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128 Musculoskeletal & Neurological Rehabilitation KCE reports 57 Figure 6.17: Average number of sessions per patient case 160 140 120 100 80 60 40 20 0 Most of the rehabilitation sessions are provided to an individual after stroke or spinal cord injury or to the individual with multiple sclerosis rather then to individuals after amputation of a lower extremity or a total hip replacement, which seems logical when the complexity and the chronic character of the consequences of the different pathologies is considered. In order to detect trends in the number of sessions per respondent a graph reflecting the average number of sessions per patient case per respondent completes the analysis. No outliers are detected though. Figure 6.18: Average number of sessions per patient case per respondent 6.3.2 Optimised rehabilitation programmes 300 250 200 150 100 50 0 Amputation of lower extremity Multiple Sclerosis Spinal Cord Injury Cerebrovascular Accident A second part of the questionnaire asks the respondents to describe ideas for optimising rehabilitation programmes for each of the five patient cases, independent of their own working situation, the current payment systems and the Belgian organisation model. Concrete recommendations, such as included in a report of the GTA (Greater Toronto Area) Rehab Network 137 , (see chapter 3.5.1) were hoped for. In that report recommendations were made for patients after hip replacements such as: • Standardize the model of care to achieve equitable access to best care; • Identify and track appropriate outcome measures; • Develop appropriate triage tools; Total Hip Replacement Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip Amputation of Multiple Spinal Cord Cerebrovascular Total Hip 1 2 3 4 5 6 7 8 9
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 129 • Improve the quality and quantity of available hip replacement data. However, every respondent formulated recommendations at the individual patient level or ‘micro’-recommendations instead of more general or ‘macro’-recommendations. Most of these recommendations are still dominated by the characteristics of the current payment systems and organisation. A synthesis of the recommendations has been made. 6.3.2.1 Spinal Cord injury (SCI) 6.3.2.2 Stroke Acute care unit • Stay as short as possible; • Stay until medical stabilisation; • Acute care unit must be specialised in spinal cord lesions; • Rehabilitation (physical therapy, occupational therapy) can start in this unit. • As soon as possible transfer to a rehabilitation organisation for a multi-disciplinary rehabilitation programme. Reference organisation specialised in spinal cord injuries • Multidisciplinary rehabilitation programme • One price per medical team for multidisciplinary interventions (neurologist, orthopaedist, physiatrist, urologist, … ). • The physiatrist is the coordinator during the stay in a rehabilitation organisation. • ADL-training, mapping of required equipment, sphincter training, … General rehabilitation organisation When the individual can perform transfers, is independent for ADL and adaptations at home are performed, outpatient rehabilitation in the rehabilitation organisation can start. When functioning at home is without problems, rehabilitation at home can start. Rehabilitation at home Acute care unit • Physical therapy • Start multidisciplinary rehabilitation programme Rehabilitation organisation specialised in stroke or non-congenital cerebral lesions • Continue the multidisciplinary rehabilitation programme After six months of rehabilitation in a rehabilitation organisation specialised in stroke or non-congenital cerebral lesions, an assessment of dependence must be performed. Depending on the results of the assessment the patient can stay in the specialised organisation or can be transferred to a general rehabilitation organisation. General rehabilitation organisation Duration of the stay in a rehabilitation organisation depends on the level of recovery and the social situation. If there is recovery of function and difficulties concerning social situation exist, early transfer to a nursing home with maintenance physical therapy is
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Dépôt légal : D/2007/10.273/19
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35. Etude relative aux coûts poten
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