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

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.