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

KCE reports 57 Musculoskeletal & Neurological Rehabilitation 19
2 SELECTION OF PATHOLOGIES AND
EPIDEMIOLOGY
2.1 SELECTION OF DIAGNOSES
Diagnosis as well as information about level of functioning, personal and environmental
criteria are important for clinical decision-making and resource allocation in rehabilitation.
20 a
To formulate advice on organisation and financing musculoskeletal and neurological
rehabilitation, some diagnoses were selected because of a lack of available information
concerning the level of functioning. For these diagnoses epidemiological data were
collected, clinical practice patterns were investigated and critical pathways of different
countries were analysed and compared.
The selection criteria for the diagnoses were:
• Criterion A: The diagnoses have to induce a musculoskeletal and/or
neurological rehabilitation process;
• Criterion B: The diagnoses have to differ mutually concerning
characteristics of concerned individuals (e.g. age), progress, impaired
body structures and functions causing activity limitations and/or
participation restrictions;
• Criterion C: The diagnoses have to be of high incidence and prevalence;
Children were excluded because of the specificity of the approach.
The researchers could have used the Minimal Clinical Data sets (Minimale Klinische
Gegevens = MKG; Résumé Clinique Minimum = RCM) which contain the ICD-9 codes per
hospital admission in Belgium to determine the medical diagnoses inducing an admission in
a rehabilitation unit. Because of time restrictions the researchers looked for existing
medical rehabilitation databases which were used to build a classification system.
The Uniform Data System for medical rehabilitation (UDSmr) seems a reliable source of
data to select medical diagnoses which meet the selection criteria. In 1988, UDSmr began
data collection and reporting services for facilities that provide comprehensive medical
rehabilitation services for adults. The UDSmr is used by approximately 60% of the
rehabilitation facilities in the United States and by facilities in Australia, Canada, France,
Germany, Italy, Japan, Portugal, and Sweden. Currently, this database includes over 13
million patient assessments. The centrepiece of the system is the Functional Independence
Measure (FIM), which measures the functional ability of individuals for 18 items across the
motor, cognitive, and self-care domains. FIM is the most widely accepted functional
assessment measure in use in the rehabilitation community. The UDSmr also contains
impairment codes (= diagnoses). The UDSmr was used for the development for the FIM-
FRGs.
The FIM-FRGs were developed in 1994 by Margaret Stineman 21 based on 36.980 patient
records from 57 freestanding rehabilitation hospitals and 68 units from 35 states in the
United States that subscribe to the UDSmr. In the first version only 18 impairment
categories were defined. A second version of this model was developed in 1997 22 which
includes two new impairment categories as well as separate groups for patients admitted
for evaluation only.
In the FIM-FRG, the patient impairment category, functional status at admission to
rehabilitation, and patient age were used to develop groups that were homogeneous with
respect to length of stay. In the FIM-FRG the functional status and age are criteria of
distinction between different groups.
a http://www.who.int/classifications/icf/en/