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An evaluation of the reablement service programme on physical ability, care needs and care plan packages. JOURNAL OF INTEGRATED CARE 2018. [DOI: 10.1108/jica-11-2017-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In response to an aging population and rising prevalence of disability, reablement initiatives have been introduced yet the evidence base concerning the long-term effects remains inconclusive. The purpose of this paper is to examine the impact of reablement on physical independence, care plans and care packages post-discharge for older adults.
Design/methodology/approach
A retrospective cohort design was used to examine patient records who had completed a reablement programme. Measures on internationally renowned and psychometrically strong tools, completed by trained healthcare professionals, were examined pre-and post-intervention with a consecutive sample (n=416) of participants since the introduction of the reablement programme.
Findings
Reablement had a significant impact on physical independence living scores and a corresponding reduction in care needs and care plans post-discharge enabling the person to stay at home.
Originality/value
The study’s findings present empirical evidence on the value of reablement health service programme developed to promote independent living at home following a short illness, for older people. While no examination of financial data was recorded in this study, the increase in physical ability and corresponding reduction in care needs and care plans post-discharge indicates a reduction in costs and a better standard of living.
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Murphy L. The Cognitive Assessment by Visual Election (CAVE): A pilot study to develop a cognitive assessment tool for people emerging from disorders of consciousness. Neuropsychol Rehabil 2018; 28:1275-1284. [DOI: 10.1080/09602011.2018.1454327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lesley Murphy
- Department for Neuro and Clinical Health Psychology, St George’s University Hospital Foundation Trust, London, UK
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The Influence of Presurgical Factors on the Rehabilitation Outcome of Patients Following Hip Arthroplasty. Rehabil Nurs 2018; 44:189-202. [PMID: 29369113 DOI: 10.1097/rnj.0000000000000126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE The aims of this study were to evaluate the relationship between sociodemographic information, anthropometric values, clinical and presurgery factors, and length of stay (LOS) in older adult patients undergoing total hip arthroplasty (THA) and to predict which factors can delay the start of the rehabilitation program and increase the corresponding LOS. METHODS A prospective cohort study was conducted in an orthopedic inpatient unit with 40 patients undergoing THA. FINDINGS The Morse Fall Scale scores and pain intensity scores delayed the commencement of the rehabilitation program. Gender and social support were important determinants of LOS and rehabilitation outcome following THA. The weight of the lower limb without osteoarthritis followed by pain intensity and overweight patients also influenced LOS. CONCLUSIONS/CLINICAL RELEVANCE Functional outcomes after THA are variable, and the rehabilitation process is an important factor to regain their normal level of physical functioning. This factor can have an impact in the discharge of patients, in resource allocation and in health care of older adult patients.
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Austin D, Frater T, Wales L, Dunford C. Measuring changes in functional ability in older children and young people with acquired brain injury using the UK FIM + FAM. Br J Occup Ther 2017. [DOI: 10.1177/0308022617735036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction There is a need for validated and responsive measurement tools to demonstrate changes in functional ability. Existing outcome measurement tools have significant limitations for children and young people with acquired brain injury (ABI). Aim This study examines the potential of the UK Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) to detect clinical change in older children and young people with ABI. Method This is a secondary retrospective pretest–post test analysis of 72 children and young people age 8–17 years. Internal responsiveness was examined using Wilcoxon signed-rank tests and effect sizes indices; external responsiveness was examined in relation to the Neurological Impairment Scale (NIS) using Spearman’s correlation coefficient. Results Highly significant changes were detected from admission to discharge on motor, cognitive and total UK FIM + FAM scores ( p < 0.001). Medium to large effect sizes were found on the total scale indicating good internal responsiveness. There was a significant, negative correlation between UK FIM + FAM change scores and NIS change scores ( p < 0.01) indicating good external responsiveness. Conclusion The UK FIM + FAM was able to detect clinically meaningful change in functional ability in children and young people with ABI over 8 years. Further validity and reliability must be established before recommending its use in this client group.
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Affiliation(s)
- Dalya Austin
- Occupational Therapist, Imperial College NHS Trust, London, UK
| | | | - Lorna Wales
- Research Professional Lead, The Children’s Trust, London, UK
| | - Carolyn Dunford
- Head of Therapy & Research, The Children’s Trust, London, UK
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Aminov A, Rogers JM, Johnstone SJ, Middleton S, Wilson PH. Acute single channel EEG predictors of cognitive function after stroke. PLoS One 2017; 12:e0185841. [PMID: 28968458 PMCID: PMC5624638 DOI: 10.1371/journal.pone.0185841] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 09/20/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early and accurate identification of factors that predict post-stroke cognitive outcome is important to set realistic targets for rehabilitation and to guide patients and their families accordingly. However, behavioral measures of cognition are difficult to obtain in the acute phase of recovery due to clinical factors (e.g. fatigue) and functional barriers (e.g. language deficits). The aim of the current study was to test whether single channel wireless EEG data obtained acutely following stroke could predict longer-term cognitive function. METHODS Resting state Relative Power (RP) of delta, theta, alpha, beta, delta/alpha ratio (DAR), and delta/theta ratio (DTR) were obtained from a single electrode over FP1 in 24 participants within 72 hours of a first-ever stroke. The Montreal Cognitive Assessment (MoCA) was administered at 90-days post-stroke. Correlation and regression analyses were completed to identify relationships between 90-day cognitive function and electrophysiological data, neurological status, and demographic characteristics at admission. RESULTS Four acute qEEG indices demonstrated moderate to high correlations with 90-day MoCA scores: DTR (r = -0.57, p = 0.01), RP theta (r = 0.50, p = 0.01), RP delta (r = -0.47, p = 0.02), and DAR (r = -0.45, p = 0.03). Acute DTR (b = -0.36, p < 0.05) and stroke severity on admission (b = -0.63, p < 0.01) were the best linear combination of predictors of MoCA scores 90-days post-stroke, accounting for 75% of variance. CONCLUSIONS Data generated by a single pre-frontal electrode support the prognostic value of acute DAR, and identify DTR as a potential marker of post-stroke cognitive outcome. Use of single channel recording in an acute clinical setting may provide an efficient and valid predictor of cognitive function after stroke.
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Affiliation(s)
- Anna Aminov
- School of Psychology, Australian Catholic University, Sydney, NSW, Australia
| | | | | | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Australia and Australian Catholic University, Sydney, NSW Australia
| | - Peter H. Wilson
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Disability and Development Research, Australian Catholic University, Melbourne, VIC, Australia
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Jackson D, Seaman K, Sharp K, Singer R, Wagland J, Turner-Stokes L. Staged residential post-acute rehabilitation for adults following acquired brain injury: A comparison of functional gains rated on the UK Functional Assessment Measure (UK FIM+FAM) and the Mayo-Portland Adaptability Inventory (MPAI-4). Brain Inj 2017; 31:1405-1413. [DOI: 10.1080/02699052.2017.1350998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Diana Jackson
- King’s College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | | | | | | | | | - Lynne Turner-Stokes
- King’s College London, Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
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Wong SG, Maida E, Harvey D, Wagner N, Sonnadara R, Amin N. Evaluation of a physiatrist-directed prehabilitation intervention in frail patients with colorectal cancer: a randomised pilot study protocol. BMJ Open 2017; 7:e015565. [PMID: 28600373 PMCID: PMC5734287 DOI: 10.1136/bmjopen-2016-015565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Prehabilitation interventions have shown efficacy in the orthopaedic and cardiothoracic surgical populations, but there has been limited evidence for general surgical patients. We present the protocol for a pilot trial of a novel prehabilitation intervention, consisting of a physiatrist-directed preoperative assessment and treatment programme. METHODS AND ANALYSIS This is a single-centre pilot randomised controlled trial investigating physiatrist-directed prehabilitation for a 4 to 6-week preoperative period. We will block randomise 40-50 participants awaiting surgery for colorectal cancer to prehabilitation versus control. Participants in the prehabilitation arm will undergo assessment by a physiatrist and enrol in a supervised exercise programme. The control group will not undergo any prehabilitation interventions in the preoperative period. Our primary outcome is feasibility, measured by examining recruitment, refusal, retention and adherence rates as well as participant satisfaction and feedback. Secondary outcomes include physical fitness, functional ability, health-related quality of life, postoperative complications, mortality, readmissions, length of stay, prehabilitation interventions performed and exercise complications. ETHICS AND DISSEMINATION This study has been approved by the Hamilton Integrated Research Ethics Board (HIREB reference number 2015-0090-GRA). The results of this pilot study will be used to design a full-scale study and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02531620; Pre-results.
