Editorial (260.5 kb)

Editorial (301.6 kb)

History of the FIMM Scientific Committee

FIMM is an international association of 29 national societies of Manual or Musculoskeletal Medicine. Its remits include the development of and improved standards of practice in Manual/Musculoskeletal Medicine (M/M Medicine) internationally. In 1997 FIMM General Assembly (GA) decided to split the existing Scientific Advisory Committee into an Education Committee (EC) and a Scientific Committee (SC) to meet the increasing needs of FIMM, and to pay more attention to evidence-based science and education in M/M Medicine. In his first report to the GA in Australia in 1998, the SC-chairman stated that science has to have a prominent place within FIMM and that the composition of the SC had to be independent of National Society interests and representation. A well-defined problem within M/M Medicine was illustrated by the phrase:

At first the SC had to create conditions for information exchange between different schools in M/M Medicine, and to stimulate scientific work within M/M Medicine. In the longer term the SC had to develop a structure, clearly related to FIMM, in which more scientists and educationalists from the different schools in M/M Medicine (in diverse countries) could be involved. The SC comprised invited scientists and researchers in M/M Medicine, recommended by the Chairman and ratified by the FIMM GA. In the early SC-meetings plans were further elaborated and it was decided that the first scientific activities of the SC were to be focused on efficacy and reliability in M/M Medicine. At the subsequent SC-meetings the different areas of the locomotion system (lumbar, cervical, shoulder/thoracic and extremities) were discussed in the framework of efficacy and reliability. The SC decided also to provide the international community of M/M Medicine with proper tools to perform scientific work. Reliability and efficacy protocols and a protocol for 13 GCP rules were developed and published. To create an international platform to discuss scientific work, a first SC-Conference was organised in cooperation with a National Society for M/M Medicine (Denmark, Odense 2003). At this SC-conference, scientists presented and discussed their (preliminary) results, and proposals for scientific protocols.

At the SC-meeting in 2004 a start was made to discuss basic research in M/M Medicine. A consensus model, in which different approaches of M/M Medicine could be integrated, was elaborated. Such a model was needed to provide M/M Medicine with outside evidence for efficacy and reliability, with a general theoretical background that included the different approaches in M/M Medicine. Besides, a protocol was developed to evaluate the reproducibility studies of diagnostic proce?dures in M/M Medicine, with the ultimate goal to provide the educational boards of the societies of the FIMM with the state of the art of evidence based diagnostic proce?dures. The same was true for the state of the art of efficacy in M/M Medicine. A paper will be published by the SC about the present status of efficacy in M/M Medicine.

In the past seven years the chairman and eleven SC-members undertook the work within the SC. From a practical point of view this composition of the SC was the best format to create a basis for future science within FIMM. However, it became clear that the SC had reached a point at which it became necessary to involve more scientists and educationalists in its work. This idea was strengthened by the fact that many requests were received from individuals to become a member of the SC. The financial status of the FIMM and the format of the SC prevented such an enlargement of the SC. In an early stage of the SC, preliminary ideas were developed to establish an International Academy of M/M Medicine and subsequently discussed with the Policy Committee of the FIMM. The Policy Committee supported these ideas and at the GA of Bratislava 2004 the plans and statutes of a FIMM International Academy for M/M Medicine were ratified by a substantial majority of the National Societies of FIMM.

Reasons for transformation from the SC to a FIMM Academy of M/M Medicine and its benefit for the profession and therefore the National Societies

The work of the SC over the past years resulted in a firm position of science within FIMM. By defining the main problem within M/M Medicine and providing solutions in the form of protocols and publications, the SC has slowly influenced a change in attitude of the international community of the FIMM towards a more evidence based M/M Medicine. However, the present composition of only twelve SC-members cannot guarantee a further development. The diversity of approaches, which exists in M/M Medicine, is not reflected in the present SC. The results of scientific work undertaken in countries with a different approach cannot be discussed and integrated internationally. M/M Medicine is by definition a multidisciplinary and eclectic profession, in which many medical disciplines such as neurology, internal medicine etc. and preclinical disciplines such as neurophysiology and clinical biomechanics are integrated, but the present format of the small SC cannot guarantee such a multidisciplinary character.

In previous years the National Societies of FIMM indirectly, by their fees, financed the work of the SC. Because of the politically independent character of the SC, the National Societies could not influence the activities of this committee. Although this political independency was the best condition for the activities of a SC within the FIMM, the disadvantage of such a format was that many scientists and educationalists from the National Societies could not be involved in the work of the present SC. As a consequence, not all-available knowledge within M/M Medicine can be assimilated and discussed on its evidence-based merits.

At the present time two different institutes (the Scientific Committee and the Educational Committee of FIMM) operate mainly in a separate way. In keeping these two institutes apart, educational programs will not professionalize with a firm evidence base.

By transforming a SC to an International Academy, many of the above-mentioned drawbacks of the SC in its present format can be overcome. A future Academy, by involving more scientists and educationalists from the National Societies, can better guarantee increased professionalism of M/M Medicine in a more evidence based way. The Academy as an international organisation will provide the National Societies of FIMM with a larger platform on which to interact and discuss the different approaches within M/M Medicine.

