Good morning and welcome to everybody.

Let me start by projecting a list of Presidents and Secretaries that Italian Society of Physical and Rehabilitation Medicine has had in its fifty-two years of history.

I believe that we cannot look to the future, if we forget our past and roots, and every congress represents a stepping stone to the future.

During the past fifty years, Physical and Rehabilitation Medicine has been created in Europe through a laborious activity done by important PRM organizations, to promote the development of the discipline and to standardize its practice across all countries in the European Community.

The organization founders and those who - over the years - have dedicated themselves to working within these organizations saw and see their mission as fully integrated in European Community growth.

Here in this Opening Ceremony, we are honoured to have all main European PRM Organization represented: the European Society of PRM, the European Academy of Rehabilitation Medicine and the UEMS PRM Section and Board.

In addition, as Italians we are glad to underline that the Presidents of two out of these four Organizations (Giustini in ESPRM and Franchignoni in UEMS PRM Board) are members of our Italian Society of PRM, SIMFER.

Moreover, we are proud for the history and role of SIMFER and its members in these European Organizations, since their very first beginning. 

The European Federation of Physical Medicine and Rehabilitation was founded in 1963 and grouped together the national scientific societies (only recently changed in ESPRM). The European Academy was founded in 1969. The monospecialist Section of Physical and Rehabilitation Medicine of the UEMS started in 1971 and its Board in 1991.

Among their founders there are persons as G. N Valobra and Dario Fiandesio, who founded also Europa Medicophysica, the Official journal of the European Federation, now European Journal of Physical & Rehabilitation Medicine, official journal of the EPSRM, that had S. Boccardi (who in those years was also President of the International Rehabilitation Medicine Association, IRMA), F. Franchignoni, P. Di Benedetto and now S. Negrini as Editors in Chief.

Moreover, leading members of these PRM organizations for many years were A. Tonazzi and C. Bertolini.

In addition, SIMFER is proud to have among its honorary Members a man as prof. Bardot, who is a bright example of top physiatrist in the world.

These colleagues had and have roles of great responsibility in European as well in International PRM bodies, together with many other friends who are here in this Opening Ceremony.

I thank all for their valuable activity for PRM in Italy, Europe and around the world.

As I appointed Carlo Bertolini, I want to send a greeting on behalf of all members SIMFER, hoping to have him with us again soon.

And now let’s look at some of the themes in this important event: QUALITY, EVIDENCE, EFFECTIVENESS AND EFFICACY. These are perfect words. They are relevant to all areas of bio-medicine, from orthopaedics to gynaecology, cardiology and paediatrics, but these words in Physical and Rehabilitation Medicine have a different interest because this science is quite different from those. It is the science of “human functioning”, and thus of COMPLEXITY and DIVERSITY, because it is a COMPREHENSIVE, HOLISTIC, INCLUSIVE, MULTIDISCIPLINARY, and EMPOWERING science.

In our DNA we have not only healing concept but also diversity concept, in all its aspects: physical, mental, cultural, and educational.

Ours is more a BIO-PSYCHO-SOCIAL discipline than a biomedical one (as the sessions on ICF will show), it looks at the whole-person functioning (as person-environment interaction) over and above the biological aspects of the disease.

Rehabilitative research finds difficulty in applying the same rules as classical EBM; it is easier for us to use parameters referenced to QUALITY OF LIFE. (Many papers submitted to this Congress demonstrate this.)

When we talk of EFFECTIVENESS and EFFICACY we inevitably bring ECONOMICS into the discussion, in times of crisis like the present. We also know, however, that rehabilitation is too often considered a luxury. Despite the fact that in many countries policies are dictated by Ministries of Finance, economists have regularly attempted to connect indicators for measuring economic wellbeing, or rather monetary progress indicators like GDP (Gross Domestic Product) to indicators for measuring social and environmental factors in order to obtain a clearer assessment of QUALITY OF LIFE. Emphasis has switched from GDP to REGIONAL DEVELOPMENT QUALITY INDEXES (GDP à QUARTZ INDEX) and this is of great importance to a congress speaking about PEOPLE.

It is very dangerous therefore to base the medical discipline dealing with ACTIVITY, DISABILITY and PARTICIPATION on economic factors alone. I would like to remind you that by over-emphasising economic factors, some disciplines have underestimated the value of the past and present. In architecture, for example, rehabilitation and re-use of buildings run parallel to scrapping and then rebuilding. In other areas the concept and the value of the individual have been forgotten. Discussions of POST-HUMANISM are already referring to HOMO ELECTRONICUS as the successor to homo abilis, homo erectus and homo sapiens.

Science and technology are obviously closely linked, but it would be a mistake to ignore the clear line of demarcation that exists and must continue to exist between the two fields. (the sessions on robotics and the many interesting Russian contributions deal with this issue). Technological research is absolutely essential. This congress will benefit from some important sessions about Advancing in rehabilitation research, perspectives and methodology for research, and contributions by De Lisa and Stucki and other leading scientists is essential for helping us to understand how to guide our future choices.

Man has driven his own evolution over the centuries, and our knowledge has allowed us to overcome many of the limits imposed by our biology. Having striven to find a thousand and one ever more effective aids for the human body (an issue dealt with by the session on technological aids in rehabilitation and the Smiling project) it is only natural for our discipline now to seek to perfect and extend the abilities of the human body. The example of Oscar Pistorius bears witness to this. His prostheses have not only enabled him to “make up for” his handicap, but have actually enabled him to improve his performance. The human body is fragile,as shown by the post-human performer Orlan’s quest for the “non-conforming body”. Advances in science are extending the limits of natural life, but at what level of quality will this extra life be lived? Will it still be possible to be UNIQUE or DIFFERENT in a world of super-heroes and bionic bodies where the old body (typified by the beautiful classical image of the body of Christ on the cross) is obsolete?

It is fine to talk of quality, effectiveness, efficiency, and even economics, but only if it confirms our DIVERSITY, our AUTONOMY and the COMPLEXITY of our being.

As the great Frida Kahlo said: “Why should I want feet to walk if I’ve got wings to fly?”

So – and I'll finish here – the terms QUALITY, EVIDENCE, EFFICIENCY and EFFECTIVENESS only have true meaning if we can combine them with the word “ETHICS”. Ethics can be and must be our guideline for the future. (I am looking forward to the extremely important session entitled “Ethical Issues and Human Rights in PRM” and to contributions from three leading physicians, Gutenbrunner, Yelnik and Saraceni). As I said at the beginning, the future is lost if we fail to learn from good and bad episodes in our past. So let me conclude by quoting a few lines by Elie Wiesel, the Nobel Prize-winner for Peace, reminding us how progress without ethics is impossible and how important memory is in reinforcing ethics:

THANK YOU and WELCOME ITALY TO 58 PRESENT COUNTRIES.

From now I declare opened the 38^th Congress of Italian Society of Physical and Rehabilitation Medicine, this year in conjunction with the 17^th  European Congress of PRM.

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