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Affiliation(s)
- Sherman G Wong
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Eugene Maida
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Harvey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Natalie Wagner
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Ranil Sonnadara
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Nalin Amin
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Illman NA, Crawford S. Late-recovery from "permanent" vegetative state in the context of severe traumatic brain injury: A case report exploring objective and subjective aspects of recovery and rehabilitation. Neuropsychol Rehabil 2017; 28:1360-1374. [PMID: 28446065 DOI: 10.1080/09602011.2017.1313167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article provides a detailed outline of the recovery of a young male patient during his emergence from a vegetative state (VS) 19 months after suffering a severe traumatic brain injury. Several similar cases have been documented, but these tend not to consider the subjective experience of the patient or family; our aim was therefore to provide a detailed account that emphasises our neuropsychological exploration of the impact of the injury on this person, and looks at the experience of his mother along the timeline from his accident to the end of a successful period in rehabilitation. Clinical details are presented including standardised and non-standard assessments, neuropsychological interventions, as well as reflections from the patient himself. Moreover, qualitative data from an interview with his mother is used to illustrate the emotional impact on family of such a vacillating diagnostic status and prognosis for the future. We conclude that late-emergence from VS is increasingly documented and further cases must be published to better understand this phenomenon. The present case illustrates the emotional impact this situation can have on a patient and his or her family, and gives an important insight into a patient's view of his or her life and identity following such an event.
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Conti J. Cognitive assessment: A challenge for occupational therapists in Brazil. Dement Neuropsychol 2017; 11:121-128. [PMID: 29213503 PMCID: PMC5710680 DOI: 10.1590/1980-57642016dn11-020004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/24/2017] [Indexed: 12/02/2022] Open
Abstract
Cognitive impairment is a common dysfunction after neurological injury. Cognitive assessment tools can help the therapist understand how impairments are affecting functional status and quality of life. OBJECTIVE The aim of the study was to identify instruments for cognitive assessment that Occupational Therapists (OT) can use in clinical practice. METHODS The instruments published in English and Portuguese between 1999 and 2016 were systematically reviewed. RESULTS The search identified 17 specific instruments for OT not validated in Brazilian Portuguese, 10 non-specific instruments for OT not validated in Brazilian Portuguese, and 25 instruments validated for Portuguese, only one of which was specific for OT (Lowenstein Occupational Therapy Cognitive Assessment). CONCLUSION There are few assessment cognitive tools validated for use in the Brazilian culture and language. The majority of the instruments appear not to be validated for use by OT in clinical practice.
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Affiliation(s)
- Juliana Conti
- Occupational Therapy Division of the Hospital das
Clínicas/Sao Paulo University, São Paulo, SP, Brazil
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Poncet F, Swaine B, Dutil E, Chevignard M, Pradat-Diehl P. How do assessments of activities of daily living address executive functions: A scoping review. Neuropsychol Rehabil 2017; 27:618-666. [PMID: 28075219 DOI: 10.1080/09602011.2016.1268171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Executive functions (EF) allow persons to adapt to situations arising in daily life and can be affected following acquired brain injury (ABI). Measuring the impact of EF impairments on the accomplishment of activities of daily living (ADL) requires specific assessment tools, but choosing the right tool may be difficult. PURPOSE To conduct a scoping review on how assessments of ADL address EF and EF impairments in persons with ABI. METHOD A scoping review of literature (peer-reviewed and grey literature) published until August 2014 was conducted. Using a systematic procedure, literature was selected, results were charted, and tools were analysed with respect to their goals, underlying models, psychometric properties and applicability. The analysis also included how tools considered components of EF according to Lezak's model. RESULTS 12 tools, developed either to assess EF in ADL, independence in ADL considering EF or ADL capacities, were identified and analysed according to multiple criteria. CONCLUSIONS This review provides important information about existing tools to assist in tool selection and clinical decision-making related to ABI and EF.
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Affiliation(s)
- Frédérique Poncet
- a APHP, Service de Médecine Physique et de Réadaptation , Hôpital Pitié-Salpêtrière , Paris , France.,b Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC n°18, Handicap cognitif et réadaptation (HanCRe); Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix , Paris , France.,c Centre for Interdisciplinary Rehabilitation Research of Greater Montreal (CRIR) - Centre de réadaptation Lucie-Bruneau , Montréal , Canada.,d School of Rehabilitation , Université de Montréal , Montréal , Canada
| | - Bonnie Swaine
- c Centre for Interdisciplinary Rehabilitation Research of Greater Montreal (CRIR) - Centre de réadaptation Lucie-Bruneau , Montréal , Canada.,d School of Rehabilitation , Université de Montréal , Montréal , Canada
| | - Elisabeth Dutil
- c Centre for Interdisciplinary Rehabilitation Research of Greater Montreal (CRIR) - Centre de réadaptation Lucie-Bruneau , Montréal , Canada.,d School of Rehabilitation , Université de Montréal , Montréal , Canada
| | - Mathilde Chevignard
- b Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC n°18, Handicap cognitif et réadaptation (HanCRe); Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix , Paris , France.,e Department of Rehabilitation for Children with Acquired Brain Injury , Hôpitaux de Saint Maurice , Saint Maurice , France
| | - Pascale Pradat-Diehl
- a APHP, Service de Médecine Physique et de Réadaptation , Hôpital Pitié-Salpêtrière , Paris , France.,b Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC n°18, Handicap cognitif et réadaptation (HanCRe); Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix , Paris , France
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Turner-Stokes L, Bavikatte G, Williams H, Bill A, Sephton K. Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis. BMJ Open 2016; 6:e012112. [PMID: 27609852 PMCID: PMC5020841 DOI: 10.1136/bmjopen-2016-012112] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions. DESIGN A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012-2015. SETTING Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. PARTICIPANTS All patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%). INTERVENTION Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. OUTCOME MEASURES Rehabilitation complexity and medical acuity: Rehabilitation Complexity Scale-version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). PRIMARY OUTCOMES (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community. RESULTS The mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: p<0.001). For the 180 (95%) patients with complete NPCNA data, the mean episode cost was £77 119 (bootstrapped 95% CI £70 614 to £83 894) and the mean reduction in 'weekly care costs' was £462/week (95% CI 349 to 582). The mean time to offset the cost of rehabilitation was 27.6 months (95% CI 13.2 to 43.8). CONCLUSIONS Despite its relatively high initial cost, specialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
| | | | - Heather Williams
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
| | - Alan Bill
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
| | - Keith Sephton
- Regional/Hyperacute Rehabilitation Unit, Northwick Park Hospital, Harrow, UK
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Yassin M, Garti A, Khatib M, Weisbrot M, Robinson D. Retentive Cup Arthroplasty in Selected Hip Fracture Patients-A Prospective Series With a Minimum 3-Year Follow-Up. Geriatr Orthop Surg Rehabil 2016; 7:178-182. [PMID: 27847676 PMCID: PMC5098687 DOI: 10.1177/2151458516661384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the efficacy of the use of retentive cup primary total hip replacement (THR) in high-dislocation risk subcapital fracture patients. Methods: During the years 2008 to 2012, 354 patients with displaced subcapital fracture were operated at our institute. The patients were selected to undergo primary constrained THR according to the following criteria: (1) a preinjury grade 4 or more on the Functional Independence Measure mobility item “5. Locomotion: walking/wheelchair” and grade 4 is defined as “4. Minimal assistance Requiring incidental hands-on help only” (patient performs >75% of the task) and (2) a disease leading to poor motor control. Exclusion criteria were normal muscular control and known infection of the involved joint. Results: Of the 354 patients, 87 fulfilled the inclusion criteria and underwent constrained total hip. Average age was 78 years with a female predominance (73%). Fifteen patients had prior hemiparesis, 19 had Parkinson disease, and 35 had generalized sarcopenia. Eighty-five patients had an uneventful recovery, with an average Hip Disability and Osteoarthritis Outcome Score (HOOS) of 76 ± 7 at 2 years. In 2 patients, the prostheses dislocated. In both cases, the dislocation was due to ring displacement and the inner head dislocated. One case was infected and the patient was treated by a Girdlestone procedure. In the other case, the prosthetic head was revised. The patient remained asymptomatic and at 4-year follow-up had an HOOS of 85. Discussion: It appears that constrained prosthesis is a suitable treatment for patients with poor muscular control having subcapital fractures. The functional results appear to be superior to those of bipolar arthroplasty and similar to the results of primary total hip arthroplasty while the dislocation risk is <3%. Conclusion: Semielective total hip arthroplasty using a retentive cup liner appears to offer good functional results with a low dislocation rate in patients with poor muscular control.
