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

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70 Physiotherapy & Physical and Rehabilitation Medicine KCE Reports 87 Finally, episodes consisting only of mono-disciplinary PRM are episodes differ from other types of rehabilitation: these episodes are quite short, usually limited to K15 and K20 sessions provided during hospitalisation. 4.3.2.2 Rehabilitation after arthrodesis of the dorso-lumbar spine In relation to rehabilitation after arthrodesis of the dorso-lumbar spine, exclusively mono PRM and multi PRM rehabilitation mostly consists of very short episodes. Most episodes consisting exclusively of PT terminate rather rapidly, while mixed rehabilitation programmes continue for more than 60 days in more than 40% of all episodes. 4.3.2.3 Rehabilitation after herniated disk In the case of herniated disk s, the rehabilitation consumption profile for exclusively PT or multi-disciplinary PRM rehabilitation programmes are very similar. Half of all patients cease treatment rather rapidly, while the other half continue treatment, terminating gradually over a matter of days. 4.3.2.4 Rehabilitation after hip prosthesis and fracture of the femur For hip prostheses and fractures of the femur, survival curves exhibit shapes which are identical, but greater numbers of patients receive longer rehabilitation episodes after surgery for fracture of the femur. 4.3.2.5 Rehabilitation after knee arthroplasty Curves per type of rehabilitation exhibit totally different shapes for knee arthroplasty. Patients receiving mixed or exclusively multi-disciplinary rehabilitation consume in a very similar manner. 4.3.2.6 Similarities between rehabilitation after one day hospitalisation Survival curves for both mixed rehabilitation are very close in the case of mastectomy, hip and knee prosthesis, fracture of the ankle, femur and tibia, surgery only on the shoulder or on the shoulder and upper arm. Survival curves are similar for exclusively PT or exclusively multi-disciplinary PRM following surgery performed in one day hospitalisation i.e. outpatient rehabilitation. 4.3.2.7 Length of episodes: two profiles A large proportion of patients stop rehabilitation after a few days, except in the case of arthrodesis of the dorso-lumbar spine, carpal tunnel release performed in one day, as well as in the case of non-mixed rehabilitation programmes following knee prosthesis, cervical spine surgery, mastectomy, hallux valgus, urinary incontinence and herniated disk . For all other surgical procedures and, in particular, for mixed rehabilitation, the duration of rehabilitation is longer. A greater number of patients are still attending rehabilitation sessions after 150 days (all types of rehabilitation combined). 4.3.3 Rehabilitation expenditure on compulsory insurance episodes per type of rehabilitation The compulsory insurance expenditure is highly variable depending on the intervention. Expenditure distributions by disorder and by type of rehabilitation are highly dispersed. The median cost of rehabilitation programmes consisting of a mixture of PT and multidisciplinary PRM, or those consisting exclusively of multi-disciplinary PRM are at least twice as high as rehabilitation programmes consisting exclusively of PT. In relation to the five most frequent surgical procedures, for nearly half of all cases, by multi-disciplinary PRM, the following was noted: • For rehabilitations following knee and hip prosthesis: if the rehabilitation included PT and multi-disciplinary PRM, the median costs were almost twice as high as for rehabilitation consisting only of PT. These median expenditures add up to €1 000 after knee prosthesis and €900 after hip prosthesis.
KCE Reports 87 Physiotherapy & Physical and Rehabilitation Medicine 71 • For knee prosthesis, there is large dispersion of expenditures for rehabilitation episodes with only multi-disciplinary PRM: for 75% of patient this type of rehabilitation costs less than €2 587. • For hip prosthesis, only multi-disciplinary PRM costs for 75% of this type of rehabilitation less than €500, which is less than the upper quartile expenditure for rehabilitation episodes with only PT. • For rehabilitations following fracture of femur: if the rehabilitation included PT and multi-disciplinary PRM, the median costs (€1 600) were three times as high as for rehabilitation consisting only of PT. In relation to other frequent procedures which are not often followed by multidisciplinary PRM, the following was noted: • For rehabilitations following outpatient meniscectomy including PT and multidisciplinary PRM, the median costs were 5 times as high as for rehabilitation consisting only of PT. Expenditures for rehabilitations including only PT are closer to those for rehabilitation with mixture of PT and mono-disciplinary PRM. • For rehabilitations following a surgical shoulder procedure including PT and multi-disciplinary PRM, the median costs were almost twice as high as for rehabilitation consisting only of PT. Expenditures for rehabilitations including only PT are closer to those for rehabilitation with mixture of PT and monodisciplinary PRM. General remark in relation to the tables that follow: Mixture of PT and multidisciplinary PRM means that an episode contains both PT and multi-disciplinary PRM. It can also contain mono-disciplinary PRM. Table 25 : Rehabilitation expenditure on compulsory insurance for knee arthroplasty Lower Upper 95% 95% N CL for CL for Lower Upper Type of rehabilitation Obs Mean Mean Mean Quartile Median Quartile Only PT 3852 696 685 708 475 652 899 Only mono-disc. PRM 30 161 86 235 64 128 168 Only multi-disc. PRM Mixture of PT and mono- 352 1505 1372 1637 330 1046 2587 disc. PRM Mixture of PT and multi- 919 715 690 740 486 701 921 disc. PRM 6341 1295 1275 1316 797 1069 1463 Table 26 : Rehabilitation expenditure on compulsory insurance for hip prosthesis Lower Upper 95% 95% N CL for CL for Lower Upper Type of rehabilitation Obs Mean Mean Mean Quartile Median Quartile Only PT 5036 470 458 482 127 389 646 Only mono-disc. PRM 419 99 92 106 64 80 112 Only multi-disc. PRM Mixture of PT and 1441 570 531 608 174 291 497 mono-disc. PRM Mixture of PT and multi- 988 636 587 684 324 518 816 disc. PRM 6573 1132 1112 1153 607 893 1347
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