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132 Musculoskeletal & Neurological Rehabilitation KCE reports 57 7 CLINICAL PATHWAYS FOR REHABILITATION 7.1 INTRODUCTION A limited research on rehabilitation practice in Belgium (See chapter 6) indicated that a large variability is possible related to intensity and duration of therapy for patients with comparable characteristics. An additional question to find out whether this variability is also represented in the currently used clinical pathways, was formulated. The goal of this chapter was an identification and comparison of clinical pathways for rehabilitation after amputation of lower extremity, multiple sclerosis, spinal cord injury, stroke and total hip replacement. Guidelines and the results of randomised clinical trials were considered as out of scope for this chapter, as they are not necessarily reflected in clinical practice. Due to a lack of scientific reports containing evidence to support all clinical decisions in rehabilitation, the content of a clinical pathway is often influenced by the opinion of stakeholders and the financing and organisational aspects of the health care system in a country. A comparison of clinical pathways developed in different countries, might neutralise these influences and might result in a more neutral description of the ‘optimal’ clinical pathway. At a macroscopic level, the clinical pathways can be used to discuss current variability in rehabilitation practice in Belgium. Besides, these clinical pathways can be used to argue certain choices related to the future supply of rehabilitation services. This chapter was performed by a collaboration between the “Centrum voor Ziekenhuis- en Verplegingswetenschap, Leuven” (CZV) and the department of Physical Medicine and Rehabilitation, Leuven (PMR). The CZV offered an introduction course on clinical pathways and continuous support during this (sub-)project. The CZV provided a network of contacts concerned with the development of clinical pathways, in different countries. PMR composed a team of residents of Physical Medicine and Rehabilitation. Clinical pathways were searched, analysed and compared by use of a general template (Figure 7.1) in which the most relevant parameters were integrated. It was not the objective to analyse the type of interventions in detail.
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 133 Phase … Phase … Figure 7.1: Template for analysis and comparison of clinical pathways General information of the clinical pathway Search algorithm Source (Website/Journal) Title Author Publication year Pathology Origin (Country/City/Hospital/Institute/Organisation/...) Objective (Clinical practice/Resource allocation/…) Method used in the development of the clinical pathway Focus on outcome/Focus on process * Focus on outcome: Tasks depend on outcomes * Focus on process: Tasks depend on delay, availability of resources, ... Content of the clinical pathway Delay after onset pathology Method of identification of patient needs Conditions to start this phase Acute care/Post-acute care/Maintenance Inpatient/Outpatient Mono-/Multidisciplinary Involved professionals Type of therapy (physical therapy, vocational therapy, …) Intensity of therapy (X Hours/Day/Week) Expected outcomes End of phase Method of outcome measurement Conditions to end this phase Length of phase Delay after onset pathology Method of identification of patient needs Conditions to start this phase Acute care/Post-acute care/Maintenance Inpatient/Outpatient Mono-/Multidisciplinary Involved professionals Type of therapy (physical therapy, vocational therapy, …) Intensity of therapy Expected outcomes End of phase Method of outcome measurement Conditions to end this phase Length of phase 7.2 LOWER EXTREMITY AMPUTATION (LEA) 7.2.1 Methodology v www.library.nhs.uk The literature for rehabilitation pathways after LEA was explored. First examples of pathways were searched on the website of evidence based medicine of KU Leuven. There was a link to the website www.consorta.com. The combinations “clinical pathway and amputation”, “clinical pathway and amputee”, “critical pathway and amputation” and “critical pathway and amputee”, were searched. No results were found. The website of NHS in the U.K. v was searched on the topic: “Protocols and Care pathways”. Under the heading “Clinical Department” one reference to “amputation leg” was found. This clinical pathway was included. But the authors remarked that the document does not allow for Care Pathway Variance recording. The origin of the
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Dépôt légal : D/2007/10.273/19
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