Download the supplement (208 p.) - KCE

More documents

Recommendations

Info

176 APPENDICES Physiotherapy KCE reports vol. 40 The evidence for and against physiotherapeutic modalities applied to treat bronchiolitis in infants and children are very weak. As other European countries, chest physiotherapy (e.g., vibration, percussion, postural drainage, assisted coughing, forced exhalation techniques) is widely used by Belgian ambulatory physiotherapists. They are generally recommended by experts consensuses from French-speaking European countries although they have not been found to be helpful to treat bronchiolitis. Moreover, the safety of chest physiotherapy (as well as of specific devices as CPAP and CNEP) should in further studies to be addressed as it has never been really studied. However, in the absence of other effective treatment modalities and evidence against, it is hazardous to give up chest physiotherapy. Weak evidence has only been demonstrated in education of the parents/family, a treatment modality frequently applied by Belgian ambulatory physiotherapists (74%). Conclusion about the effectiveness of treatment modalities applied by Belgian ambulatory physiotherapists Among the five selected conditions, enough evidence relative to physiotherapeutic modalities was only available in low back pain and hemiplegia/hemiparesis conditions. Overall, evidence has been found in the literature for the most common treatment modalities applied by Belgian ambulatory physiotherapists to treat these two conditions. More studies investigating the evidence level of physiotherapeutic modalities applied in total knee replacement, gait disorders in the elderly, and bronchiolitis in infants and children are required before drawing any conclusion about the effectiveness of treatment modalities applied by Belgian ambulatory physiotherapists to treat these conditions. 1.3.3. Functional tests used in Belgium ambulatory physiotherapy and key element in the establishment of physiotherapeutic treatment planning Although most of the Belgian ambulatory physiotherapists (89%) consider the patient s functional status as the key element to establish their treatment planning, they do not use in their practice standardised functional assessment tools (i.e., functional tests whose metric properties and quality appraisal have been pretty documented in the literature) to determine the evolution of their patients. One exception however occurs in the assessment of gait disorders in elderly people. Indeed, two standardised functional assessment tools (i.e., Tinetti Balance and Gait Evaluation, 6-Minutes Walk Test) are regularly used by Belgian ambulatory physiotherapists as they are requisite by the INAMI/RIZIV but other standardised tools are rarely carried out. The non-use of standardised functional assessment tools in physiotherapeutic practice has been demonstrated for only the five conditions selected in the survey but it can be assumed that the same trend would be found in other conditions requiring a physiotherapeutic treatment. Unlike standardised functional assessment tools, clinical tests are regularly carried out by Belgian ambulatory physiotherapists as part of the patients clinical examination. Ambulatory physiotherapists seem to appraise the evolution of the patients on an everyday basis using observation, anamnesis, palpation, muscular testing, and goniometry. Although these clinical tests can be useful in the physiotherapeutic management, they can hardly be used as a rationale for financing physiotherapy since their metric properties and quality appraisal have not (or almost not) been documented in the literature. Discussions with the physiotherapists associations that have collaborated to the development of the survey have highlighted some interesting points about the implementation of standardised assessment tools as a rationale for financing physiotherapy: The implementation of standardised assessment tools as a rationale for financing physiotherapy should not increase the physiotherapists administrative workload. Some time allocated to perform the functional assessment should be planned to avoid harming the patients, especially for those requiring more refundable sessions than the predetermined quota. A functional assessment carried out during one single session is not always representative of the actual treatment needs of the patients. In addition to the functional assessment of motor and physical problems, psychological, mental, behavioural, and social aspects should be taken into account. The implementation of a functional cut-off within the framework of the refunding of physiotherapeutic sessions (e.g., patients with a score > x would be eligible for only Y refundable sessions) is dangerous as it is difficult to entirely cover all dimensions representative of the actual treatment needs of the patients. These points highlighted by some ambulatory physiotherapists could be used as thinking basis in the possible implementation of standardised assessment tools as rationale for financing physiotherapy.
KCE reports vol. 40 APPENDICES Physiotherapy 177 1.3.4. Knowledge and use of the ICF concepts Most of the Belgian ambulatory physiotherapists do not know the concepts of the International Classification of Functioning, Disability, and Health (85%). Youngest Dutch-speaking physiotherapists with a recent degree had the better knowledge of the ICF concepts. This probably indicates that Universities/Colleges, especially those belonging to the Flemish community, currently participate to the dissemination of the ICF knowledge. However, only 4% of the physiotherapists knowing the ICF concepts use these concepts in their ambulatory practice (e.g., to define the objectives of the treatment or to determine the patient s evolution).
Page 1 and 2:
Functional status of the patient: a
Page 3 and 4:
Functional status of the patient: a
Page 5 and 6:
KCE reports vol. 40 APPENDICES Phys
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
KCE reports vol.40 APPENDICES Physi
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
5 KCE reports vol.40 APPENDICES Phy
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128: KCE reports vol. 40 APPENDICES Phys
Page 175 and 176: KCE reports vol.40 APPENDICES Physi
Page 177: KCE reports vol.40 APPENDICES Physi
Page 191 and 192: 13 14 15 16 17 18 19 20 21 22 23 24
show all

Download the supplement (208 p.) - KCE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?