B. Rousseau

Using the Risk Assessment and Predictor Tool (RAPT) for patients after total knee replacement surgery

OBJECTIVES The aim of this study was to use the Risk Assessment and Predictor Tool (RAPT) to evaluate the risk of complications in patients hospitalized after total knee replacement (TKR) surgery. METHOD The medical charts of 272 patients who had TKR surgery for knee osteoarthritis (OA) were included in the study. The presurgical RAPT score and Lequesne functional pain index score were determined based on a thorough analysis of the medical charts. Complications that had an impact on the vital prognosis or knee prosthesis outcomes were reported. Patients were compared according to the RAPT and a relative risk of complications was established. RESULTS Only 12.2% of patients hospitalized in a Physical Medicine and Rehabilitation (PM&R) center after their surgery could have been discharged home directly after their initial hospital stay for TKR surgery (score RAPT more than 9). These patients were mostly men and significantly younger. Their Lequesne score was significantly lower by an average of at least two points. Their relative risk of complications was 0.45 vs. 2.16 for patients who had a RAPT score less than 6. CONCLUSION Patients with a RAPT score more than 9 have a low risk of complications. They should not systematically be admitted to a PM&R unit after surgery. On the other hand, for patients with a RAPT score less than 6 a hospital stay in a PM&R care center is justified after TKR surgery.

Funding of PRM activity in France

to share their opinion on a specific item. The criteria and modalities of reimbursement of lower limb prostheses has been revised in 2004. First, an ‘evaluation’ prosthesis is provided followed six months later by a permanent prosthesis, taking into account the classification of the patient in one of five defined functional categories. This functional classification determines the technical components that will be reimbursed for the confection of the prosthesis as well as the delay for renewal (between 3 and 10 years). An annual technical revision is also foreseen, thus, preventing technical defects of the prosthesis. When the volume or the morphology of the stump shows a significant modification, a new socket can be reimbursed. A physician specialised in PRM, surgery, rheumatology, neurology or paediatrics is required to fill in a document describing the clinical status of the patient and informing the prosthetist of specific clinical aspects that have to be taken into account. The physician also has to ratify the functional category as proposed by the prosthetist when it concerns the categories 4 or 5, indicating the highest functional levels. However, this document is not a medical prescription sensu stricto. The advantages and problems of this reimbursement system will be discussed more in detail during the lecture. Pour en savoir plus http://www.inami.be/care/fr/nomenclature/pdf/art29.pdf

Tarification de l’activité libérale en MPR

journée ». Une tarification à l’activité a été instituée dans le MCO. Pour les SSR, les Ministères peinent à trouver un modèle satisfaisant, malgré plusieurs années de recueil informatisé de données (PMSI). Le modèle transitoire actuel comprend quatre compartiments : l’Indice de valorisation de l’activité (IVA), les molécules onéreuses, les plateaux techniques spécialisés et les missions d’intérêt général (MIG). Le SYFMER et la SOFMER réclament une meilleure prise en compte de la dépendance ainsi que des facteurs personnels (pathologies associées, déficits cognitifs et comportementaux, précarité sociale) et environnementaux (selon le modèle de la C.I.F) à l’origine de surcoûts justifiés et de séjours prolongés en services de MPR. Une étude pilote sur le parcours de soins des patients souffrant d’accidents vasculaires cérébraux est en cours d’organisation sous l’impulsion de la SOFMER. Pour en savoir plus SYFMER : http://www.syfmer.org/ SOFMER : http://www.sofmer.com/ COFEMER : http://www.cofemer.fr/