By the late 1990’s, Marc Soenen, Doctor of Physical Medicine and Rehabilitation at St. Lucas Hospital in Bruges, had come to realize that treating chronic back and neck pain with traditional treatment methods was inefficient. At first, there were instructional lessons for patients based on active treatment methods, but this did not help alleviate their back pain. That is when they started to use device-based therapy and found the DAVID solution.
Most patients are able to return to work.
When we started the program, some doctors were laughing at us. In the beginning, there was no reimbursement for active-therapy treatment from the government. St. Lucas succeeded to get an agreement with the Belgian government to take 50 chronic back-pain patients to undergo a 3-month, 2 times a week, treatment program to see if there are better pain scores and overall functionality. The end goal of this program was to have these patients capable of returning to work. They thought this was impossible, but we made it happen. After proof of concept, a reimbursement model was made available for the Belgian population.
How the David Solution transformed clinic operations
“By using the DAVID devices in our therapy, we have now convinced our patients that chronic back pain cannot only be solved with pills, injections, or even spinal surgery. This has taken several years for people to understand, but I think we’ve finally gotten the message across” Dr. Soenen explained. Currently, about 500 back tests and 300 neck tests are done each year. Of these, about 80% are put into the rehabilitation program as patients. These are only the new patients, in total, approximately 1300 patients visit the rehabilitation center each year.
DAVID is a whole system with its devices, protocols and software capabilities.
Luc van Compernolle is the coordinator of the center and works as a physiotherapist as well: “What is important to me, is that we have the whole package with DAVID’s software capabilities. We can record everything, do testing, give questionnaires, provide additional exercises, follow-up of therapy. I think it’s great that everything is in one package and very accessible”.
The St. Lucas clinic has four back systems (four devices each) and one cervical unit (two devices). Three back units and the cervical unit are fully utilized, with one back unit being used for testing.
Physiotherapist Luc van Compernolle and Dr. Marc Soenen run a government-reimbursed back rehabilitation program at St. Lucas hospital in Bruges, Belgium.
Multidisciplinary program with individualized exercise treatments
Patients can come to the clinic directly, although most patients are referred by their general physician. Some arrive through in-house referrals from the hospital’s spinal surgeon or neurosurgeon. Before the individuals get access into the program, they are seen by one of the eight doctors in the team. The clinic includes 3 rheumatologists and 5 doctors of physical medicine and rehabilitation. First, a clinical examination and the back functional tests are done. Results are then discussed with the patient to conclude if he/she can benefit from the back/neck rehab program.
All exercises are individualized based on strength and mobility tests and the use of customized protocol templates.
The program runs for 14 weeks, which includes two visits a week for 2 hours. This includes warming up, a customized exercise program with the DAVID devices, and additional mobilization and relaxation exercises. The treatment is multidisciplinary and includes follow-up meetings with a psychologist as well as ergonomic advice.
After these initial sessions, we can work more specifically with our patients, focusing on their needs, guiding them individually.
The reimbursement plan means that if a person suffers from chronic back or neck pain, the government will reimburse the program which includes 36 sessions over 6 months. Patients can follow a second treatment if there has been a special surgery. Also, if the patient is out of work due to back pain, the test can be done again if permission is granted. This is called a “socio-professional integration” and is granted for most cases. The government reimburses 90% of the total cost of the treatment program. The total cost for the program in Belgium is 2000 euros, and the patient only pays 200 euros by him/herself. So, per session, it comes down to around 70 euros of which 90% is reimbursed and the patient pays less than 8 euros.
Most patients want to continue by participating in the ongoing program
An ongoing program is also available which is reimbursed by 20 euros, with some co-payment. There are about 10-12 patients per physiotherapist so there is less guidance. Most of these patients continue at the clinic because they prefer to get specific and excellent care for their back and/or neck problems as opposed to visiting a gym. Currently, there are around 650 patients in this ongoing program who are training around once a week.
We are convinced that we can achieve the same success with a shoulder program that we had with the back and neck programs.
Dr. Soenen and Luc van Compernolle visited MEDICA 2018 exhibition to test the new DAVID shoulder exercise therapy system. Convinced by what they saw, they now believe that they can achieve the same success with the shoulder program that they had with the back and neck program.
The DAVID shoulder solution is built on the same philosophy as the spine solution. It uses target area isolation, biomechanics optimization, and control of all factors of the exercises. The solution consists of five different devices (photo for illustration purposes).
In an upcoming article we will discuss our success with the EVE software-platform and how we are planning to tackle shoulder pain problems. Stay tuned!