of
physiotherapeutic prevention, followed by the deve-
Someone may ask: why do we need these provisions, lopment of physiotherapeutic prevention program-
if we do it anyway? Personally, I treat this provision mes that can contribute to restructuring the cur-
in the act as the sanctioning and emphasising of our rently delivered physiotherapeutic services. We can
role – as individuals who exercise a medical profes- mention here work in the area of diagnostics and tre-
sion – in the health care system in our country. The- atment of body posture disorders and mild scoliosis,
20 VOICE OF PHYSIOTHERAPISTYou can also read
