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

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 215
TOTAL HIP REPLACEMENT
The assumption is that 85% of the patients with THR have only temporary and simple
rehabilitation needs, wich can usually be covered by monodisciplinary treatment. About
15 % of the patients are considered as fragile (mostly after traumatic hip fracture) or
present with polypathology (e.g. rheumatoid arthritis, stroke or polyneuropathy). These
patients may need a simple multidisciplinary approach.
The required rehabilitation activities in patients with THR can be provided by general
rehabilitation services, present in most of the acute hospitals. The overall incidence of
patients with THR in Belgium was 16.599 in 2004 46 . In the Study of prof. Closon of the
Sp facilities they account for 26% of the hospital stays 24 .
LOWER EXTREMITY AMPUTATION
The incidence of LEA is difficult to estimate in Belgium as in literature it is not always
specified which amputation levels are included. In the Sp-study by prof. Closon LEA
accounts for only 3 % of the hospital stays 24 . The majority of LEA is due to vascular
disease (82%), mostly in diabetic patients. A minority are traumatic (9%) or oncological
(9%) 237 . In other studies the percentages of vascular causes are often even higher. About
half of the patients with LEA are fitted with a prosthesis 66 . Patients who are not fitted
with a prosthesis can usually be treated in general rehabilitation services (except e.g. for
bilateral above knee amputation).
Based on literature, expert opinion and RIZIV/INAMI data the assumption is that in
Belgium there are about 600 new prosthesis patients each year. Of these prostheses,
the proportion above knee/below knee is approximately 50/50%.
The majority of the LEA needing a prosthesis can be treated in specific services. In
order to admit 30 new LEA patients per centre per year maximum 20 specific centres
are needed.
The patients with above knee amputation, associated problems (traumatic or
oncological etiology) and younger age, with broader rehabilitation goals, can even need
highly specific services. Technology has become very specialised and the indication for
expensive knee mechanisms such as microprocessor knees should depend on the
decision of a highly specialised multidisciplinary team. For the small number of patients
(maximum 10 %) with highly specific needs (associated problems, high technology needs,
pelvic level of amputation for traumatic or oncological reasons), 2 to 3 centres are
sufficient which need to collaborate with the specific centres in the network. For
reasons of efficiency the highly specific centres could combine the specific function for
the own region.
SPINAL CORD INJURY
The incidence of spinal cord injury in Belgium is estimated between 1 and 3/ 100.000 /
year. Nearly all present with complex rehabilitation needs. These patients need
treatment in highly specific services.
This means that there are about 200 new SCI patients per year in Belgium (100-300).
Considering, as is defined in the report of “the Ministerial subgroup for locomotor and
neurological rehabilitation”, that a total critical mass of minimum 30 patients/day and 30
new patients per year is needed this brings us to a total of three or four centres for
Belgium. This still means 1 centre for 2.500.000 inhabitants whereas abroad there
usually is one centre for 4 to 6.000.000 inhabitants (e.g. UK and France 12 centres,
Denmark 2 centres).
These highly specific centres need to work in collaboration with a network of specific
centres, for instance if the distance to the highly specific centre would be to important
for ambulatory treatment.