The first two weeks of March 2020, I traveled to Malaga, Spain with eight students and a fellow faculty member. This was before there were coronavirus outbreaks noted in the area. This international experience was created to develop students via a Level I fieldwork placement through cultural immersion. The plan was for students to gain approximately 40 hours of patient interaction with as much "hands-on" experience as sites and local therapists would allow. The students were originally scheduled at three different sites, but then COVID-19 fear infiltrated our experience. Understandably, some sites canceled our students after the first couple of days. Two sites agreed to continue to allow our students to complete the experience, one of those was a private outpatient hand therapy.
Spain has a universal (social-pubic) healthcare system that is essentially free except for small, often symbolic co-payments for some products and services, but there is also a private system. The social system is for people who contribute to the Spanish social security and their families. This public system also provides free healthcare for retirees, including those from other European countries.
In the public system, the doctor-specialist in rehabilitation is the one who must write the prescription. The hand surgeon cannot directly prescribe rehabilitation for the patient. The number of weekly, and total sessions are determined by the doctor. Typically, for patients who are post-surgical, visits are daily. Conservative treatment visits are typically two per week or three in the most serious cases. Generally, in the public sector, more treatment sessions are provided; however, this treatment is not individualized, and manual therapy is rarely used due to insufficient time allotted per session.
The private system is different. Patients can opt to pay for private coverage and can go directly to rehabilitation and the occupational or physical therapist can treat without any prescription. The number of sessions needed are determined by the therapist based on their own assessment. In private healthcare, treatments are usually individualized, and treatment time allotted is 45 minutes or more per visit. According to one hand therapist, this “lengthy” and individualized treatment equated to a much quicker recovery time. Typical diagnoses include osteoarthritis of the thumb, distal radius fractures, scaphoid fractures and tendon injuries.
One of the most interesting (and disheartening) things I learned is that hand therapy in Spain is not a recognized specialty. Currently, the Spanish association of hand therapists determines, at its discretion, who meets the requirements to be a hand therapist. There is no access to specific training common to physical and occupational therapists. Those who specialize in the area of hand therapy are not recognized in Spain, despite having global recognition. It is believed that in order to advance the field and recognition of hand therapy in Spain, the support of the different occupational and physical therapy institutions is warranted.