Het gebruik van kinesitherapie en van fysische geneeskunde ... - KCE

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56 Physiotherapy & Physical and Rehabilitation Medicine KCE reports 87 4.1.8 Exclusion criteria Patients with very atypical profiles were excluded in order to identify common traits in the follow-up of the populations who had rehabilitation. Details relating to the exclusions are given in Appendix 16. The causes for exclusion are as follows. 4.1.8.1 Surgical procedures excluded for insufficient data relating to the rehabilitation Surgical procedures for persons who do not benefit from the coverage of “minor risks” by health insurance Restrictions on reimbursement may influence the type of rehabilitation. Some people are not entitled to “minor risks” i.e. do not have compulsory insurance coverage o for PT or PRM, except when hospitalised or suffering from E-listed disorders, or in relation to childbirth (PT). These patients are likely to opt for rehabilitation treatment with PRM. Complete information is therefore not available in relation to their whole rehabilitation, in particular on an outpatient basis. There are not many patients in this situation. These patients are more often treated by PRM (p-value Chi²
KCE Reports 87 Physiotherapy & Physical and Rehabilitation Medicine 57 4.1.8.2 Surgical procedures excluded because they are linked to complex hospital stays • Exclusion when other procedures of the list were performed during the same hospital stay; • Exclusion when other major procedures were performed during the same hospital stay; • Exclusion of persons re-hospitalised during the rehabilitation episode in a service other than an SP rehabilitation service. 4.1.8.3 Exclusion of rehabilitation episodes for which the reason for rehabilitation remains uncertain • Exclusion of episodes with a rehabilitation that occurred too late. This way, we minimised the risk of erroneously linking a rehabilitation to a surgical operation. The maximum delay between surgical intervention and start of rehabilitation was fixed at 60 days except for: o mastectomies or ganglial excisions (maximum period fixed at 90 days); o hip arthroplasties (maximum period fixed at 30 days). This was the most important reason for exclusion. The distributions of the periods between the operation and the first session, classified by surgical procedure and expressed in number of days, are in Appendix 16 4.1.8.4 Exclusion of rehabilitation episodes lasting more than one year 4.1.8.5 Exclusion of rehabilitation episodes linked to particularly lengthy hospitalisations • All stays with a total duration (including stay in SP service) exceeding 180 days (six months); • Exclusion of outlier hospital stays. These outliers were defined separately for each surgical operation based on the distributions of stay durations. The maximum permissible stay duration corresponds to the 95th percentile of the distribution of stay durations. 4.1.9 Homogeneity of the populations treated The episodes selected consisted therefore of rehabilitation episodes with the following characteristics: • Episode is preceded by one single surgical operation from the list of interventions. • No other major surgery is performed during the hospital stay and hospital stay is not abnormally long. • Episode not interrupted by readmission, except in the rehabilitation service. • Rehabilitation episode begins within a certain delay after the surgical operation. • Rehabilitation episode is not spread over more than 365 days. The analyses (see further) looked for differences within the populations based on: • Indicators of functional dependence based on conventions (conventions relating to nursing lump sums, E-listed disorders, attendance allowance, etc). Nevertheless, there is no information on diagnosis and co-morbidity. • Proxy ASA: that identifies patients in good or relatively poor health based on the outpatient consumption of medications before the operation. This proxy ASA score is binary: "A patient treated with a class ATC medication for less than 90 days over the course of the year prior to the operation is considered to be in good health". This score was developed and utilised within the framework of a previous study by the IMA. 15 This proxy ASA offers good concordance with the ASA score or "Physical Status Score". 4.1.10 Importance of rehabilitation for the selected cases
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