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

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.