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12 Musculoskeletal & Neurological Rehabilitation KCE reports 57 • How are patients assessed and/or selected? The researchers collaborated with the Belgian Centre for Evidence Based Medicine (CEBAM) to respect the principles of evidence based medicine during their search for definitions. Because the general acknowledged Oxford Centre for Evidence-based Medicine Levels of Evidence speaks only to the validity of evidence concerning prevention, diagnosis, prognosis, therapy, harm, differential diagnosis, symptom prevalence study and economic and decision analyses, the researchers decided to identify a proper hierarchy for evidence related to the objective of the study. By preference guidelines were explored presuming that no guideline concerning rehabilitation practices can be developed without an agreement on a definition of rehabilitation. In the second instance also systematic reviews were included supposing that systematic reviews of published definitions of rehabilitation exist. No meta-analyses were included for the reason that the focus on clinical practice was expected without any statement of general definition. The researchers searched Medline, Embase, PEDro and relevant websites (NHS Guidelines Finder, National Guidelines Clearinghouse, the website of the Disability and Rehabilitation Team of the WHO, the UN website, the website of the New Zealand Guidelines Group). Papers of particular interest were those that analyse and discuss functional outcomes and contained a definition for rehabilitation. CEBAM validated the search methodology as well as the final development of the definition. See for a detailed description of the search algorithms. Information from the several sources was incorporated into an Excel format intended to maximally facilitate decision-making. Information such as title, author, year of publication, the inclusion of a definition of rehabilitation, the mention of the use of assessment tools, the consideration of a specific pathology or therapy and the identification of outcomes was registered. Analysing the existing definitions and the opinion of their developers the main point during rehabilitation would be the individual centred approach. The importance of this focus induced an additional search looking for papers concerning the study of individuals’ needs and demands related to rehabilitation and the value of these needs as a predictive factor for the outcome of the rehabilitation process. The objective of this additional search was not to make up an exhaustive list of papers reporting individuals’ needs and demands but rather to perform a global survey to know if something was published yet. Because no definitions for musculoskeletal and neurological rehabilitation were found, the project team agreed on the incorporation of the criterion that the musculoskeletal and/or the neurological system must be affected. 1.1.4 Definition of musculoskeletal and neurological rehabilitation The project team agreed on some conditions related to the content of the definition after consultation of an expert panel. The content of the definition must be clear and meaningful, precise and unambiguous, not related to a specific functional disorder or disease nor coloured by the opinion of a professional group. All different aspects of the rehabilitation process must be covered. The domain of rehabilitation must be bordered to obtain a clear distinction between acute as well as chronic care. For that reason, the definition must contain criteria to select and follow up individuals for rehabilitation, to define rehabilitation services, to identify the type of involved professionals and to organise rehabilitation. To cover these aspects four main question nouns were answered in the definition. Four main question nouns of the definition: • What? Individual and Outcome • How? Services • Who? Professionals • Where? Organisation
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 13 DEFINITION Rehabilitation is a process 2-10 comprising a range of goal-oriented activities 2 providing opportunities 6 to achieve and maintain 11 2, 6, 12, 8, 13 and an optimal level of independence functioning {, 1997 #107 for individuals with impaired body structures or functions related to the musculoskeletal and/or the neurological system causing activity limitations and/or participation restrictions, considering the relevant contextual factors (personal and environmental) 2, 14 for whom there is a reasonable expectation of functional gain and/or increase in quality of life. Rehabilitation comprises four core phases 5 : • Identification of the individual’s needs, preferences and capabilities by use of a recognised functional assessment measure 15 ; • Collaborative goal setting in partnership with the patient or his/her advocates and the team members, focused on the restoration of function as well as prevention of activity limitations and participation restrictions, including an indicative time frame 15 ; • Evidence based activities with proven added value to achieve the predefined goals; • Assessment of the progress against the agreed goals by means of the functional assessment measure used in step 1) and defining the necessity to reiterate the rehabilitation cycle. Different types of professionals can be involved in the performance of the rehabilitation process. Professionals must have accredited skills and expertise, appropriate as related to the required interventions in order to achieve the predefined goals. Rehabilitation services are provided in a specialist rehabilitation organisation 15 accredited as such by a recognised instance. The most appropriate rehabilitation organisation is determined by criteria inherent to the individual’s characteristics, the complexity of the individuals’ needs and goals, the different professionals involved and the infrastructure and equipment required for the activities. 16 A rehabilitation organisation is part of a network which meets the demand for rehabilitation at all levels of specialisation and in all phases of the process. 1.1.5 Interpretation rules for the definition of musculoskeletal and neurological rehabilitation For each component of the definition of musculoskeletal and neurological rehabilitation, we shortly explain the keywords.
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Dépôt légal : D/2007/10.273/19
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35. Etude relative aux coûts poten
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