Before the restoration of Ukraine’s Independence in 1991, rehabilitation occurred within the Soviet paradigm, which set itself in opposition to Western ideology – not out of rational consideration, but out of the need to be different. Some of the key features were:
- a medical approach to rehabilitation;
- an ideological basis built on dogma (right – wrong);
- a separate field within the health care system, remedial gymnastics (лікувальна фізична культура -ЛФК), which was not considered physical culture but also lacked an individual approach;
- the training of specialists took the form of self-education, as a response to the absence of a proper system of state education; and
- the success of rehabilitation depended very heavily on the specialist’s experience; professional competence was formed on the basis of one’s own observations.
For the first years after the collapse of the USSR, by inertia, the state of affairs remained relatively unchanged. However, in the early 1990s, with Ukraine gaining Independence, the idea of physical rehabilitation/therapy began to take shape, drawing on European and International practice.
Education First
In 1994–1995 the first university programme for training physical therapists began at the Lviv State Institute of Physical Culture (LSIPC), in cooperation with the Canadian International Development Agency (CIDA) under the Ukrainian-Canadian programme ‘Partners in Health Care’ and the project ‘Rehabilitation Programme in Lviv’. The aim of the project was to assist LSIPC in developing and introducing the first training course in Ukraine in physical rehabilitation. It should be noted separately that for a long time the profession was called a specialist in physical rehabilitation, although the original idea was to create the profession of physical therapist. But the medical community categorically opposed this, arguing that therapy is the business of physicians.
Nevertheless, the syllabus of the curriculum met the requirements of the World Confederation for Physical Therapy. Eleven Canadian specialists delivered lectures, conducted practical classes and supervised students’ practical training at LSIPC. Five graduates and lecturers of LSIPC underwent additional training in the specialty at the University of Manitoba.
In 1998 the graduates of this programme created the first regional Association of Physical Rehabilitation Specialists in Ukraine (the Lviv Regional Association of Physical Rehabilitation Specialists, LRAPRS), and its primary tasks became to unite practitioners, create standards of rehabilitation practice, develop requirements for the quality and scope of practice, and foster the professional level of specialists and the scientific potential of the field.
Government Support and Legislation
In that same year, thanks to the work of LRAPRS with governmental and other organisations, under code 3226 the profession of ‘Physical Rehabilitation Specialist’ was entered into the Classifier of Occupations of Ukraine; in form and content it corresponded to the international name of the profession – physical therapist.
In 2000, the first textbook on the subject in Ukraine, “Physical Rehabilitation”, was published under the editorship of Professor V. M. Mukhin. This textbook introduced new concepts that were close to the modern notion of rehabilitation, in particular individualisation, justification for the use of exercises, and so on.
It should be clarified that at that time health care institutions did not provide for positions of physical therapists. And in 2001, after a meeting between members of LRAPRS and the Minister of Health Vitaliy Fedorovych Moskalenko, the Ministry of Health of Ukraine published a letter providing for (at the discretion of the official) the introduction of the position of “Physical Rehabilitation Specialist” in institutions subordinated to the Ministry of Health of Ukraine. It was now became possible to not only to hold the corresponding position in hospitals, but also to work under job descriptions that were new at the time and that provided for the performance of duties corresponding to the profession of physical therapist.
In the period 2002–2004 the Lviv Regional Association of Physical Rehabilitation Specialists developed and released, for the first time, a number of informational materials (booklets, a bulletin, video clips) about the profession of physical rehabilitation specialist/physical therapist. Also for the first time, a foreign book was translated into Ukrainian – Gary Okamoto’s “Fundamentals of Physical Rehabilitation”.
The development of physical rehabilitation/therapy took place not only in the practical direction. In 2005, by order of the Higher Attestation Commission (HAC) of Ukraine, the specialty 24.00.03 – PHYSICAL REHABILITATION was included in the list of specialties in which dissertations were defended for the academic degrees of Candidate and Doctor of Sciences in the field of Physical Education and Sport.
Candidate of Sciences (kandydat nauk) was the first-tier doctoral degree in the Soviet-inherited system and is internationally treated as the equivalent of a PhD. Doctor of Sciences (doktor nauk) is a second, higher research degree earned later in a career — closer to the German Habilitation than to anything in the US or Australian systems. In the same year, the Ukrainian parliament (Verkhovna Rada) voted for the Law “On Rehabilitation of the Disabled in Ukraine” in which, for the first time, the types of rehabilitation, including physical rehabilitation, were described in legislation.
A Professional Association
From left to right: Kalandyak Oleksandra, Stepan Kobelyev, and Marilyn Moffat. 17th General Meeting of the World Confederation for Physical Therapy. Amsterdam, the Netherlands, 2011.
For the systematic, consistent and comprehensive shaping of the rights and the unification of physical rehabilitation specialists/physical therapists the Lviv Regional Association of Physical Rehabilitation Specialists took the decision to create an Ukrainian organisation that could represent the interests of pracitioners not only within Ukraine, but also at the international level. Thus, in 2007 the first Ukrainian public organisation was created, the “Ukrainian Association of Physical Rehabilitation Specialists”. In 2010 the name was updated to the Ukrainian Association of Physical Therapy – in keeping with international nomenclature.
In 2011, at the 17th General Meeting of the World Confederation for Physical Therapy (Amsterdam, the Netherlands) the Ukrainian Association of Physical Therapy joined the global professional community by becoming a full member.
Refinement and Further achievements
2015 – the specialty physical rehabilitation was transferred from the field of education ‘Physical Culture and Sport’ to the field of education ‘Health Care’. The name of the profession of Physical Therapist was legitimised by the presidential decree.
2016 – the occupational title ‘Physical therapist was added to the Classifier of Occupations.
2018 – qualification characteristics were approved for the professions of Physical Therapist and Physical Therapist Assistant. The higher education standard for specialty 227 “Physical Therapy, Occupational therapy”, for the first (bachelor’s) level of higher education was approved.
2019 – the position of Physical therapist was added to the list of positions of professionals in the field of health care in health care institutions
2020 – The Law of Ukraine “On Rehabilitation in the Field of Health Care” was adopted by the Ukrainian Parliament. In this Law the physical therapist is assigned to the category of rehabilitation specialists and is a member of the multidisciplinary rehabilitation team. Also, the Ukrainian Association of Physical Therapy, together with international consultants, developed and approved one of the important documents: “Physical Therapist’s Scope of professional practice in Ukraine”.
2022 – Entry level of training for the profession is the master’s degree.
2023 – the Ukrainian Association of Physical Therapy developed and approved the professional standards to form the basis of the professional practice of the physical therapist and assistant in Ukraine and serve as a reference point for the development of educational and other documents regulating the profession.
Conclusion
Over the past 35 years the profession of physical therapist in Ukraine has come a very long way. From something resembling an assistant to a rehabilitation physician within the post-Soviet paradigm to an autonomous professional with a national professional standard based on the Standards of physiotherapy practice published by World Physiotherapy.
