INTRODUCTION
Besides a multidisciplinary pain team in each of the 102 general Belgian hospitals and 13 dedicated teams for the management of pain in children, 35 multidisciplinary centers for the treatment of patients with chronic pain (MPS), are financed by the Belgian government since 2013 to provide pain management based on a biopsychosocial (BPS) rehabilitation model. Therefore, the team composition was strictly prescribed and the centers were expected to report yearly some structure and activity indicators. However, the elaboration of guidelines for the BPS model nor its implementation has been evaluated since. The goal of this observational survey was to investigate the level of BPS approach and whether the use of a structuralized model, such as the International Classification of Functioning, Disability and Health (ICF) as proposed by the WHO (1), had an influence on it.
METHODS
In April-May 2019, 2 questionnaires were integrated in an on-line survey: the BPS questionnaire by Van de Velde et all (2) and the ICF questionnaire developed by the Canadian ….. (3). The BPS questionnaire allows to quantify a level (scale 0-5) of BPS activity in 5 domains: “professional skills”, ”use of the patients’ expertise”,” use of the patients’ environmental element”, “networking” and “measurement and reporting”. The ICF can be used in 4 levels: the scheme with its components, the categories, the coresets and the qualifiers. In this presentation we focus on its use in daily practice with patients with chronic pain: patients’ assessment, multidisciplinary team discussion, evaluation of the rehabilitation progress and reporting to other health care professionals.
The medical coordinators of each of the 35 centers were invited to respond from the teams’ point of view. To avoid biased answering, i.e. to ensure their financing, respondents were guaranteed by a trusted third party that only anonymous results would be available to the steering committee of the government.
RESULTS:
At closure date 32/35 centers completed the full survey. In respect to BPS approach, all coordinators report to work on a BPS based model. This statement is confirmed by the scores on each domain of the BPS scale which are summarized in Table 1. In all domains the MPS score higher than the heterogeneous composed reference group of health care professionals in the validation study of this instrument. The scores were also higher than those in 2 non-published recent studies in health care professionals of respectively Flemish rehabilitation clinics and Flemish community health care centers. Even though higher scores, the results follow the same trend of those references: best score in “professional skills” and lowest score in the “use of environment elements” surrounding the patient.
Except for one MPC, team members are recognized by their coordinator to have knowledge of the ICF. This knowledge remains in 25/31 teams “theoretical but well detailed” and in 6/31 teams “with practical application”. Exactly 50% (16/32) report to use the ICF in daily practice. As presented in table 2, there was no significant difference in the mean overall BPS score between the group using ICF or not (3.89 versus 3.84; p=0.797). The use of ICF classification is limited in 6/16 teams to the patients’ assessment; 7/16 teams also use the ICF as a guidance in the multidisciplinary case discussion and 3/16 finds the classification useful in the evaluation of rehabilitation progress. None of the teams uses ICF in their reporting.
Otherwise, 7/16 (44%) teams report only the ICF scheme as the maximum of usefulness, 3/16 (19%) are using the categories, 2/16 (12%) report to use a corset, and 4/16 (25%) teams report to use the qualifiers. 
Of the teams which do not use ICF at the moment, 13/16 team coordinators indicate their intention of its use in the future but expect support through specific formation (10/13) and integration in the electronic patient record (12/13).
DISCUSSION
In this observational survey, Belgian MPC report a rehabilitation activity which scores high on the BPS scale. As the problem of chronic pain may has a substantial impact on the immediate social environment of the patient, the use of environmental elements stays behind in this model. Although this does not differ from the trend as observed in other professional settings, it might be a point of special attention for this target group.
The high scores on the BPS scale are not influenced whether ICF is part of the care model, or not. The use of ICF in this domain does not seem to be mandatory for the application of a BPS approach of the patient. 
On the other hand, when used, ICF remains mainly limited by the application in the patients’ assessment and its team discussion, and stays limited to the use of its scheme and its categories. Structuralized use by core sets and qualifiers, and in the use of follow-up of the rehabilitation progress and external reporting stays behind. As the ICF is meant to be a categorizing system for individual as well as larger population reporting, support in user friendly digitalized registration systems, preferably integrated with other reporting systems as ICD and electronic patient records will be needed.
Although apparently not mandatory for BPS care, much interest exists in the Belgian MPC actually not using ICF for its implementation in the future. Here lies a challenge for policy makers and supporting organizations to facilitate in an implementation strategy and supporting activities as formation and expertise sharing.
CONCLUSION
Although the use of ICF does not seem to be mandatory for a well comprehensive BPS approach by the Belgian MPC in the rehabilitation process of patients with chronic pain, almost all team coordinators are in favor of its actual or future use. Policy initiatives to facilitate general as well as local integration of structuralized reporting on patients’ functional possibilities are desired.

HOW IS A BIOPSYCHOSOCIAL REHABILITATION MODEL USED IN THE BELGIAN MULTIDISCIPLINARY CENTERS FOR THE TREATMENT OF CHRONIC PAIN?