Physiotherapy in Nepal

Nepal currently only has two physiotherapy programs that are available through Kathmandu University and Pokhara University as a bachelor's degree. It is equivalent to four-and-a-half years of full-time study. The minimum level of education to start this program is upper secondary.[1][2]

Practicing physical therapists

Titles for practicing therapist is Physiotherapist and भौतिक चिकित्सक (Vautik Chikitshak) (protected by law).[1]

Currently according to the World Confederation for Physical Therapy (WCPT), there are an estimated 2000 practicing physiotherapists as of December 2017.[1] There are 369 members of the national organization with the percentage of female physical therapists numbering at 42%.[1] WCPT reports that there a total of 153,830 members organization for their Asia Western Pacific region of the organization. Support personnel are part of the workforce.[1]

Regulation

The scope of practice is defined by the Ministry of Health that has a regulated code of conduct. There is currently no legislation to prevent private practice clinics. Patients have direct access meaning they can self-refer to private practice clinics without referral from another health care professional.[1]

A physical therapist's scope in Nepal permits:[1]

  • Assess patients/clients
  • Make a diagnosis
  • Treat (interventions, advice and evaluation of outcome)
  • Refer to other specialists/services
  • Offer preventative advice/services

Registration is required to practice as a licensed physiotherapist in Nepal.[1][3] As of the current code of ethics, continuing professional development is not required for re-registration and membership,[1] however, the amendment of the code of ethics have incorporated a mandatory evidence of continuing professional development, which will soon come in action.

Role of physiotherapy after the earthquake

On April 25 and May 12, 2015, two major earthquakes measuring 7.8 and 7.3 on the Richter scale struck Nepal.[4] Out of the 75 districts of Nepal, 14 were severely affected by the earthquakes with an estimated 8600 deaths, 22,000 injuries and 505,000 homes completely destroyed.[4] Post-disaster, health care facilities faced shortages in space and resources.[4] Furthermore, patients facing discharge after acute care faced challenges of accessibility living in remote locations with limited health care services especially those requiring ongoing rehabilitation.[4] With natural elements such as monsoon season, floods and landslides made access more difficult post-earthquake.[4]

Injuries included traumatic cases due to falling debris and houses collapsing due to poor building construction and high population density in larger cities.[4] 70% of injuries were fractures with a large number of patients suffering from spinal cord injuries (200-300), amputations (40-60) as well as traumatic brain injuries, crush injuries and neuropraxia.[4]

During the time of the earthquake, 393 physiotherapists were registered with the majority of therapists located in Kathmandu.[4] The role of physical therapist in disaster response was poorly defined with the profession being relatively new.[4] Many physical therapists at the time worked in facilities treating patients with musculoskeletal conditions followed by neurology and rehabilitation with a small number in intensive care-unit, obstetrics and pediatrics.[4]

In response to the earthquake, physical therapists worked alongside doctors, nurses and other heath providers with triage, screening and acute care management of patients.[4] This would includes services such as brace fitting, applying plaster cases, temporary backslabs, skin traction for femoral fractures and hip dislocations, dressing wounds, fitting assistive devices.[4] Physiotherapists also mobilized patients, prescribed exercises, re-positioned patients to prevent secondary complications such as bed sores and chest complications post-surgery or prolonged bed rest.[4]

References
  1. "Nepal: a profile of the profession". World Confederation for Physical Therapy. 2017. Retrieved 2 May 2018.
  2. "Bachelor of Physiotherapy (BPT)". Kathmandu University School of Medical Sciences: A Collaborative Program of Kathmandu University and Dhulikhel Hospital. Retrieved 2 May 2018.
  3. "Registration Procedure for Health Professionals स्वास्थ्य व्यवसायीको नाम दर्ता प्रक्रिया (Online Registration)". Nepal Health Professional Council. 2016. Retrieved 2 May 2018.
  4. "The Role of Physical Therapists in the Medical Response Team Following a Natural Disasters: Our Experience in Nepal" (PDF). Journal of Orthopaedic & Sports Physical Therapy. 45 (9): 644–646. September 2015.
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