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Affiliation(s)
- Mustafa Yassin
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Avraham Garti
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Muhammad Khatib
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Moshe Weisbrot
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Dror Robinson
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
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McGilloway E, Mitchell J, Dharm-Datta S, Roberts A, Tilley H, Etherington J. The Mayo Portland Adaptability Inventory-4 outcome measure is superior to UK FIM+FAM in a British military population. Brain Inj 2016; 30:1208-12. [PMID: 27467810 DOI: 10.1080/02699052.2016.1188215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to identify the most appropriate rehabilitation outcome measure for use in a young adult population with acquired brain injury. METHODS A 2-year prospective study of patients admitted to a UK military neuro-rehabilitation unit with acquired brain injury to compare the appropriateness of the Functional Independence Measure/Functional Assessment Measure (FIM+FAM) vs the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) in assessing outcomes. Patients were assessed at admission, discharge and at 4-month follow-up using FIM+FAM and MPAI-4. RESULTS The FIM+FAM total motor score showed a marked ceiling affect, 42% of patients scored the maximum on admission rising to 80% at discharge. The MPAI-4 did not show significant ceiling effects. The other sub-scales of FIM+FAM and MPAI-4 were generally comparable, no more than 17% achieved ceiling at follow-up. CONCLUSIONS This is the first comparative study of FIM+FAM and MPAI-4 in a young adult military population following acquired brain injury. All patients showed improvements in both outcome measures following intensive inpatient rehabilitation. However, the MPAI-4 did not show ceiling effects in motor scores. This measure was, therefore, found to be more appropriate in the cohort.
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Affiliation(s)
- Emer McGilloway
- a Defence Medical Rehabilitation Centre (DMRC) Headley Court , Epsom , Surrey , UK
| | - James Mitchell
- a Defence Medical Rehabilitation Centre (DMRC) Headley Court , Epsom , Surrey , UK
| | - Shreshth Dharm-Datta
- a Defence Medical Rehabilitation Centre (DMRC) Headley Court , Epsom , Surrey , UK
| | - Andrew Roberts
- a Defence Medical Rehabilitation Centre (DMRC) Headley Court , Epsom , Surrey , UK
| | - Haydn Tilley
- a Defence Medical Rehabilitation Centre (DMRC) Headley Court , Epsom , Surrey , UK
| | - John Etherington
- a Defence Medical Rehabilitation Centre (DMRC) Headley Court , Epsom , Surrey , UK
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Holliday RC, Antoun M, Playford ED. A Survey of Goal-Setting Methods Used in Rehabilitation. Neurorehabil Neural Repair 2016; 19:227-31. [PMID: 16093413 DOI: 10.1177/1545968305279206] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. This survey provides a description of the goal-setting methods that are currently being used in community and inpatient rehabilitation centers across the United Kingdom. Given current policy, emphasis was placed on finding out how much patient involvement in the goal-setting process exists, concentrating on how such involvement may be facilitated. Design. A postal survey design was used to access a large sample size over a broad geographical area. The questionnaire was piloted at a British Society for Rehabilitation Medicine (BSRM) meeting; subsequently, some response categories were expanded. The questionnaire was approved by the BSRM Research and Clinical Standards committee. Questionnaires were coded to track responses from individuals. The received data were anonymized and analyzed using a statistics package for social science (SPSS) database. Subjects. Members of the BSRM were selected for this survey because this represents one of the most comprehensive listings of rehabilitation services in the United Kingdom. Results. The survey had a 60% response rate. A problem-orientated approach to goal setting was most commonly reported, with rehabilitation teams defining, formulating, and evaluating the goals. Patients were supplied with limited information about goal setting during their rehabilitation admission, although 60% of respondents reported giving patients a copy of their goals. Thirty percent of respondents used goals as a measure of rehabilitation effectiveness. Standardized goal-setting measures were not commonly used. Conclusion. These data demonstrate that individual disciplines tend to discuss potential goals with their patients during treatment sessions and then formulate goals on the basis of the discussion. There is scope to develop and refine the approach to goal setting so the patients have more opportunities to engage in the goal-setting process.
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Affiliation(s)
- Rosaline C Holliday
- Rehabilitation Group, Institute of Neurology, University College London, Queen Square, London, National Hospital for Neurology and Neurosurgery, Queen Square, London
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Ford CEL, Malley D, Bateman A, Clare IC, Wagner AP, Gracey F. Selection and visualisation of outcome measures for complex post-acute acquired brain injury rehabilitation interventions. NeuroRehabilitation 2016; 39:65-79. [PMID: 27341362 PMCID: PMC5268089 DOI: 10.3233/nre-161339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Outcome measurement challenges rehabilitation services to select tools that promote stakeholder engagement in measuring complex interventions. OBJECTIVES To examine the suitability of outcome measures for complex post-acute acquired brain injury (ABI) rehabilitation interventions, report outcomes of a holistic, neuropsychological ABI rehabilitation program and propose a simple way of visualizing complex outcomes. METHODS Patient/carer reported outcome measures (PROMS), experience measures (PREMS) and staff-rated measures were collected for consecutive admissions over 1 year to an 18-week holistic, neuropsychological rehabilitation programme at baseline, 18 weeks and 3- and 6-month follow-up. RESULTS Engagement with outcome measurement was poorest for carers and at follow-up for all stakeholders. Dependence, abilities, adjustment, unmet needs, symptomatology including executive dysfunction, and self-reassurance showed improvements at 18 weeks. Adjustment, social participation, perceived health, symptomatology including dysexecutive difficulties, and anxiety were worse at baseline for those who did not complete rehabilitation, than those who did. A radar plot facilitated outcome visualization. CONCLUSIONS Engagement with outcome measurement was best when time and support were provided. Supplementing patient- with staff-rated and attendance measures may explain missing data and help quantify healthcare needs. The MPAI4, EBIQ and DEX-R appeared suitable measures to evaluate outcomes and distinguish those completing and not completing neuropsychological rehabilitation.
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Affiliation(s)
- Catherine Elaine Longworth Ford
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
| | - Donna Malley
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrew Bateman
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Isabel C.H. Clare
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Adam P. Wagner
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Fergus Gracey
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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Balasch i Bernat M, Balasch i Parisi S, Sebastián EN, Moscardó LD, Ferri Campos J, López Bueno L. Determining cut-off points in functional assessment scales in stroke. NeuroRehabilitation 2016; 37:165-72. [PMID: 26484508 DOI: 10.3233/nre-151249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS A high correlation was observed between the DOS and mRS scales (Kendall's tau-b = 0.475; p = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26-69.29) and 21.30 (95% CI, 16.34-26.03) for the BI; 70.62 (95% CI, 66.65-75.22) and 38.29 (95% CI, 34.07-42.25) for the FIM; and 116.07 (95% CI, 110.30-122.68) and 66.02 (95% CI, 59.20-72.35) for the FAM. CONCLUSION(S) DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients.
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Affiliation(s)
| | - Sebastiá Balasch i Parisi
- Department of Applied Statistics and Operational Research, and Quality, Universidad Politécnica de Valencia, Valencia, Spain
| | | | | | | | - Laura López Bueno
- Department of Physiotherapy, Universidad de Valencia, Valencia, Spain
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Turner-Stokes L, Williams H, Bill A, Bassett P, Sephton K. Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set. BMJ Open 2016; 6:e010238. [PMID: 26911586 PMCID: PMC4769383 DOI: 10.1136/bmjopen-2015-010238] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability, comparing different diagnostic groups across 3 levels of dependency. DESIGN A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010-2015. SETTING All 62 specialist (levels 1 and 2) rehabilitation services in England. PARTICIPANTS Working-aged adults (16-65 years) with complex neurological disability. INCLUSION CRITERIA all episodes with length of stay (LOS) 8-400 days and complete outcome measures recorded on admission and discharge. Total N=5739: acquired brain injury n=4182 (73%); spinal cord injury n=506 (9%); peripheral neurological conditions n=282 (5%); progressive conditions n=769 (13%). INTERVENTION Specialist inpatient multidisciplinary rehabilitation. OUTCOME MEASURES Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK Functional Independence Measure (FIM)+FAM). Cost-efficiency: (1) time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care, (2) FIM efficiency (FIM gain/LOS days), (3) FIM+FAM efficiency (FIM+FAM gain/LOS days). Patients were analysed in 3 groups of dependency. RESULTS Mean LOS 90.1 (SD 66) days. All groups showed significant reduction in dependency between admission and discharge on all measures (paired t tests: p<0.001). Mean reduction in 'weekly care costs' was greatest in the high-dependency group at £760/week (95% CI 726 to 794)), compared with the medium-dependency (£408/week (95% CI 370 to 445)), and low-dependency (£130/week (95% CI 82 to 178)), groups. Despite longer LOS, time taken to offset the cost of rehabilitation was 14.2 (95% CI 9.9 to 18.8) months in the high-dependency group, compared with 22.3 (95% CI 16.9 to 29.2) months (medium dependency), and 27.7 (95% CI 15.9 to 39.7) months (low dependency). FIM efficiency appeared greatest in medium-dependency patients (0.54), compared with the low-dependency (0.37) and high-dependency (0.38) groups. Broadly similar patterns were seen across all 4 diagnostic groups. CONCLUSIONS Specialist rehabilitation can be highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients.
