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

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 169
for professional participation as well as the patient inclusion, as there are no common
indication standards.
Inpatient care and support is generally offered in specialized hospital units for short
stays. Long term specialized inpatient facilities exist, but are very few in number, leading
to particular problems for MS patients with very severe complications. There are
currently 5 centres for long term stay for highly dependent ms patients with specific
medical and paramedical needs (offering about 230 beds). Experts confirm that the need
for this kind of facilities is a lot bigger, but no precise epidemiological estimates are
available (ms patient organizations claim that 2000 of these beds should be available to
answer the needs).
Other centres have developed units for MS-patients within their general neurological
functions. The capacity of the centres varies enormously, some offering 1 to 2 beds,
while others have about 60 beds available for MS patients. The average period of stay is
between 2 and 6 weeks.
The coordination of medical care is generally in the hands of a private or hospital based
neurologist (neurologue de proximité), having to play a role in the network of carers
(réseau). The hospital settings vary, as not all hospitals have a neurology department. It
can however happen that some of these hospitals hire the services of a neurologist,
doing the follow-up of the patients. Many neurologists in France have a private practice
within the hospitals (des attachés).
Some university hospitals (Dijon, Rennes) organize themselves inspired by a Canadian
specialized model of clinical practice for MS. During a whole day, and in collaborative
practice with different physicians, the whole spectrum of problems of different MS
patients is assessed. These centres also try to work in networks of care.
More common forms of multidisciplinary follow-up (medico-social) of ms-patients are
found in regional hospitals (generally funded through proper means of the hospital and
private gifts).
For assessing the status of MS patients, the Expanded Disability Status Scale (EDSS, also
named Kurtzke scale) is used, measuring 8 functional domains and enabling the
neurologist to give a Functional system score. The scoring scale is mainly used as tool
to assess the severity of the condition of the patient, and mainly as a clinical tool to
assess the progress of ms. The scores are also used as an informal indication setting
tool for offering particular health care services.
8.4.6 Example : Spinal Cord Injury
France has no really integrated approach of the rehabilitation of people with spinal cord
injuries. However recently particular concerns are developed on the organization of
care.
A circular letter (Circulaire DHOS/SDO/01/DGS/SD5D/DGAS/PHAN/3 B n° 2004-280
du 18 juin 2004) focuses on the organisation of care for patients with SCI and TBI, with
a particular attention on necessary care and the demand for continuity of care. The
SROS (schéma régional d'organisation sanitaire) should provide in foreseeing the
necessary conditions.
The "Académie Nationale De Médecine” has formulated recommendations on the
rehabilitation of SCI patients 166 . The main line of reasoning is that specific and
specialised rehabilitation centres are needed in the French rehabilitation landscape. The
“Académie” recommends to develop a territorial map and a list of reference centres for
the French territory. The Académie recommends to create 12 reference rehabilitation
centres, with a maximum of 3 or 4 for the Ile the France and neighbouring departments.
The recommendation is however not clear on the criteria used to make this
recommendation.