Croatia

On behalf of the Croatian Society of Physical and Rehabilitation Medicine (CSPRM) of Croatian Medical Association, I would like to present few facts about the history of the society, PRM specialty and and our activities.

Croatia  has over 16000 licensed and 12000 practising physicians taking care of the population of 4 million in 43 different specialties. There are 398 licensed PRM specialists, majority working in public health system, and approximately 40 trainees, adding to one of the highest ratio of PRM specialists/100000 inhabitants in Europe. More than 2000 PTs and OTs also work in the system, as well as psychologists, speech therapists, social workers.

Croatian Medical Asssociation was formed in 1874, and in 1911 first two sections within it were created: of Surgery and Internal medicine. Throughout years, more sections emerged, one of those Section of Rheumatology, Physical Medicine and Balneoclimatology in 1947.

It was divided into PRM Section and Rheumatology Section in 1966 and has remained this way ever since.

PRM residency was established in 1960. Nowadays, education in PRM consists of two-weeks training during undergraduate studies at all of four University Medical Schools, while PRM  requires additional 4.5 years of training in nationally approved training centres, with obligatory logbook and final examination. Rheumatology is still a subspecialty (following either PRM training or training in internal medicine), although it is nowadays switching to a self-standing specialty.

Curriculum in PRM has been approved between representatives of the Ministry of Health, 4 University Medical Schools, Croatian Medical Chamber and elected members of the CSPRM, implementing in many ways the “Curriculum of Studies and Theoretical Knowledge for the European Board Diploma”, as part of accession process of Croatia to EU.

One can not speak about PRM in Croatia without mentioning the heritage of balneoclimatology. It is and will remain integral part of undergraduate studies and PRM specialty in Croatia. Croatia has 27 hot springs, 17 spas, of which 10 evolved to special rehabilitation hospitals, more than 100 wellsprings with mineral waters, 26 peloid resorts, 90 seaside thalassotherapy and 13 mountainous resorts. The Institute for Balneo-climatology was established in 1949, and its balneolaboratory has carried out 400 termomineral water analysis and provided many expert opinions, produced related books and organized symposia and congresses.

As for the medical rehabilitation, it is estimated that Croatia has the incidence of 8500 stroke survivers, with 7000 in need of inpatient rehabilitation, 100 traumatic SCI patients and 700 brain injuries, with 10% in coma. Approximately 1000 lower limb amputations are made, with or without the need and abilities for prosthetics. The prevalence rate of osteoarthritis is 11%, that of rheumatoid arthritis 4%, while the needs of patients with  MS, Parkinsons disease, polyneuropathies, congenital anomalies, severe compound limb fractures and arthroplasty should be added.

Medical rehabilitation is carried out in approximately 1900 rehabilitation beds, with very abundant ratio of 0.42 per 1000 inhabitants. It is done in 10 Special hospitals, in Rehabilitation departments of teaching hospitals and in General hospitals. Stroke and major trauma, especially TBI, SCI and post-amputee rehabilitation are divided among Special hospitals, while teaching hospitals also focus on rheumatology patients. All facilities have outpatient departments, serving as consultants to other departments and in an acute-rehabilitation phase, and provide physical and kinesiotherapy to ambulatory patients. Community-based rehabilitation was organized as a project, now continued as a home physical therapy service. In addition to above numbers, special hospitals have some 1900 beds available on the market and for private insurance schemes for balneotherapy and health tourism.

Croatian Society of PRM has a steady membership of 250 members and the fee is 20 Euro provided the member pays to Croatian Medical Association 20 Euro as well. We communicate with members by regular mail, e-mail, and through our web site (www.hdfrm.com).

The Society has regular meetings with lectures up to four times a year and the general assembly is held every year, with elections every 4th year, as well as national congresses.

The Society publishes its Journal: “Fizikalna i rehabilitacijska medicina”, and in 2007 we published the localised version of the White Book of PRM. The journal has entered in the European network of PRM journals. Croatian Society of PRM is actively negotiating all vital aspects of the specialty with Croatian Institute for Health Insurance, Ministry of Health, Croatian Medical Chamber, University Medical Schools and PRM Clinics and Departments.

8th Croatian Congress of Physical and Rehabilitation Medicine will take place in 2020.

Since 2008, trainees have attended European School Marseille and Haim Ring EuroMediteranean PRM school in Syracuse. By 2014, there are 398 PRM specialist in Croatia with 14 PRM Croatian specialists passing the European PRM Board examinanition, and 9 certified by equivalence. In total, 23  PRM specialists in Croatia have attained UEMS PRM Board Fellowship. Furthermore, there are 2 national teaching centres certified by UEMS PRM Board (Zagreb and Varazdinske Toplice), and 5 certified Trainers. There is also one programme of care accredited by the UEMS PRM Section Clinical Affairs Committee (Programme of care for Spinal cord injured patients, Varazdinske Toplice).

Hopefully, Croatian Society of Physical and Rehabilitation Medicine of Croatian Medical Association can be useful and active member to the European Society of PRM and PRM community.