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Affiliation(s)
- Lynne Turner-Stokes
- Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | - Heather Williams
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | - Alan Bill
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | | | - Keith Sephton
- Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
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Palmer C, Kneebone II, Strauss C, Jones AM. Using reliability of change analysis to evaluate post-acute neuro-rehabilitation. NeuroRehabilitation 2016; 38:93-8. [PMID: 26889803 DOI: 10.3233/nre-151300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is important to evaluate change in order to re-assure commissioners, staff and patients of the effectiveness of interventions, but also in order to identify areas for improvement. OBJECTIVE To consider whether analysis of improvement at the level of the individual, taking into account measurement error, may offer a further valuable way to assess change and inform service development over considering change at the group level in a post-acute neuro-rehabilitation unit. METHOD Pre and post intervention Scores on the FIM+FAM Full Scale and Cognitive and Motor subscales were considered for eighteen patients aged between 35 and 81 with mixed diagnoses who attended a post-acute inpatient neuro-rehabilitation unit for treatment. RESULTS Statistically significant improvements were achieved on the FIM+FAM Full Scale and Cognitive and Motor subscales in a whole group analysis. Reliable change analyses for each patient within each subscale however identified only half of the sample achieved reliable improvement within the Motor domain and just one person within the Cognitive domain (5.6%). CONCLUSIONS Findings are consistent with the emphasis of the rehabilitation unit on physical/motor function, and unsurprising as many of those assessed had multiple sclerosis, an often deteriorative condition. Use of reliable change analysis allowed a more detailed understanding of intervention impact, potentially identifying what services reliably work for whom, thereby informing future planning.
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Affiliation(s)
- Christina Palmer
- University of Surrey, School of Psychology, Guildford, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Ian I Kneebone
- Virgin Care, Department of Psychology, Haslemere, UK.,University of Technology Sydney, Discipline of Clinical Psychology, Sydney, Australia
| | - Clara Strauss
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,University of Sussex, School of Psychology, Brighton, UK
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Nayar M, Vanderstay R, Siegert RJ, Turner-Stokes L. The UK Functional Assessment Measure (UK FIM+FAM): Psychometric Evaluation in Patients Undergoing Specialist Rehabilitation following a Stroke from the National UK Clinical Dataset. PLoS One 2016; 11:e0147288. [PMID: 26824696 PMCID: PMC4732596 DOI: 10.1371/journal.pone.0147288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 01/01/2016] [Indexed: 12/02/2022] Open
Abstract
The UK Functional Assessment Measure (UKFIM+FAM) is the principal outcome measure for the UK Rehabilitation Outcomes Collaborative (UKROC) national database for specialist rehabilitation. Previously validated in a mixed neurorehabilitation cohort, this study is the first to explore its psychometric properties in a stroke population, and compare left and right hemispheric strokes (LHS vs RHS). We analysed in-patient episode data from 62 specialist rehabilitation units collated through the UKROC database 2010-2013. Complete data were analysed for 1,539 stroke patients (LHS: 588, RHS: 566 with clear localisation). For factor analysis, admission and discharge data were pooled and randomised into two equivalent samples; the first for exploratory factor analysis (EFA) using principal components analysis, and the second for confirmatory factor analysis (CFA). Responsiveness for each subject (change from admission to discharge) was examined using paired t-tests and differences between LHS and RHS for the entire group were examined using non-paired t-tests. EFA showed a strong general factor accounting for >48% of the total variance. A three-factor solution comprising motor, communication and psychosocial subscales, accounting for >69% total variance, provided acceptable fit statistics on CFA (Root Mean Square Error of Approximation was 0.08 and Comparative Fit Index/ Tucker Lewis Index 0.922/0.907). All three subscales showed significant improvement between admission and discharge (p<0.001) with moderate effect sizes (>0.5). Total scores between LHS and RHS were not significantly different. However, LHS showed significantly higher motor scores (Mean 5.7, 95%CI 2.7, 8.6 p<0.001), while LHS had significantly lower cognitive scores, primarily in the communication domain (-6.8 95%CI -7.7, -5.8 p<0.001). To conclude, the UK FIM+FAM has a three-factor structure in stroke, similar to the general neurorehabilitation population. It is responsive to change during in-patient rehabilitation, and distinguishes between LHS and RHS. This tool extends stroke outcome measurement beyond physical disability to include cognitive, communication and psychosocial function.
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Affiliation(s)
- Meenakshi Nayar
- Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom
- Regional Hyper Acute Rehabilitation Unit (RHRU), Northwick Park Hospital, London, United Kingdom
| | - Roxana Vanderstay
- Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Richard J. Siegert
- School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Lynne Turner-Stokes
- Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom
- Regional Hyper Acute Rehabilitation Unit (RHRU), Northwick Park Hospital, London, United Kingdom
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Dhamapurkar SK, Rose A, Florschutz G, Wilson BA. The natural history of continuing improvement in an individual after a long period of impaired consciousness: The story of I.J. Brain Inj 2015; 30:230-6. [PMID: 26680113 DOI: 10.3109/02699052.2015.1094132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Recovery of consciousness and recovery of function among patients with prolonged disorders of consciousness rarely occur. Those patients who do regain consciousness typically remain with severe disability. The aim of this retrospective study is to suggest that continuing improvement is possible in a survivor of catastrophic brain injury after being in a prolonged state of disordered consciousness. CASE STUDY This retrospective single case study follows the progress of a 29 year old man, I.J, who sustained a severe traumatic brain injury following an assault in October 2011. He was in a vegetative state for 15 months and in a minimally conscious state for a further 4 months. This was followed by a slow and steady recovery of motor and cognitive functions. At 3 years post-injury I.J is considered to be moderately disabled. He is now living in the community with continuing outpatient support. On the disability rating scale his level of functioning is rated as mildly dependent. CONCLUSION This study shows that continuing recovery to a level of moderate disability is possible, even after a prolonged disorder of consciousness. Intense multi-disciplinary long-term rehabilitation and cranioplasty may be contributing factors for such an unexpected recovery.
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Affiliation(s)
| | - Anita Rose
- a The Raphael Medical Centre , Kent , UK
| | | | - Barbara A Wilson
- a The Raphael Medical Centre , Kent , UK.,b Oliver Zangwill Centre , Cambridgeshire , UK
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Acute and Chronic Effect of Acoustic and Visual Cues on Gait Training in Parkinson's Disease: A Randomized, Controlled Study. PARKINSONS DISEASE 2015; 2015:978590. [PMID: 26693384 PMCID: PMC4674608 DOI: 10.1155/2015/978590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/17/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022]
Abstract
In this randomized controlled study we analyse and compare the acute and chronic effects of visual and acoustic cues on gait performance in Parkinson's Disease (PD). We enrolled 46 patients with idiopathic PD who were assigned to 3 different modalities of gait training: (1) use of acoustic cues, (2) use of visual cues, or (3) overground training without cues. All patients were tested with kinematic analysis of gait at baseline (T0), at the end of the 4-week rehabilitation programme (T1), and 3 months later (T2). Regarding the acute effect, acoustic cues increased stride length and stride duration, while visual cues reduced the number of strides and normalized the stride/stance distribution but also reduced gait speed. As regards the chronic effect of cues, we recorded an improvement in some gait parameters in all 3 groups of patients: all 3 types of training improved gait speed; visual cues also normalized the stance/swing ratio, acoustic cues reduced the number of strides and increased stride length, and overground training improved stride length. The changes were not retained at T2 in any of the experimental groups. Our findings support and characterize the usefulness of cueing strategies in the rehabilitation of gait in PD.
