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

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 17
… the different professionals concerned, … An interdisciplinary coordination in case of a
multidisciplinary rehabilitation service includes
some specific requirements for a rehabilitation
organisation.
… and the infrastructure required for the Hospital facilities, therapy rooms, meeting-
activities.
A rehabilitation organisation is part of a network
which meets the demand for rehabilitation on all
levels of specialisation and in all phases of the
process.
1.1.6 Discussion
rooms, equipment,…
Rehabilitation must be organised along the
continuum of care (in the acute, post-acute as
well as the chronic phase). Close collaboration
between the different facilities is necessary. It
might be possible that geographical aspects affect
the design of this network.
The proposed definition which we will use as a framework during this project, is very
comparable to the WHO definition of rehabilitation.
Currently, the WHO defines rehabilitation as: "A progressive, dynamic, goal-oriented and
often time-limited process, which enables an individual with an impairment to identify and
reach his/her optimal mental, physical, cognitive and/or social functional level.
Rehabilitation provides opportunities for the individual, the family and the community to
accommodate a limitation or loss of function and aims to facilitate social integration and
independence." 6
Both definitions (Project & WHO) contain a clear reference to the ICF. Although there is
only limited experience related to the use of the ICF in practice, there is an agreement on
the more global approach on functioning covered by the different components of the ICF
model.
We recognise the imperfections of the newly developed definition. A term as ‘reasonable
expectation’ is still too vague. A public discussion is necessary to identify clear criteria to
consider reasonability because it concerns the allocation of public resources. We tried to
describe ‘appropriate’ by incorporating a logical relation between individual’s needs, goals,
interventions, professionals, infrastructure and equipment but this might still be
insufficient. Also our attempt to distinct rehabilitation from chronic care by specifying that
functional gain and/or increase in quality of life must be expected, can be insufficient.
1.2 CONCLUSIONS
This chapter contains a definition of musculoskeletal and neurological rehabilitation.
A definition of musculoskeletal and neurological rehabilitation is developed based on a
systematic search of the published literature. The researchers agreed on a patient centred
focus. The definition is built around the outcome and goals of rehabilitation. Four main
questions are answered in the definition: what, how, who and where.
The definition of rehabilitation is a critical issue to be resolved in recommending both a
patient classification system and options for the organisation model and financing system
of rehabilitation. In the next chapter this conceptual definition will be made operational.
With the new definition, the researchers recommend implicitly the move from a
classification of rehabilitation programmes to a classification of rehabilitation patients. It
will be a challenge to select a patient classification system which supports patient referral
(clinical decision making) as well as resource allocation.