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For physiotherapists, the battle for independence has just begun.

Summary: Jalal Tabaja was struggling to choose the best facility to undergo surgery for lower back pain when his son's principal recommended he see Fady Hanna, a physical therapist.

BEIRUT: Jalal Tabaja was struggling to choose the best facility to undergo surgery for lower back pain when his son's principal recommended he see Fady Hanna, a physical therapist. A physician had told Tabaja, 35, he needed immediate surgery for his herniated disc to restore mobility to his left leg. But Tabaja, aware that back surgeries do not always go well, consulted three other doctors. All recommended surgery.

Still Tabaja took a chance with physical therapy, believing it could help him avoid the often unnecessary risks of surgery.

By his fifth treatment session, his paralyzed leg muscles started to function and Tabaja gradually resumed his normal lifestyle.

"I owe Dr. Hanna a lot for helping me get back into shape to play my favorite sport, football," Tabaja said of the 36-year-old health care professional whose practice merges physical therapy with chiropracty.

While physiotherapists aim to restore both mobility and quality of life through therapy, movement and therapeutic exercise, the art of the chiropractor exclusively uses techniques of manipulation to relieve pain, align the spine, adjust posture and restore joint function.

"The results were remarkable and I was able to travel after the seventh session," added Tabaja, whose career as a senior manager at an insurance broker company requires frequent travel to other countries.

In 2000, nearly seven years after the Doctor of Physical Therapy degree was initiated in the U.S., Lebanon amended its three-year Physical Therapy Technician certificate program, requiring students to take an extra year of university education at the Lebanese University to be able to practice.

The decision was made shortly after the American Physical Therapy Association passed its Vision Statement, which states in part that by 2020, physical therapy will be provided by physical therapists who have professional degrees in the field.

It was not until this year that the state-run Lebanese University, Universite Saint Joseph and Beirut Arab University began offering a transitional DPT program for those already holdinga degree in physical therapy.

"We decided to follow suit after we felt a powerful urge to keep abreast of developments in this field," said Dr. Tina Zaidan, dean of the School of Public Health at the Lebanese University.

However, there were dark moments for physiotherapy as the real battle for dominance between orthopedic physicians and physical therapists has yet to begin when graduates prepare to become practitioners and have direct access to patients.

"Some physicians are concerned that we will strip them of their livelihoods," said Hanna, who managed to squeeze in time for The Daily Star between treating patients.

But Hanna is not worried about his future after 13 years' experience. The therapist, and his strong hands, have already garnered a reputation as a health care professional, handling between 25-30 clients on a normal day between two clinics in Furn al-Shubbak and St. Joseph Hospital in Dora, where he serves as coordinator-general of the Physical Therapy Department.

Hanna, a member of the World Confederation for Physical Therapy and administrative affairs secretary at the Lebanese Order of Physical Therapists, said of the 2,000 registered PTs in Lebanon, the first batch of 120 joined the two-year DPT program, including himself.

The therapist hopes DPT holders will eventually achieve their ultimate goal of autonomy with direct access, which allows individuals to be evaluated and treated by a physical therapist without first seeing a physician for a prescription or referral.

"Direct access gives us more independence. We can have our say. We can tell [medical] doctors that we can develop our own plan of care for our patients," Hanna said, adding that talks aimed at achieving direct patient access were ongoing between a parliamentary health committee and the Order of Physical Therapists.

Dr. Ahmad Rifai, head of the Physical Therapy Department at LU's Hadath branch, anticipated hurdles associated with direct access.

The Lebanese Order of Physicians was already against the measure to introduce the DPT program in Lebanese universities, let alone direct access, he highlighted.

"In Lebanon, medical doctors are domineering," Rifai said, noting that it took 13 years to establish the Lebanese Order of Physical Therapists.

"Giving us autonomy means a decrease in patient visits to physicians," he added.

Rifai nevertheless expressed hope that officials and the 12 lawmakers who double as medical doctors would engender excitement when the DPT degree makes its way to the Health Ministry, then to the legislature. Without Parliament's approval, he argued, DPT-degree seekers cannot assume the title Doctor of Physical Therapy.

"Negotiations are underway. We will face many obstacles, but so far there are no problems," he said.

Certain physicians, like Dr. Marwan Baaklini, an Orthopedist at St. Joseph Hospital, expressed concern about the use of the title "doctor" for PTs. However, according to Hanna, the Education Ministry will allow holders of the DPT degree to use the title, if the decision is passed.

"Calling them doctors, that's not logical," Baaklini lamented.

"This is bizarre."

Nisrine Lattouf, director of the Physical Therapy Institute at USJ, believed it was too early to discuss direct access, which is said to save patients both time and money.

"If there will be direct access it will be based on the American, Canadian and Australian model; so it will address a list of affections especially in the prevention," she commented, adding that the objective is to "help students make differential diagnosis and put Lebanese physiotherapists at the same level of knowledge as in the U.S."

Antoine Romanos, head of the Department of Medical Professions at the Health Ministry, said the ministry has been engaged in talks with the Order of Physical Therapists over the past two years with the purpose of redefining the practice of physical therapy "such as it protects holders of Bachelor of Science degrees while opening a new field of competence."

"The Health Ministry has no history of obstructing progress on issues," Romanos said, adding that the ministry has yet to receive the revised draft from the Order of Physical Therapists.

Once finalized, Romanos believes the draft has a long way to go before it becomes law, given that the Order of Physicians -- which is not fully supportive of the measure -- would still have to give its opinion.

Hanna stresses that physiotherapists think differently from physicians. "We believe that we should work hand-in-hand with [medical] doctors to provide our patients with the most effective treatment."

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Publication:The Daily Star (Beirut, Lebanon)
Geographic Code:7LEBA
Date:Nov 22, 2014
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