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The Relationship of Health Locus of Control and Health-Related Quality of Life in the Chronic Phase After Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:424-31. [DOI: 10.1097/htr.0000000000000128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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73
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Miki E, Yamane S, Yamaoka M, Fujii H, Ueno H, Kawahara T, Tanaka K, Tamashiro H, Inoue E, Okamoto T, Kuriyama M. Validity and reliability of the Japanese version of the FIM + FAM in patients with cerebrovascular accident. Scand J Occup Ther 2015; 23:398-404. [DOI: 10.3109/11038128.2015.1095236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Turner-Stokes L, Vanderstay R, Stevermuer T, Simmonds F, Khan F, Eagar K. Comparison of Rehabilitation Outcomes for Long Term Neurological Conditions: A Cohort Analysis of the Australian Rehabilitation Outcomes Centre Dataset for Adults of Working Age. PLoS One 2015; 10:e0132275. [PMID: 26167877 PMCID: PMC4500577 DOI: 10.1371/journal.pone.0132275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/11/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe and compare outcomes from in-patient rehabilitation (IPR) in working-aged adults across different groups of long-term neurological conditions, as defined by the UK National Service Framework. DESIGN Analysis of a large Australian prospectively collected dataset for completed IPR episodes (n = 28,596) from 2003-2012. METHODS De-identified data for adults (16-65 years) with specified neurological impairment codes were extracted, cleaned and divided into 'Sudden-onset' conditions: (Stroke (n = 12527), brain injury (n = 7565), spinal cord injury (SCI) (n = 3753), Guillain-Barré syndrome (GBS) (n = 805)) and 'Progressive/stable' conditions (Progressive (n = 3750) and Cerebral palsy (n = 196)). Key outcomes included Functional Independence Measure (FIM) scores, length of stay (LOS), and discharge destination. RESULTS Mean LOS ranged from 21-57 days with significant group differences in gender, source of admission and discharge destination. All six groups showed significant change (p<0.001) between admission and discharge that was likely to be clinically important across a range of items. Significant between-group differences were observed for FIM Motor and Cognitive change scores (Kruskal-Wallis p<0.001), and item-by-item analysis confirmed distinct patterns for each of the six groups. SCI and GBS patients were generally at the ceiling of the cognitive subscale. The 'Progressive/stable' conditions made smaller improvements in FIM score than the 'Sudden-onset conditions', but also had shorter LOS. CONCLUSION All groups made gains in independence during admission, although pattern of change varied between conditions, and ceiling effects were observed in the FIM-cognitive subscale. Relative cost-efficiency between groups can only be indirectly inferred. Limitations of the current dataset are discussed, together with opportunities for expansion and further development.
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Affiliation(s)
- Lynne Turner-Stokes
- King’s College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- * E-mail:
| | - Roxana Vanderstay
- King’s College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Tara Stevermuer
- University of Wollongong, Australasian Rehabilitation Outcomes Centre / Australian Health Services Research Institute, Wollongong, Australia
| | - Frances Simmonds
- University of Wollongong, Australasian Rehabilitation Outcomes Centre / Australian Health Services Research Institute, Wollongong, Australia
| | - Fary Khan
- University of Melbourne and Royal Melbourne Hospital, Department of Rehabilitation, Melbourne, Australia
| | - Kathy Eagar
- University of Wollongong, Australasian Rehabilitation Outcomes Centre / Australian Health Services Research Institute, Wollongong, Australia
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Turner-Stokes L, Rose H, Ashford S, Singer B. Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.5.210] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lynne Turner-Stokes
- Herbert Dunhill Professor of Rehabilitation, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, UK and Director, Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK
| | - Hilary Rose
- Head of therapy services, Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK
| | - Stephen Ashford
- Clinical lecturer and consultant physiotherapist, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, UK and Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK
| | - Barbara Singer
- Professor, Centre for Musculoskeletal Studies, School of Surgery, University of Western Australia, Perth, Australia
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Turner-Stokes L, Bassett P, Rose H, Ashford S, Thu A. Serial measurement of Wessex Head Injury Matrix in the diagnosis of patients in vegetative and minimally conscious states: a cohort analysis. BMJ Open 2015; 5:e006051. [PMID: 25900459 PMCID: PMC4410122 DOI: 10.1136/bmjopen-2014-006051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 02/02/2015] [Accepted: 02/06/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To evaluate serial application of the Wessex Head Injury Matrix (WHIM) in diagnosis of prolonged disorders of consciousness (PDOC). Specifically, to determine whether the trajectory of change predicts outcome status, and whether the current hierarchical order of WHIM items is correct for this context. DESIGN Analysis of prospectively gathered clinical cohort data. SETTING Consecutive admissions to a tertiary in-patient neurorehabilitation service for evaluation of PDOC in real-life clinical practice, over a 10-year period (2004-2014). PARTICIPANTS Patients (n=65) presenting in sudden-onset vegetative (VS) or minimally conscious states (MCS). Mean age 38.4 (sd14.1) years; male:female ratio 66%:33%. Aetiology of brain injury: 40(62%) traumatic; 12(19%) vascular; 11(17%) hypoxic; 3(3%) other. PRIMARY OUTCOME MEASURE WHIM alongside detailed clinical evaluation. METHODS The WHIM was administered serially by the multidisciplinary team throughout an in-patient evaluation programme (mean length 74 (sd42) days). Patients were divided into four groups, according to PDOC status on discharge (VS, MCS-Minus, MCS-Plus or Emerged). RESULTS WHIM hierarchical scores (Most Advanced Behaviour (MAB)) correlated with PDOC status at discharge (Pearson r=0.49, p<0.001). In the original order, the MAB distinguished the 'VS', 'MCS' and 'Emerged' categories (analysis of variance (ANOVA) post hoc p<0.001), but not the subgroups of MCS-Minus and MCS-Plus. In stepwise regression analysis, MAB-Ex (excluding two items) accounted for 68% of the variance in PDOC status at discharge. On multilevel statistical modelling, trajectory of change in MAB separated the four PDOC groups, both at individual and at group level (p<0.001). After reordering of items, the new-order MAB accounted for more (73%) of the variance in PDOC status, and also distinguished significantly between MCS-Minus and MCS-Plus groups at discharge (p<0.002). CONCLUSIONS The WHIM is a useful diagnostic tool in PDOC, and trajectory of change is an important predictor of outcome. The proposed new hierarchical order requires further evaluation in future multicentre analyses.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care Policy and Rehabilitation, King's College London, School of Medicine, London, UK
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | | | - Hilary Rose
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Stephen Ashford
- Department of Palliative Care Policy and Rehabilitation, King's College London, School of Medicine, London, UK
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Aung Thu
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
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Abstract
IntroductionThis study evaluates the need for adaptive equipment following total knee replacement. There are no recent studies to guide occupational therapists in the optimum time adaptive equipment is required following total knee replacement.MethodA non-experimental, concurrent mixed methods approach was used. The study population was patients attending for total knee replacement at a large general hospital. Outcome measures were the Oxford Knee Score, the United Kingdom Functional Independence Measure and a weekly diary.ResultsA total of 19 patients were included in the study. Following assessment, 53% ( n = 10) required adaptive equipment following total knee replacement. No significant difference was found in pre-operative pain or function scores, gender or surgical pathway when comparing those who did and did not need adaptive equipment post-operatively. Patients who required adaptive equipment post-operatively had significantly worse pain ( p = 0.030) and function ( p = 0.040) at 6 weeks post-operatively and had significantly longer inpatient stay ( p = 0.041).ConclusionAlthough there are resource implications, patients requiring adaptive equipment following total knee replacement should be assessed by occupational therapy staff 6 weeks post-operatively to ensure optimal functional outcomes following surgery.
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Affiliation(s)
- Jamie McNaught
- Senior Occupational Therapist, Royal Alexandra Hospital, Paisley, UK
| | - Lorna Paul
- Reader in Rehabilitation, University of Glasgow, Glasgow, UK
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Zali A, Arab L, Ashrafi F, Mardpour S, Niknejhadi M, Hedayati-Asl AA, Halimi-Asl A, Ommi D, Hosseini SE, Baharvand H, Aghdami N. Intrathecal injection of CD133-positive enriched bone marrow progenitor cells in children with cerebral palsy: feasibility and safety. Cytotherapy 2015; 17:232-41. [DOI: 10.1016/j.jcyt.2014.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 10/09/2014] [Accepted: 10/26/2014] [Indexed: 12/12/2022]
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Alexandrescu R, Siegert RJ, Turner-Stokes L. The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset. Disabil Rehabil 2015; 37:1976-83. [PMID: 25598001 PMCID: PMC4720035 DOI: 10.3109/09638288.2014.998779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose: To assess the internal reliability, construct and concurrent validity and responsiveness of the Northwick Park Therapy Dependency Assessment (NPTDA) scale. Method: A cohort of 2505 neurorehabilitation patients submitted to the UK Rehabilitation Outcomes Collaborative database. Cronbach’s coefficient-α was used to assess internal reliability and factor analysis (FA) to assess construct validity. We compared NPTDA scores at admission and discharge to determine responsiveness. Results: Coefficient-α for the whole scale was 0.74. The exploratory FA resulted in a four-factor model (Physical, Psychosocial, Discharge planning and Activities) that accounted for 43% of variance. This model was further supported by the confirmatory FA. The final model had a good fit: root-mean-square error of approximation of 0.069, comparative fit index/Tucker–Lewis index of 0.739/0.701 and the goodness of fit index of 0.909. The NPTDA scores at admission and discharge were significantly different for each of the factors. Expected correlations were seen between the admission scores for the NPTDA, the Rehabilitation Complexity Scale (r = 0.30, p < 0.01) and the Functional Independence Measure (r = −0.25, p < 0.01). Conclusions: The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA may be used to describe and quantify changes in therapy inputs in the course of a rehabilitation programme.Implications for Rehabilitation The Northwick Park Therapy Dependency Assessment (NPTDA) is designed as a measure therapy intervention, which reflects both quantitative and qualitative aspects of the inputs provided (including staff time and the different types of intervention) during inpatient rehabilitation. The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA is responsive to change in the therapy inputs provided during neurorehabilitation between admission and discharge.
