Development, execution and evaluation of implementing guidelines in the health care within people after stroke.

Every year, 200 to 230 per 100,000 people in Belgium are affected by a cerebrovascular accident (CVA), often with persistent consequences. The importance of early rehabilitation has been demonstrated and translated into evidence-based recommendations. An important condition for the effectiveness of these guidelines is that these guidelines are applied consistently by healthcare providers.

This project aims to improve the rehabilitation of a patient after a stroke by concretising a priority recommendation of the practice guideline, developing an implementation plan of the stroke guideline, executing and evaluating the implementation plan. Within this project, the priority recommendation is goalsetting within an interdisciplinary setting' and linked to this is the involvement of the client and the basic clinimetry for assessing the goals.

Four clinical clusters from 4 regions participate in this project, namely Limburg West (Jessa Rehabilitation), Limburg North (Noorderhart), Brabant (Flemish) (UZ Leuven) and Brussels Region and Brabant (Walloon)(UCL). Each second-line institution works together with its first-line partners in the region, trying to reach a large number of healthcare providers.

Direct access to physiotherapy for acute low back pain in Belgium (the Direct-Physio trail)

Low back pain (LBP) is the number-one cause of disability worldwide. Increasing disease burden and high health-related costs urge the need for an optimised care pathway. Early or direct access to physiotherapy (PT) has already resulted in improved clinical outcomes, decreased health care usage and costs, and has been implemented in other European countries (e.g., the Netherlands and the United Kingdom).

Despite its positive impact, direct access to PT has never been investigated in Belgium. Therefore, the aim of this study is to investigate the added value of direct access to PT in terms of pain, disability and cost-effectiveness compared to usual care with general practitioner (GP) referral for patients with acute LBP. In this study, 600 adults with acute LBP, lasting >24 hours and <6 weeks, will be recruited and semi-randomly allocated to either the usual care pathway with GP referral or to the experimental pathway consisting of direct access to PT. Primary outcomes include pain intensity and location, assessed with a numeric rating scale and pain drawings respectively, as well as disability, assessed with the Oswestry Disability Index.

Secondly, a cost-effectiveness analysis will be conducted to evaluate the costs associated with acute LBP and its treatment for both the patient and society. Secondary outcomes include beliefs and cognitions related to LBP, quality of life, work disability, amount of flare ups, and global perceived effect of change. All outcomes will be evaluated through validated questionnaires at baseline, at the end of intervention, at 3 months following enrolment, at 1 year and at 2 years following enrolment.

The results of this study will be used to optimise the care pathway for acute LBP in Belgium. The study is approved by the Medical Ethical Committee of UHasselt (ID number CME2021/066). This research is performed in collaboration with AXXON, KU Leuven, UAntwerpen, UCLouvain and funded by RIZIV-INAMI.