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114 APPENDICES Physiotherapy KCE reports vol. B Waddell G, Sommerville D, Henderson I and al. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617-28. Waddell G (1999) The back pain revolution. London, UK: Churchill Livingstone. Waddell G, Burton AK (2001) Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med (Lond), 51(2): 124-35. Wang 2004. Low level laser therapy. Washington State Department of Labor and Industries. Washington State Department of Labor and Industries (WSDLI) 2004: 36. Washington State Department of labor and Industries. Technology assessment Update-Intradiscal electrothermal Therapy (IDET). Olympia, WA: Washington State Department of labor and Industries; 2003. Available at http://www.lni.wa.gov. Watts RW, Silagy CA (1995) A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care, 23(5): 564-9. Weiner DK, Rudy TE, Glick RM, Boston JR, Lieber SJ, Morrow LA, Taylor S (2003) Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults. J Am Geriatr Soc, 51(5): 599-608. Weishaupt D, Zanetti M, Hodler J, Boos N (1998) MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology, 209(3): 661-6. Wetzel FT, McNally TA, Phillips FM (2002) Intradiscal electrothermal therapy used to manage chronic discogenic low back pain: new directions and interventions. Spine, 27(22): 2621-6. Wetzel, F. T. and R. Donelson (2003). "The role of repeated end-range/pain response assessment in the management of symptomatic lumbar discs." Spine Journal: Official Journal of the North American Spine Society 3(2): 146-54. Weyland A, Meyer G, Weyland W, Ensink FB, Haack A, Hildebrandt J (1992) Adrenal suppression following epidural corticosteroid administration for discogenic pain: influence of injection site. Eur J Anaesthesiol, 9: 36-7. Worz R, Bolten W, Heller B, Krainick JU, Pergande G (1996) [Flupirtine in comparison with chlormezanone in chronic musculoskeletal back pain. Results of a multicenter randomized double-blind study]. Fortschr Med, 114(35-36): 500-4. Yelland MJ, Del Mar C, Pirozzo S et al. Prolotherapy injections for chronic low back pain. Cochrane Database of Systematic Reviews. 1, 2006.
KCE reports vol. 40 APPENDICES Physiotherapy 115 APPENDICES OF CHAPTER V: SURVEY AMONG PHYSIOTHERAPISTS IN BELGIUM (OUTPATIENT SERVICES) A. DETAILED DESCRIPTION AND RESULTS OF THE SURVEY The Belgian physiotherapy nomenclature is currently based on the type of pathology (common pathology -C list-, heavy pathology -E list-, perinatal pathology -P list-, pathology of acute FA list, and pathology of chronic FB list), the place of the rehabilitation (physiotherapist s office, hospital, patients home, nursing home, ), and the length of the physiotherapeutic session. This nomenclature poses several problems of administrative, access, and equity nature. First, the complexity of the nomenclature leads to an administrative overloading. Second, the imposition of a fixed and predetermined quota on the number of refundable sessions is sometimes inappropriate. Some patients need more sessions than the predetermined quota whereas other patients receive more sessions than what they need if the physiotherapist follows the entire medical prescription independently of the patient s functional status. However, when needed, wealthy patients can pay the supplementary sessions required for their recovery while less wealthy patients cannot. Ideally, a nomenclature based on the functional assessment could better share the finances out according to the actual treatment needs of the patients. The possible adaptation of the current nomenclature requires the knowledge of the activities of physiotherapists working in ambulatory practice in Belgium. Such information is however unavailable in Belgium. Consequently, the purpose of this survey is to establish a snapshot of the ambulatory physiotherapeutic practice in Belgium. More specifically, the survey will deal with (1) the most frequent pathologies treated in Belgian ambulatory physiotherapy, (2) the physiotherapeutic treatment modalities applied and (3) the functional assessment tools used to determine the patient s evolution. The results of this survey will be confronted with the other parts of the project, namely, the literature review of physical therapy modalities in some common medical and musculoskeletal conditions and the literature review on functional assessment in physiotherapy. 1.1. METHODOLOGY 1.1.1 Population and sampling Universe of the study and sampling frame The universe of the study (i.e., the population of interest) concerned all ambulatory physiotherapists practising in Belgium at least one session in ambulatory care in 2004 (i.e. 15,874 physiotherapists). Ambulatory care is defined here as care that took place either at the physiotherapist s office (benefit payments of type Ia), or at the patient s home (benefit payments of type II), or at the patient s nursing home (benefit payments of type VI). In order to focus on physiotherapists having a minimum of practice in ambulatory care, the sampling frame was constituted by all physiotherapists practising in Belgium at least 1000 benefit payments per year in one of the three main ambulatory places cited above. The exhaustive and updated database of the Institut National d Assurance Maladie-Invalidité/RijksInstituut voor Ziekte- en InvaliditeitsVerzekering (INAMI/RIZIV) counts 10440 physiotherapists (i.e., 66% of the universe of the study) practising in Belgium with at least 1000 benefit payments of types Ia and/or II and/or VI per year. Sampling was done by INAMI/RIZIV. Note that the 10,440 physiotherapists of the sampling frame account for 93% of all sessions billed in ambulatory care in 2004 (Source: INAMI/RIZIV). The INAMI/RIZIV information about the 10440 physiotherapists included their name, address, age, sex and linguistic role. Sampling We calculated that 138 respondents would be needed to estimate practices reported by 10% of the participants with a desired statistical precision of at least 5%. Given the expected low response rate, a simple random sample of 2000 physiotherapists was drawn from the sampling frame. The simple random sampling was preferred to ensure that each member of the source population would have a similar and an independent
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