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120 APPENDICES Physiotherapy KCE reports vol. B West- Vlaanderen Bruxelles- Brussels Brabant Wallon Oost- Vlaanderen Hainaut Antwerpen Vlaams-Brabant Namur Limburg Liège Luxembourg Respondents (n = 367) 4% 10% 4% 10% 14% 5% 6% 11% Non-respondents (n = 1633) 4% 9% 4% 9% Figure 4.1 Distribution of physiotherapists according to Belgian provinces for respondents (n = 367) and nonrespondents (n = 1633). 1.2.2. Pathologies treated in Belgian ambulatory physiotherapy Pathologies treated in Belgian ambulatory physiotherapy were recorded by asking the respondents to indicate all sessions performed by them during one working day. Reason(s) for treatment (i.e., pathology/ies treated during physiotherapeutic sessions), age and sex of the patients treated during these sessions, and Belgian nomenclature code of each session were recorded. Overall, 5300 sessions were recorded in the questionnaire. However, it was not always possible to interpret the pathologies indicated by the physiotherapists because some pathologies were unreadable or too vague. As a result, only 5170 sessions were available for analysis, that is, an average of 14 sessions by respondents. The main reasons for treatment (RFT) in Belgian ambulatory physiotherapy are presented in Table 4.2. The RFT are sorted, from top to bottom, in order of decreasing frequency. Only RFT mentioned in at least 100 out of the 5170 sessions examined in the questionnaire were considered. Eleven RFT met this requirement and represented together 48.82% of the entire set of examined sessions. Most of these RFT refer to musculoskeletal disorders (i.e., low back pain, arthrosis and polyarthrosis, cervicalgia, enthesopathy and tendinitis, adhesive capsulitis of shoulder). Other common RFT include neurological (hemiplegia/hemiparesis and stroke/cerebrovascular disorders, Parkinson), orthopaedic (orthopaedic joint implants), general (gait disorders), cardiovascular (lymphoedema and edema), and respiratory (chronic obstructive pulmonary diseases) disorders. Interestingly, four of the five conditions a priori selected in the questionnaire to study treatment modalities applied by Belgian physiotherapists and functional tests used in their practice were counted among the main RFT. They represented together 21.62% of the entire set of examined sessions. Only bronchiolitis in infants and children was not included in the main RFT and explains just 0.03% (n = 14) of the entire set of examined sessions. It is also interesting to note that the distribution of chronic obstructive pulmonary diseases (COPD) varies according to the Belgian provinces (see Appendix 4.G). Indeed, COPD are more common in Walloon area than in Flanders and Brussels, especially in the Hainaut (37% of the 137 encounters with COPD) and Liege (14% of the 137 encounters with COPD) provinces in which there were a lot of coalmines and heavy industries. 13% 5% 6% 11% 13% 7% 3% 13% 8% 11% 16% 2% 15% 14%
KCE reports vol. 40 APPENDICES Physiotherapy 121 Table 2 Main reasons for treatment in Belgian ambulatory physiotherapy Reason for treatment (when n 100 out of 5170 sessions) Number Proportion* Hemiplegia/hemiparesis and stroke/cerebrovascular disorders 431 8.34 ± 0.75% Low back pain 332 6.42 ± 0.67% Presence of orthopaedic joint implants 286 5.53 ± 0.62% Total hip replacement 134 2.59 ± 0.43% Total knee replacement 120 2.32 ± 0.41% Other orthopaedic joint implants 032 0.62 ± 0.21% Arthrosis and polyarthrosis 245 4.74 ± 0.58% Gait disorders 235 4.55 ± 0.57% Cervicalgia 204 3.95 ± 0.53% Lymphoedema and edema 192 3.71 ± 0.52% Postmastectomy lymphoedema 104 2.01 ± 0.38% Other lymphoedema and edema 088 1.70 ± 0.35% Parkinson 174 3.37 ± 0.49% Enthesopathy and tendinitis 169 3.27 ± 0.48% Chronic obstructive pulmonary diseases (COPD) 137 2.65 ± 0.44% Adhesive capsulitis of shoulder 119 2.30 ± 0.41% Other 2646 51.18 ± 1.36%0 Total 5170 100 ± 0.00% * Proportion ± accuracy corresponding to the 95% confidence interval Pathologies treated during physiotherapeutic sessions were also classified according to two well-known classifications: The International Classification of Primary Care 2 nd Edition (ICPC-2) proposed by the Wonca International Classification Committee (WICC) (World Organisation of National Colleges, Academic & Academic Associations of General Practitioners / Family Physicians 1998). The International Statistical Classification of Diseases and Related Health Problems 10 th Revision (ICD-10) proposed by the World Health Organization (WHO) (World Health Organisation 1992). The ICPC-2 was primarily designed for the classification of patient reasons for treatment by the primary care provider at the time of consultation. This classification is based on body systems, following the principle that localization has precedence over aetiology in primary care. Indeed, many of the conditions treated in primary care are vague, can sometimes only be diagnosed in terms of symptoms/complaints, and are not necessarily related to an underlying disease (e.g., gait disorders in elderly people). Contrary to the ICPC-2, ICD-10 has an emphasis on disease in terms of its aetiology, pathology, and morphology. The ICD-10 is the oldest and most widely recognized classification of diseases and presents the advantage of international recognition, aiding comparability of data from different countries. Physiotherapeutic sessions during one working day according to the International Classification of Primary Care 2 nd Edition (ICPC-2) One physiotherapeutic session may be used to treat more than one condition when co-morbidity exists. In such situation, the session was divided into the number of RFT/conditions that are treated during this session if they belong to different ICPC-2 chapters. As a result, the 5170 examined sessions increased up to 5416 reasons for treatment (RFT). The number and the proportion of RFT according to each of the 17 ICPC-2 chapters are illustrated in Figure 4.2. Most of the pathologies treated in Belgium during ambulatory physiotherapeutic sessions refer to musculoskeletal (49.78 1.33%) and neurological (21.38 1.09%) disorders.
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