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

50 Musculoskeletal & Neurological Rehabilitation KCE reports 57
4.4 INTERNATIONALLY ACCEPTED REHABILITATION SCALES
USED FOR ORGANISATIONAL AND FINANCING PURPOSES
As already pointed out in chapter 3, specific organisational and payment systems in
rehabilitation medicine use FIM and Barthel-Index. These scales are considered to be
suitable for organisational and financing purposes in rehabilitation. FIM and Barthel-Index
(BI) are used for clinical purposes in some Belgian rehabilitation centers. The scales are
not used in all rehabilitation facilities.
As mentioned 117 these scales do not cover all the domains proposed by ICF, accepted
internationally and endorsed by WHO as a general framework in rehabilitation medicine.
(See Appendix to chapter 4 for comparison of ICF core sets for post-acute rehabilitation,
FIM and BI). However, the use of ICF itself as an organizational and financial tool is still
under development; and many problems still have to be solved. Until this work has
proceeded, some initiatives could be launched to use the FIM and Barthel Index at a more
generalised level in Belgium, alike some other countries.
Figure 4.4 shows the kind of information that can be generated by a systematic use of
these scales. Average FIM and/or BI are shown for 2 Belgian rehabilitation services (one
tertiary referral hospital and one secondary level general hospital) that already use these
scales for clinical purposes. It are illustrations for those specific hospitals and should not
be generalized to all Belgian rehabilitation centres.
Figure 4.4 X represents the average outcome for patients admitted to the rehabilitation
ward (BI at admission compared to average BI at discharge).
Figure 4.4 Y is a longitudinal comparison (two years) of the average BI for a rehabilitation
ward.
Figure 4.4 Z represents average FIM-scores at admission and at first follow-up evaluation
for 2 patient groups: stroke and spinal cord injury (SCI). In this last example, it would be
even more appropriate to compare the subscales of the FIM-score (motor and cognitive
subscale), which on average is very different for these 2 pathologies, but this is beyond the
scope of this exercise.
Figure 4.5 represents the average disability level for different months of the year in three
different rehabilitation wards in the same hospital, measured by BI.