Format of the Academy and the need for a firm relationship to FIMM

The present SC had an intimate relationship to FIMM. The FIMM General Assembly ratified the proceedings and plans of the SC. A firm relationship has also to be present with respect to an International Academy for M/M Medicine. In addition to medico-political issues, FIMM has an overall responsibility for scientific and educational aspects of M/M Medicine. The organisational format of an Academy, with an Executive Board and a Science Board, and the election of different officers by the FIMM General Assembly, reflects in a constitutional way this mutual relationship. Furthermore, both the chairman of the Executive Board and the chairman of the Science Board are obliged to present their annual reports to the General Assembly.

An Academy without a connection with the National Societies through the FIMM is meaningless. Participation and support of the National Societies of FIMM is mandatory for the future of an Academy. By ratifying the founding of the Academy, the National Societies not only confirm the need for a strong relationship between an Academy and the FIMM, but they subscribe to the goals of the previous SC, which also forms the basis for future activities of the Academy. More precisely, the National Societies subscribe to the need for improved professionalism of and increased evidenced basis for M/M Medicine.

Academy as an organisation, membership and Academy Conference

The Academy has two separate structures: logistic and scientific. The logistics fall under the responsibility of the Executive Board of the Academy. This Board comprises a Chairman, the Scientific Director, an Administrative officer and a Finance officer. The Executive Board is responsible for all logistics and finance of the Academy. The Science Board comprises a Scientific Director (chairman) and 9 Science Board members (SB-members). Additionally, the Chairman of the Education Committee of FIMM participates in the activities of the Science Board of the Academy together with the Administrative officer. The Science Board is responsible for all science and education within the Academy.

All members of the Academy have full voting rights at the annual general meeting. They choose the Scientific Director and the members of the Science Board. Members of the Academy are expected to make presentations to the Academy conferences, and to uphold the principles of FIMM, the parent organisation. Interactions and contributions to discussions and the development of consensus papers on diverse topics will be open to all members.

The further organisation of the Science Board of the Academy comprises a subdivision into different areas of special attention for which individual SB-members will bear full responsibility. For these areas of special interest, such as efficacy, reliability, basic research, complications, education, paediatric M/M Medicine, additional diagnostics etc, individual SB-members will have the task to elaborate plans, to involve more scientists and educationalists and to establish a special Academy working group. In these Academy working groups, future Academy members can be involved such as those proposed by National Societies. The previous SC-Conference will be transformed to an Academy Conference, which will be held every second year. At this conference, Academy members can present their papers on scientific and educational issues. Participation in the Academy Conference is intended for both Academy members and others who are interested. The Academy will also be involved in the scientific organisation of FIMM congresses.

So far a rough outline is presented, because scientific and educational plans within the Academy will have to be elaborated in more detail in due course. Nevertheless, the activities of the Academy will be a logical continuation of the work of the previous SC. The defined remit of the previous SC and its proposed problem solving will form the basis for future activities of the Academy, however with the involve?ment of more scientists and educationalists.

Education and the Academy

The starting point in the Academy is the opinion that science is nothing without education and vice versa. This means that education must have its place within the Academy. First of all, this relationship is illustrated by the fact that the Chairman of the Education Committee (EC) of FIMM will participate in the Science Board of the Academy. In this way the connection between the Academy and the Education Boards of the National Societies is guaranteed. Secondly, a section of educationalists must be formed within the Academy with the responsibility for the level of international educational standards within M/M Medicine and development of new formats for education programs. Further plans will be elaborated in cooperation with the EC-Chairman. Although science plays a major role within the Academy, educational concerns within the Academy are indispensable. It guarantees the implantation of scientific results and consensus produced by the Academy. Conditions for membership will be elaborated in cooperation with the EC of FIMM.

Future plans of Academy

As already mentioned the future work of the Academy will be a logical continuation of the work of the late SC. The problem defined by the SC and its proposed solutions will form the base of the activities. Areas with special interest will be defined and elaborated in Academy working groups. In these working groups Academy members will be involved and/or invited under the responsibility of a member of the Science Board. Projects, which have not been completed by the late SC, will be finalised. Plans for a first Academy Conference will be elaborated. The possibility to establish an international journal for M/M Medicine in cooperation with existing journals for M/M Medicine will be explored. A logistical structure of the Academy will be developed which has to guarantee maximal transparency, maximal information dissemination to the National Societies, scientists, educationalists and FIMM as an organisation. A public relations policy will be elaborated to involve all the National Societies of FIMM in the work of the Academy and to stimulate membership of the Academy.

The need of the support of the National Societies

For the work of the SC, the support of the National Societies of FIMM was indispensable. For the future of the Academy, substantial participation in its development and support of its activities by the FIMM and its National Societies is even more necessary. The ratification of the Academy and adoption of its Articles of Association by a large majority of the National Societies at the FIMM GA in Bratislava 2004 not only reflects a substantial support of the idea of an Academy, it also obliges FIMM in general and its National Societies in particular to contribute wholeheartedly to the success of the Academy. As science is nothing without education, so an Academy is nothing without the National Societies of FIMM. The work of the Academy is firstly to professionalize M/M Medicine in a more evidence based way, secondly, to be an international platform for mutual discussions and cooperation between schools and/or approaches of Na?tional Societies.

FIMM has, by creating an International Academy for M/M Medicine, taken a step towards a new future of its organisation whereby scientists, educationalists, and practitioners in M/M Medicine can meet each other in a more personal way. This Academy will also provide FIMM with the necessary knowledge to meet medico-political problems it will face in present and future times.