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Affiliation(s)
- Roxana Alexandrescu
- a Department of Palliative Care, Policy and Rehabilitation , School of Medicine, King's College London , London , UK
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Alexandrescu R, Siegert RJ, Turner-Stokes L. Functional outcomes and efficiency of rehabilitation in a national cohort of patients with Guillain-Barré syndrome and other inflammatory polyneuropathies. PLoS One 2014; 9:e110532. [PMID: 25402491 PMCID: PMC4234218 DOI: 10.1371/journal.pone.0110532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives To describe functional outcomes, care needs and cost-efficiency of hospital rehabilitation for a UK cohort of inpatients with complex rehabilitation needs arising from inflammatory polyneuropathies. Subjects and Setting 186 patients consecutively admitted to specialist neurorehabilitation centres in England with Guillain-Barré Syndrome (n = 118 (63.4%)) or other inflammatory polyneuropathies, including chronic inflammatory demyelinating polyneuropathy (n = 15 (8.1%) or critical illness neuropathy (n = 32 (17.2%)). Methods Cohort analysis of data from the UK Rehabilitation Outcomes Collaborative national clinical dataset. Outcome measures include the UK Functional Assessment Measure, Northwick Park Dependency Score (NPDS) and Care Needs Assessment (NPCNA). Patients were analysed in three groups of dependency based on their admission NPDS score: ‘low’ (NPDS<10), ‘medium’ (NPDS 10–24) and ‘high’ (NPDS ≥25). Cost-efficiency was measured as the time taken to offset the cost of rehabilitation by savings in NPCNA-estimated costs of on-going care in the community. Results The mean rehabilitation length of stay was 72.2 (sd = 66.6) days. Significant differences were seen between the diagnostic groups on admission, but all showed significant improvements between admission and discharge, in both motor and cognitive function (p<0.0001). Patients who were highly dependent on admission had the longest lengths of stay (mean 97.0 (SD 79.0) days), but also showed the greatest reduction in on-going care costs (£1049 per week (SD £994)), so that overall they were the most cost-efficient to treat. Conclusions Patients with polyneuropathies have both physical and cognitive disabilities that are amenable to change with rehabilitation, resulting in significant reduction in on-going care-costs, especially for highly dependent patients.
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Affiliation(s)
- Roxana Alexandrescu
- Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King’s College London, London, United Kingdom
- * E-mail:
| | - Richard John Siegert
- School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Auckland University of Technology, Auckland, New Zealand
| | - Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King’s College London, London, United Kingdom
- Regional Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom
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Van Heugten CM, Walton L, Hentschel U. Can we forget the Mini-Mental State Examination? A systematic review of the validity of cognitive screening instruments within one month after stroke. Clin Rehabil 2014; 29:694-704. [PMID: 25381346 DOI: 10.1177/0269215514553012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/04/2014] [Indexed: 11/15/2022]
Abstract
Objective: To review systematically studies investigating the convergent, criterion, and predictive validity of multi-domain cognitive screening instruments in the first four weeks after stroke. Data sources: Electronic databases (Pubmed, PsycINFO, CINAHL, Embase) were searched until June 2014. Review methods: Studies concerning screening for cognitive dysfunction in stroke patients using multi-domain instruments, within four weeks postinfarct or haemorrhagic stroke, using tests taking no longer than one hour. Convergent, criterion, and predictive validity were examined. Results: A total of 51 studies investigating 16 cognitive screening instruments were identified. None of the instruments covered all of the most affected cognitive domains. Only one study investigated the convergent validity of a multi-domain test during the (sub)acute phase after stroke. A total of 15 studies examined the criterion validity of cognitive measurements during the acute phase after stroke. The Montreal Cognitive Assessment and Higher Cortical Function Deficit Test had good criterion validity. A total of 24 studies examined the predictive ability of multi-domain cognitive instruments applied in the acute phase after stroke. The Cognistat, Montreal Cognitive Assessment, and Functional Independence Measure-cognitive showed good predictive validity. The Mini-Mental State Examination is the most widely used cognitive screening instrument, but shows insufficient criterion validity. Conclusion: None of the existing instruments fulfils all criteria. The Montreal Cognitive Assessment is the best candidate at present, provided items measuring speed of information processing are added, and further studies investigating the optimal cut-offs are conducted.
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Affiliation(s)
- Caroline M Van Heugten
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - L Walton
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - U Hentschel
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
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Turner-Stokes L, Fadyl J, Rose H, Williams H, Schlüter P, McPherson K. The Work-ability Support Scale: evaluation of scoring accuracy and rater reliability. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:511-24. [PMID: 24338285 PMCID: PMC4118042 DOI: 10.1007/s10926-013-9486-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The Work-ability Support Scale (WSS) is a new tool designed to assess vocational ability and support needs following onset of acquired disability, to assist decision-making in vocational rehabilitation. In this article, we report an iterative process of development through evaluation of inter- and intra-rater reliability and scoring accuracy, using vignettes. The impact of different methodological approaches to analysis of reliability is highlighted. METHODS Following preliminary evaluation using case-histories, six occupational therapists scored vignettes, first individually and then together in two teams. Scoring was repeated blind after 1 month. Scoring accuracy was tested against agreed 'reference standard' vignette scores using intraclass correlation coefficients (ICCs) for total scores and linear-weighted kappas (kw) for individual items. Item-by-item inter- and intra-rater reliability was evaluated for both individual and team scores, using two different statistical methods. RESULTS ICCs for scoring accuracy ranged from 0.95 (95 % CI 0.78-0.98) to 0.96 (0.89-0.99) for Part A, and from 0.78 (95 % CI 0.67-0.85) to 0.84 (0.69-0.92) for Part B. Item by item analysis of scoring accuracy, inter- and intra-rater reliability all showed 'substantial' to 'almost perfect' agreement (kw ≥ 0.60) for all Part-A and 8/12 Part-B items, although multi-rater kappa (Fleiss) produced more conservative results (mK = 0.34-0.79). Team rating produced marginal improvements for Part-A but not Part-B. Four problematic contextual items were identified, leading to adjustment of the scoring manual. CONCLUSION This vignette-based study demonstrates generally acceptable levels of scoring accuracy and reliability for the WSS. Further testing in real-life situations is now warranted.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King's College London, London, UK,
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83
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Health-Related Quality of Life 3 Years After Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study. Arch Phys Med Rehabil 2014; 95:1268-76. [DOI: 10.1016/j.apmr.2014.02.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 11/18/2022]
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84
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Fadyl JK, McPherson KM, Schlüter PJ, Turner-Stokes L. Development of a new tool to evaluate work support needs and guide vocational rehabilitation: the Work-ability Support Scale (WSS). Disabil Rehabil 2014; 37:247-58. [PMID: 24786967 DOI: 10.3109/09638288.2014.914586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joanna K Fadyl
- Auckland University of Technology, Centre for Person Centred Research, Health and Rehabilitation Research Institute , Northcote, Auckland , New Zealand
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85
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Siegert RJ, Jackson DM, Playford ED, Fleminger S, Turner-Stokes L. A longitudinal, multicentre, cohort study of community rehabilitation service delivery in long-term neurological conditions. BMJ Open 2014; 4:e004231. [PMID: 24583762 PMCID: PMC3939653 DOI: 10.1136/bmjopen-2013-004231] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/10/2014] [Accepted: 01/24/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Part A: To pilot the use of a register to identify and monitor patients with complex needs arising from long-term neurological conditions. Part B: To determine the extent to which patients' needs for health and social services are met following discharge to the community after inpatient rehabilitation; to identify which factors predict unmet needs and to explore the relationship between service provision and outcomes at 12 months. DESIGN A multicentre, prospective, cohort study surveying participants at 1, 6 and 12 months using postal/online questionnaires and telephone interview. SETTING Consecutive discharges to the community from all nine tertiary, specialist, inpatient neurorehabilitation services in London over 18 months in 2010-2011. PARTICIPANTS Of 576 admissions 428 patients were recruited at discharge: 256 responded at 4 weeks, 212 at 6 months and 190 at 12 months. MEASURES Neurological Impairment Scale, The Needs and Provision Complexity Scale, The Northwick Park Dependency Scale, Community Integration Questionnaire, Zarit Burden Inventory. RESULTS n=322 (75%) expressed willingness to be registered, but in practice less than half responded to questionnaires at 6 and 12 months (49% and 44%, respectively), despite extensive efforts to contact them, with no significant differences between responders and non-responders. Significant unmet needs were identified within the first year following discharge, particularly in rehabilitation, social work support and provision of specialist equipment. Dependency for basic care and motor and cognitive impairment predicted services received, together accounting for 40% of the variance. Contra to expectation, patients whose rehabilitation needs were met were more dependent and less well integrated at 12 months post discharge than those with unmet needs. CONCLUSIONS Registration is acceptable to most patients, but questionnaires/telephone interviews may not be the most efficient way to reach them. When community resources are limited, service provision tends to be focused on the most dependent patients. REGISTRATION The study was registered with the NIHR Comprehensive Local Research Network: ID number 7503.
