Abstract

Objectives: Small countries face distinctive challenges when developing Physical and Rehabilitation Medicine (PRM): limited specialist numbers, constrained academic infrastructure and marginalization in national health policy. Malta, one of the smallest European states, is undergoing substantial reforms to strengthen PRM locally. Providing a comprehensive analysis of Malta’s PRM development, while deriving lessons relevant to other small states facing similar pressures. The report covers professional identity, governance, workforce, clinical practice, training, and academic alignment.

Materials and methods: Synthesis of international and European rehabilitation frameworks, academic initiatives (such as the European Organization of University PRM, UniPRM), and peer-reviewed literature on PRM policy and small-country system development. Subsequently, Malta’s PRM activity timelines, educational strategies and specialist training frameworks were reviewed.

Results: Malta has implemented a wide range of reforms in the last three years from a shift towards the internationally recognized term of PRM totargeted public awareness campaigns on rehabilitation and disability empowerment. On a more concrete level one can find the introduction of a new undergraduate PRM teaching schedule, the introduction of evidence-based clinical practice guidelines, and the creation of a competency-based national PRM training program. These actions have increased visibility, improved service quality, and attracted new trainees. However, significant structural gaps persist: the absence of PRM clinical and academic departments, limited leadership representation, and a critically small workforce.

Conclusion: Malta demonstrates that small states can make meaningful progress in PRM through sustained, coordinated reform across identity building, training, clinical governance, and academic alignment. Continued progress now requires embedding PRM within clinical and academic structures, strengthening governance representation, and consolidating the workforce to ensure PRM fulfils its essential role in the Rehabilitation 2030 agenda.

Citation: Anastasi AA, Vella CM. Strengthening Physical and Rehabilitation Medicine (PRM) in small health systems: Identity, training and system integration in Malta. Arch ISPRM 2026;1(x):i-ix. https://doi.org/10.5606/archisprm.2026.3.