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

More documents

Recommendations

Info

260 Musculoskeletal & Neurological Rehabilitation KCE Reports 57 Tabel 13.1: Comparison between report of Ministerial workgroup and KCE-report: pathologies in each level of the rehabilitation model. General/Basic Specific/LRC Highly spec./CRC Amputations BK (nomencl.) AK ; bilat.; BK + contralat. limb; (75 instead of 60 sessions) upper limb LEA (without prosthesis; monodisciplinary) Most LEA in need of prosthesis Very complex needs (very small number) Brain Injury 1 system involved; temporary needs; motor system and dicrete speech problems 1 system involved; temporary needs; motor system and dicrete speech problems - Complex strokes with several deficits (motor + e.g. aphasia, bladder problems, cognition,..) Stroke (temporary needs) Permanent disability (15% of stroke-incidence) SCI and periph. neurol. disorders Only motor system involved; always first consult in CRC >=2 limbs involved; paraplegia and tetraplegia if only motor system involved; always first consult in CRC SCI (AMB in 2 nd level if geographically too far from third level to follow AMB in third level) TBI (in function of younger age, combined deficits, functional and socio-professional prognosis) Always advice of CRC for patients with behaviour problems treated in general level or LRC Very complex needs (e.g. socio-professional rehabilitation) and younger age (small number) >=2 limbs involved + other system; HOS and AMB Progressive neurol.disorders Maintenance treatment (AMB) AMB in function of CRC program Complex rehabilitation in particular clinical situations MS AMB HOS and AMB Rheumatological disorders Most rheumatological patients Educational and professional needs Complex rheumatological cases Orthopaedic disorders and multiple trauma THR all THR (85% mono; 15% multi) Simple bone or joint lesions >=3 limbs involved; >=2 limbs + pelvis or trunk involved Very complex situation with other systems involved than orthopaedic (burns, respiratory deficit, bladder problem, neurolog. involvement…) Children & adolescents Maintenance treatment More specialised Neurolocomotor specific and complex; HOS; research and education
KCE Reports 57 Musculoskeletal & Neurological Rehabilitation 261 ASSESSMENT TOOL In order to function, an objective PCS is needed to refer the patient to the adequate service level in the network, at the right time. Both authors refer to ICF as the framework of choice for a PCS in the future. The KCE report contains an extensive overview of the outcome measures, models and PCS currently used in other countries in musculoskeletal and neurological rehabilitation. At this moment, no such system or corresponding assessment instrument is ready for combined use for clinical as well as managerial objectives. Available PCS are mainly used for organisational/financing purposes, and in all these PCS, registration of the necessary data occurs at least at the beginning and at the end of the rehabilitation period. The KCE team proposes to start introducing one of the assessment instruments currently in use abroad within existing PCS for organisational/financing objectives: FIM or Barthel Index. At the same time, medical diagnosis, comorbidities, age and contextual factors (e.g. social situation) should be registered (e.g. at the beginning and at the end of the rehabilitation). The results of this data collection can already be used to refine the epidemiological data proposed in their study (and used to estimate number of services needed in Belgium). Next, a pilot study can be set up to validate the first results of this registration against data of RIM2 and ICF-core sets; or to validate a PCS currently already in use other countries. The Ministerial subgroup proposes an application form combined with FIM as an evaluation instrument (“rehabilitation needs evaluation”), to be performed at the start and then every three months during the rehabilitation trajectory. AMBULATORY TREATMENT VERSUS HOSPITALISATION In the KCE report there are some limited data on inpatient versus outpatient therapy but no scientific rules to make the distinction were found on this topic in literature. The Ministerial subgroup separately treats the importance of ambulatory rehabilitation in the different phases of rehabilitation, as far as the personal and environmental factors of the patient permit discharge home. It is stated in the report that ambulatory rehabilitation encourages patients’ independence and quality of life and decreases hospitalisation cost. However, this implies sufficient nursing care in this setting, the organisation and financing of transport and cooperation with the general practitioner and primary care services. The Ministerial subgroup report underlines the importance of continuity of care and immediacy of the necessary services through the network. Concerning hospitalisation, the Ministerial subgroup proposes a new type of beds for hospitalisation in LRC and CRC: SpR-beds. Also, in this report criteria for qualifications of the medical staff are defined for the different levels.
Page 1 and 2:
Organisation et Financement de la R
Page 3 and 4:
Organisation et financement de la r
Page 5 and 6:
KCE Reports 57B Réadaptation locom
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
KCE Reports 57 Musculoskeletal & Ne
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
KCE reports 57 Musculoskeletal & Ne
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224: KCE reports 57 Musculoskeletal & Ne
Page 249 and 250: KCE Reporst 57 Musculoskeletal & Ne
Page 273: KCE Reporst 57 Musculoskeletal & Ne
Page 277 and 278: KCE Reports 57 Musculoskeletal & Ne
Page 291: KCE Reports 57 Musculoskeletal & Ne
Page 294 and 295: Dépôt légal : D/2007/10.273/19
Page 296: 35. Etude relative aux coûts poten
show all

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

Create successful ePaper yourself

Delete template?

Save as template?