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Affiliation(s)
- Richard J Siegert
- School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, AUT University, Auckland, New Zealand
| | - Diana M Jackson
- Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King's College London, London, UK
| | | | | | - Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King's College London, London, UK
- Regional Rehabilitation Unit, Northwick Park Hospital, London, UK
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86
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Osborne LA, Gareth Noble J, Maramba IDC, Jones KH, Middleton RM, Lyons RA, Ford DV, Reed P. Outcome measures for multiple sclerosis. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x13y.0000000094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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87
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Dyer K, das Nair R. Talking about sex after traumatic brain injury: perceptions and experiences of multidisciplinary rehabilitation professionals. Disabil Rehabil 2013; 36:1431-8. [PMID: 24286234 DOI: 10.3109/09638288.2013.859747] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Research indicates that although 50-60% of people who have had a traumatic brain injury (TBI) experience changes in sexual functioning, sexuality issues remain largely unaddressed in rehabilitation. This study aimed to explore rehabilitation professionals' perceptions and experiences of discussing sexuality with service-users who have had a TBI. METHOD Purposeful sampling was used to recruit 24 participants from two local National Health Service trusts and from a national charity. Four focus groups were conducted with pre-existing groups of professionals, using a semi-structured interview schedule. Focus group data were transcribed verbatim and analysed using thematic analysis. RESULTS Six main themes were derived from the analysis: (1) sexuality after TBI is a specialist issue; (2) sexuality is a sensitive subject; (3) practicalities of discussing sexuality; (4) roles and responsibilities; (5) dilemmas about risk and vulnerabilities; and (6) organisational and structural issues. CONCLUSIONS Our findings suggest that a more proactive approach to addressing sexuality issues be taken by incorporating sexuality into assessments and by having sexuality information available for service-users. Support for professionals is also needed in the form of the development of policy, on-going training and supervision. Implications for Rehabilitation Rehabilitation professionals find it difficult to deal with issues of sexuality following TBI, and the reasons for this are complex and interrelated. To provide holistic care, a more proactive approach to addressing sexuality issues should be taken. Professionals do not need to be an expert in sexual issues to open dialogue. Sexuality discussions should be incorporated into assessments, and written information should be available for service-users. Further training for professionals and organisational policy change is sometimes required to effectively deal with sexuality issues.
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Affiliation(s)
- Kerry Dyer
- Institute of Health, Life and Social Sciences, University of Lincoln , Lincoln , UK
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88
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Rogan C, Fortune DG, Prentice G. Post-traumatic growth, illness perceptions and coping in people with acquired brain injury. Neuropsychol Rehabil 2013; 23:639-57. [DOI: 10.1080/09602011.2013.799076] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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89
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Lin NU, Wefel JS, Lee EQ, Schiff D, van den Bent MJ, Soffietti R, Suh JH, Vogelbaum MA, Mehta MP, Dancey J, Linskey ME, Camidge DR, Aoyama H, Brown PD, Chang SM, Kalkanis SN, Barani IJ, Baumert BG, Gaspar LE, Hodi FS, Macdonald DR, Wen PY. Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group. Lancet Oncol 2013; 14:e407-16. [PMID: 23993385 DOI: 10.1016/s1470-2045(13)70308-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Neurocognitive function, neurological symptoms, functional independence, and health-related quality of life are major concerns for patients with brain metastases. The inclusion of these endpoints in trials of brain metastases and the methods by which these measures are assessed vary substantially. If functional independence or health-related quality of life are planned as key study outcomes, then the reliability and validity of these endpoints can be crucial because methodological issues might affect the interpretation and acceptance of findings. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, and collaborative effort to improve the design of clinical trials in patients with brain tumours. In this report, the second in a two-part series, we review clinical trials of brain metastases in relation to measures of clinical benefit and provide a framework for the design and conduct of future trials.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Enderby P. Introducing the therapy outcome measure for AAC services in the context of a review of other measures. Disabil Rehabil Assist Technol 2013; 9:33-40. [PMID: 23924388 DOI: 10.3109/17483107.2013.823576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article discusses the importance of outcome measures in improving Augmentative and Alternative Communication (AAC) services, reviews existing methods and introduces a new approach. METHOD Three methods were used in this study. 1. A literature review identifying outcome measures used in AAC research. 2. A questionnaire to AAC services in the UK which aimed to identify the objectives of their services and the outcome measures commonly used. 3. A working group of AAC experts provided additional information and interpretation. Central properties and conceptual framework were considered. RESULTS The literature review and questionnaire identified 23 outcome measures none of which cover the conceptual frameworks associated with all of the overall objectives of AAC provision. The review has informed the further development of a particular outcome measure the AAC Therapy Outcome Measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning (ICF-WHO) are retained and the measure can be used in benchmarking. CONCLUSION An outcome measure needs to reflect change associated with service delivery. AAC services endeavour to impact on all of the domains of the ICF. A new measure is required in order to reflect the nature of these services. This article introduces an outcome measure which is in the process of being trialled by some services in the UK.
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Affiliation(s)
- Pam Enderby
- The Innovation Centre, University of Sheffield , Sheffield , UK
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91
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Turner-Stokes L, Thu A, Williams H, Casey R, Rose H, Siegert RJ. The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation. Disabil Rehabil 2013; 36:23-31. [PMID: 23721497 PMCID: PMC3906250 DOI: 10.3109/09638288.2013.775360] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To examine the construct validity and inter-rater reliability of the Neurological Impairment Scale (NIS) and compare ratings by medical and multidisciplinary teams in a mixed neurorehabilitation sample. To assess its concurrent and predictive validity as a predictor of outcome and functional gains during inpatient rehabilitation. Methods The NIS was rated in a consecutive cohort of patients (n = 428) recruited from nine specialist neurorehabilitation units in London. Dimensionality and internal consistency were explored through principal components analysis with Varimax rotation. Inter-rater reliability and the relationship between NIS and functional outcome (UK Functional Assessment Measure (FIM + FAM)) were analysed in a sub-sample (n = 94) from one centre. Results Factor analysis identified two principal domains (“Physical” and “Cognitive”) together accounting for 35% of the variance: their Cronbach’s alpha values were 0.76 and 0.67, respectively. Inter-rater reliability was excellent for overall scores between doctors (ICC = 0.95 (95% CI = 0.91–0.97)) and acceptable between the medical and multidisciplinary team (ICC = 0.92 (95% CI = 0.88–0.95)). Change in NIS-physical score predicted 29% of the variance in functional gain (FIM + FAM change). Conclusion These findings provide the first formal evidence for the validity and reliability of the NIS as a measure of neurological impairment for use in general neuro-rehabilitation settings. Its further application and exploration are now warranted. Implications for Rehabilitation
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Affiliation(s)
- Lynne Turner-Stokes
- School of Medicine, Department of Palliative Care Policy and Rehabilitation, King's College London , London , UK
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92
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Kosy JD, Blackshaw R, Swart M, Fordyce A, Lofthouse RA. Fractured neck of femur patient care improved by simulated fast-track system. J Orthop Traumatol 2013; 14:165-70. [PMID: 23558794 PMCID: PMC3751275 DOI: 10.1007/s10195-013-0240-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 03/20/2013] [Indexed: 12/03/2022] Open
Abstract
Background Fractured neck of femur patients represent a large demand on trauma services, and timely management results in improvements in morbidity and mortality. NICE guidance, advocating surgery on the day of admission or the following day, emphasises this. We set out to investigate whether a simulated fast-track management system could improve neck of femur fracture patient care. Materials and methods This prospective study was performed in a district general hospital in South West England, following a change in practise. We studied 429 patients over a 1-year period. Patients were phoned through, by the ambulance crew, to a trauma coordinator who arranged prompt radiological assessment and review. Patients with confirmed fractures were transferred to an optimisation area for orthopaedic and anaesthetic assessment prior to surgery the same day or early the following day. Our primary outcome measures were time to theatre (h) and length of hospital stay (days/h). Results Time to theatre reduced from 44.95 (±27.42) to 29.28 (±21.23) h. Length of stay reduced from 10 days (245.92 (±131.02) h) to 9 days (225.30 (±128.75) h). Both of these improvements were statistically significant (P < 0.05). Despite operating on virtually all patients, no increase in adverse events was seen, there was no increase in 30-day mortality and there were no perioperative deaths. Conclusions This coordinated management pathway improves the efficiency of the service and reduces inpatient length of stay. Increased productivity may lead to financial savings and improve our ability to meet guidelines.
