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KCE reports vol. 40 APPENDICES Physiotherapy 153
The data were also broken down into physiotherapists age, sex, linguistic role, and delay since the degree of
physiotherapy and rehabilitation (see Table 4.8). Concerning the knowledge of the ICF concepts, a significant
difference was observed with regard to age, linguistic role, and delay since the degree of physiotherapy and
rehabilitation. Younger physiotherapists had a significantly better knowledge of the ICF concepts than older
physiotherapists. Correspondingly, physiotherapists with a recent degree also presented a significantly better
knowledge of the ICF concepts than those with an old degree. A significantly higher number of Dutch-speaking
physiotherapists knew the ICF concepts as compared with French-speaking physiotherapists. No significant
difference was found between males and females. Contrary to the knowledge of the ICF concepts, no
significant difference about the use of these concepts in the physiotherapeutic practice was observed in the
questionnaire.
1.3. DISCUSSION
The present survey allowed a picture of the current state of ambulatory physiotherapeutic practice to be
determined in Belgium. Indeed, such information was not yet available. The survey has identified the most
frequent pathologies treated in Belgian ambulatory physiotherapy, the physiotherapeutic treatment modalities
generally applied in five common conditions (i.e., acute low back pain, total knee replacement,
hemiplegia/hemiparesis, gait disorders in elderly people, and bronchiolitis in infants and children), and the
functional tests regularly used in these five common conditions to determine the patient s evolution. The
results of the survey will be now confronted with the other parts of the project, namely, the literature review
of physiotherapeutic modalities and the literature review on functional assessment in physiotherapy.
Several factors could challenge the validity of the results of the survey. First, survey data exclude less active
physiotherapists (i.e., with less than 1000 sessions billed per year). They represent one third of all
physiotherapists practising ambulatory care but are responsible for only 7% of all sessions in ambulatory care
(Source: INAMI/RIZIV). Second, response rate was low (20%), and although respondents were similar to nonrespondents
as regards age, sex, language, and geographical distribution, selection bias cannot be excluded (for
instance, respondents could be more dedicated physiotherapists, and on average provide a better quality of
care than non-respondents). As usual in such a survey what is reported might not be what is done in practice.
The proportion of heavy pathologies was less encountered in the survey than in the whole INAMI/RIZIV
database (28% vs. 37%). Actually, some pathologies may be underestimated in the survey as they fall under a
different funding mechanism in Belgium (e.g., cardivascular diseases are under convention). Keeping in mind
their limitations, these data can still be seen as the first ones describing the global features of community
physiotherapy in Belgium, in terms of pathologies encountered, treatment modalities applied, and functional
tests used in ambulatory care.
1.3.1. Pathologies treated in Belgian ambulatory physiotherapy
Eleven conditions have been identified as the most common disorders treated in Belgian ambulatory
physiotherapy. They represented together 48% of the examined sessions. Most of these common conditions
refer to musculoskeletal disorders, the pathology category the most frequently treated by Belgian ambulatory
physiotherapists. Four of the five conditions selected in the survey to investigate treatment modalities and
functional tests used by physiotherapists in their practice were counted among the most common conditions.
Low back pain, total knee replacement, hemiplegia/hemiparesis, and gait disorders in elderly people
represented together 21% of the examined sessions. Among them, hemiplegia/hemiparesis and low back pain
seem to be the more adequate pathologies that could be selected in the achievement of a subsequent study
intended to examine the feasibility of a physiotherapeutic nomenclature based on the functional assessment.
First, they represented together a large proportion of ambulatory physiotherapeutic sessions (i.e., 15% of the
examined sessions). Second, they correspond to two different types of pathologies, respectively, heavy
neurological and common musculoskeletal pathologies. Third, they are the diagnostic groups for which the
largest number of evidence-based data has been identified (see the literature review of physical therapy
modalities) and for which the largest number of high quality tests has been identified (see the literature review
on functional assessment in physiotherapy).
Pathologies treated in Belgian ambulatory physiotherapy were also classified according to the International
Classification of Primary Care 2 nd Edition (ICPC-2) and the International Statistical Classification of Diseases
and Related Health Problems 10 th Revision (ICD-10). The two classifications lead to the same results:
Most of the pathologies treated in Belgium during ambulatory physiotherapeutic sessions refer to
musculoskeletal and neurological disorders.