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

258 Musculoskeletal & Neurological Rehabilitation KCE Reports 57
13.2.3 Included Pathologies
The Ministerial subgroup, divided the disorders needing musculoskeletal and
neurological rehabilitation into six groups with exclusion of children and adolescents
who are treated as a separate entity.
For the KCE study five representative pathologies were selected, accounting for about
75% of inpatient rehabilitation and roughly 60% of outpatient rehabilitation. These five
pathologies belong to five different groups of the Ministerial subgroup report, so only
one subgroup (rheumatological disorders) is not represented in the analyses of the KCE
study.
Ministerial subgroup KCE study
1. Amputations LEA
2. Brain injury Stroke
3. Spinal cord lesion and peripheral neurological disorders SCI
4. Progressive neurological disorders MS
5. Rheumatological disorders
6. Orthopaedic disorders and multiple trauma THR
In the report of the Ministerial subgroup factors related to rehabilitation needs at level
of intensity and duration were taken into account in the description of the six different
groups of pathologies. These factors are based on the number of functional systems
involved (e.g. motor system alone or motor system and cognition) as well as the
anatomical distribution of the functional impairments (e.g. number of limbs involved),
referring to the ICF-domain “Body Structures and Functions”. Taking these factors into
account, a distinction was made between patients whose rehabilitation needs can be
answered by activities financed through ‘Nomenclature PM&R’ and patients for whom
this nomenclature is insufficient to provide the necessary activities, again, in terms of
intensity or duration.
The KCE as well as the Ministerial subgroup referred to the necessity to take all ICF
domains into account when defining rehabilitation needs of patients. However, a full
classification system for patient referral based on ICF is still under development.
The KCE did a literature search to find information on how to divide patients in need of
musculoskeletal or neurological rehabilitation into distinct subgroups in funtion of
organisation and financing. Of the described patient classification systems already in use
in other countries, FIM-FRG and AN-SNAP were found to be the best. One of the
limitations of these two systems is that they are based on assessment tools only
evaluating ADL-activities. If one should aim at implementing FIM-FRG or AN-SNAP, a
data-set of Belgian patients is necessary, so that the system can be validated for use in
the Belgian context.