The report is available in English with a French summary - KCE

More documents

Recommendations

Info

130 Musculoskeletal & Neurological Rehabilitation KCE reports 57 preferred. If recovery and/or acceptable social situation are present, the duration of the stay in a rehabilitation organisation is by preference 3 months but can be prolonged. Rehabilitation at home • Physical therapy + Speech therapy. Payment related to the patients’ characteristics. 6.3.2.3 Multiple Sclerosis (MS) Therapy planning is performed during a short stay in a “categoral” rehabilitation organisation. Multidisciplinary medical follow-up (neurologist, physiatrist, urologist, … ). Only in case of complication or relapse, a short stay in a rehabilitation organisation for intensification of the rehabilitation programme is essential. In all the other cases outpatient rehabilitation in a rehabilitation organisation or at home is preferred. Rehabilitation “categoral” organisation (Inpatient/Outpatient depending on the geographical situation) Locoregional rehabilitation organisation Rehabilitation at home: physical therapy + speech therapy Maintenance physical therapy 6.3.2.4 Lower Extremity Amputation (LEA) Start production of prosthesis 15 – 21 days after amputation. Rehabilitation “reference” organisation with a technical department for rehabilitation equipment OR IF older patient or patient without professional occupations THEN locoregional rehabilitation organisation • An inpatient rehabilitation during the first 8 – 12 weeks seems less fatiguing and more efficient than an outpatient rehabilitation. • Admission as short as possible (only: ADL-training, handling and adapting the prosthesis, preparation of home care). • During the inpatient phase social reintegration must be prepared. • Admission in an rehabilitation organisation where a surgeon, a reconstructive surgeon, paramedics, orthopaedic technicians, … are available. • As soon as the patient is independent for ADL: monodisciplinary rehabilitation at home. Rehabilitation at home • Physical therapy 6.3.2.5 Total Hip Replacement (THR) Before the intervention informative lessons and exercises must be provided. Acute care unit • After surgical intervention progressively start physical therapy. Department for physical medicine and rehabilitation • Physical therapy + Occupational therapy (maximum one month). • Length of stay depends on the social situation. Rehabilitation at home
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 131 6.4 CONCLUSION • Physical therapy (maximum 3 months). A large variability in current rehabilitation programmes appears per patient case. A link to the type of rehabilitation organisation was not made in order to guarantee the anonymity of the respondents. Duration of therapy was very different between respondents. Furthermore, for all but one case every possible payment system was suggested at least once in the proposed rehabilitation programmes. This accentuates the overlap, related to accessibility as well as content, between the different payment systems as described in chapter 5. Possibly the variability can be explained by a lack of criteria permitting a uniform interpretation of the individuals’ needs. Another possibility is that the variability in rehabilitation programmes is related to the preferences of the practitioner and to the accessibility of payment systems which differs between rehabilitation organisations. Important is the remark that it is not known whether this variability induces differences in quality and/or outcome. In Belgium, as in many other Western countries, there is no systematic registration of quality and outcome information. Concerning the propositions to optimise rehabilitation programmes independent of the own working situation, the current payment systems and the Belgian organisation model, only recommendations at the level of an individual patient were given comparable to the content of a clinical pathway. Another important fact is that most recommendations still seem inspired by the characteristics of the current payment systems and organisation model. Key points • A small exploratory survey shows a large variability in current rehabilitation practice in Belgium for five patient cases (LEA, MS, SCI, stroke and THR). • The variability concerns duration of the rehabilitation programmes (expressed as a number of treatment sessions), type of therapy (mono- versus multidisciplinary) as well as payment system (M- or Knomenclature, 9.50 or 7.71 convention). • Rehabilitation organisations have a different access to payment systems. • The variability in rehabilitation programmes is probably rather explained by the type of rehabilitation organisation (and associated financing system) locally available, and not by patient’s rehabilitation needs and goals. Except for medical diagnosis, no patient referral criteria are available. • Quality and outcome parameters, measuring the impact of the variability in clinical practice are not registered systematically. • Recommendations of practitioners for optimising rehabilitation programmes are mostly inspired by the characteristics of the current payment system and organisation model. • Most practitioners recommend different steps in the organisational setting (e.g. acute setting, specialised centres, general centres, home care), thus subscribing a network of organisations.
Page 1 and 2:
Organisation et Financement de la R
Page 3 and 4:
Organisation et financement de la r
Page 5 and 6:
KCE Reports 57B Réadaptation locom
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
KCE Reports 57 Musculoskeletal & Ne
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
KCE reports 57 Musculoskeletal & Ne
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94: KCE reports 57 Musculoskeletal & Ne
Page 143: KCE reports 57 Musculoskeletal & Ne
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
KCE Reporst 57 Musculoskeletal & Ne
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291:
Page 294 and 295:
Dépôt légal : D/2007/10.273/19
Page 296:
35. Etude relative aux coûts poten
show all

The report is available in English with a French summary - KCE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?