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Affiliation(s)
- Jonathan D Kosy
- Department of Trauma and Orthopaedic Surgery, Torbay Hospital, Lawes Bridge, Torquay, TQ2 7AA, UK.
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Siddiqui FJ, Venketasubramanian N, Chan ESY, Chen C. Efficacy and safety of MLC601 (NeuroAiD®), a traditional Chinese medicine, in poststroke recovery: a systematic review. Cerebrovasc Dis 2013; 35 Suppl 1:8-17. [PMID: 23548914 DOI: 10.1159/000346231] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subsequent to a pooled analysis of 2 trials, several more studies have been published assessing the benefit of MLC601 in stroke patients. Hence, it is timely to conduct an updated meta-analysis to frame the interpretation of the results of an ongoing large multicenter, randomized, double-blind, placebo-controlled study. Therefore, we conducted a systematic review of the efficacy of MLC601 in improving the recovery of stroke patients. METHODS PubMed® and the Cochrane Library® databases were searched for trials evaluating MLC601 in stroke patients. Primary outcome was functional independence, assessed by the Barthel Index or the Diagnostic Therapeutic Effects of Apoplexy scoring system, item 8. Secondary outcomes were improvement in functional independence scores, motor recovery, reduction in visual field defect and increase in cerebral blood flow. Two authors performed the article selection, appraisal and data extraction while resolving differences through discussion or consulting a third author. Data were analyzed in RevMan5®. Meta-analysis was conducted using a random effects model. RESULTS This review included 6 studies with overall low risk of bias but some clinical heterogeneity. MLC601 increased the chances of achieving functional independence after stroke compared to control treatments (risk ratio, 2.35; 95% CI, 1.31-4.23). No deaths and 4 serious adverse events were reported in the MLC601 group, although detail was sparse with inconsistent reporting. CONCLUSIONS There is evidence that MLC601 as an add-on to standard treatment could be effective in improving functional independence and motor recovery and is safe for patients with primarily nonacute stable stroke.
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Abstract
Purpose: To evaluate the psychometric properties of the UK FIM + FAM. Methods: (a) A systematic literature review integrating the evidence for psychometric qualities of both the original and UK versions, and (b) exploratory and confirmatory factor analysis of admission/discharge data from an inpatient general neuro-rehabilitation cohort using parametric and non-parametric techniques. A prospective cohort of 459 patients with a male:female ratio of 57:43 and mean age of 44.5 (SD 14.3) years participated in this study. Results: Seven published articles together demonstrated acceptable utility, concurrent validity, inter-rater reliability and responsiveness of the UK FIM + FAM. Factor analysis demonstrated that all items loaded high (>0.58) on the first principal component and distinct motor and cognitive factors emerged after rotation. A four-factor solution also demonstrated four distinct, interpretable dimensions (Physical, Psychosocial, Communication and Extended Activities of Everyday Living (EADL)). Mokken analysis of the second data set confirmed these dimensions. Cronbach’s αs were 0.97 and 0.96 for the motor and cognitive domains and 0.90–0.97 for the subscales. Analysis of responsiveness demonstrated “large” effect sizes (0.86–1.29). Conclusions: The UK FIM + FAM, including the newer EADL module, is a valid, reliable scale of functional independence. It has high internal consistency in two domains and four subscales and is responsive to changes occurring in a general inpatient neuro-rehabilitation population.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation , London , UK
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Abstract
In the past 20 years there have been many changes in the way that neurological rehabilitation is delivered worldwide. This is in part a reflection of improved acute medical therapies and intensive care and also related to the development of a more holistic approach to recovery, embracing the principles of the WHO International Classification of Functioning as a model for rehabilitation. Traditionally, rehabilitation services have tended to develop piecemeal according to local resources and need. By definition such services should be driven by a patient-centered approach and thus there is wide variety in service provision nationally and internationally. This chapter describes the background to current service set-ups and provision, exploring models of rehabilitation delivery and common presentations in neurological rehabilitation. Relevant legislation and guidance documents are reviewed. The text provides an overview of different aspects of rehabilitation services including acute and inpatient provision, outpatient services, community-based rehabilitation, residential facilities, and vocational services.
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Affiliation(s)
- Laura A Graham
- Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK.
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Wilkinson D, Sakel M, Camp SJ, Hammond L. Patients With Hemispatial Neglect Are More Prone to Limb Spasticity, but This Does Not Prolong Their Hospital Stay. Arch Phys Med Rehabil 2012; 93:1191-5. [DOI: 10.1016/j.apmr.2012.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/13/2012] [Accepted: 01/16/2012] [Indexed: 11/29/2022]
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Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM. A Prospective Study on Employment Outcome 3 Years After Moderate to Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:993-9. [DOI: 10.1016/j.apmr.2012.01.018] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 01/06/2012] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
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Turner-Stokes L, Williams H, Sephton K, Rose H, Harris S, Thu A. Engaging the hearts and minds of clinicians in outcome measurement - the UK Rehabilitation Outcomes Collaborative approach. Disabil Rehabil 2012; 34:1871-9. [PMID: 22506959 PMCID: PMC3477889 DOI: 10.3109/09638288.2012.670033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article explores the rationale for choosing the instruments included within the UK Rehabilitation Outcomes Collaborative (UKROC) data set. Using one specialist neuro-rehabilitation unit as an exemplar service, it describes an approach to engaging the hearts and minds of clinicians in recording the data. KEY MESSAGES AND IMPLICATIONS Measures included within a national data set for rehabilitation should be psychometrically robust and feasible to use in routine clinical practice; they should also support clinical decision-making so that clinicians actually want to use them. Learning from other international casemix models and benchmarking data sets, the UKROC team has developed a cluster of measures to inform the development of effective and cost-efficient rehabilitation services. These include measures of (1) "needs" for rehabilitation (complexity), (2) inputs provided to meet those needs (nursing and therapy intervention), and (3) outcome, including the attainment of personal goals as well as gains in functional independence. CONCLUSIONS By integrating the use of the data set measures in everyday clinical practice, we have achieved a very high rate of compliance with data collection. However, staff training and ongoing commitment from senior staff and managers are critical to the maintenance of effort required to provide assurance of data quality in the longer term.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK.
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Turner-Stokes L, Poppleton R, Williams H, Schoewenaars K, Badwan D. Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation. Disabil Rehabil 2012; 34:1900-6. [PMID: 22506504 PMCID: PMC3477888 DOI: 10.3109/09638288.2012.670042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. Key messages (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. Conclusion (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London School of Medicine, Department of Palliative Care Policy and Rehabilitation, London, UK.
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Kneebone II, Hull SL, McGurk R, Cropley M. Reliability and Validity of the Neurorehabilitation Experience Questionnaire for Inpatients. Neurorehabil Neural Repair 2012; 26:834-41. [DOI: 10.1177/1545968311431962] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Patient-centered measures of the inpatient neurorehabilitation experience are needed to assess services. Objective. The objective of this study was to develop a valid and reliable Neurorehabilitation Experience Questionnaire (NREQ) to assess whether neurorehabilitation inpatients experience service elements important to them. Methods. Based on the themes established in prior qualitative research, adopting questions from established inventories and using a literature review, a draft version of the NREQ was generated. Focus groups and interviews were conducted with 9 patients and 26 staff from neurological rehabilitation units to establish face validity. Then, 70 patients were recruited to complete the NREQ to ascertain reliability (internal and test-retest) and concurrent validity. Results. On the basis of the face validity testing, several modifications were made to the draft version of the NREQ. Subsequently, internal reliability (time 1 α = .76, time 2 α = .80), test retest reliability ( r = 0.70), and concurrent validity ( r = 0.32 and r = 0.56) were established for the revised version. Whereas responses were associated with positive mood ( r = 0.30), they appeared not to be influenced by negative mood, age, education, length of stay, sex, functional independence, or whether a participant had been a patient on a unit previously. Conclusions. Preliminary validation of the NREQ suggests promise for use with its target population.
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Affiliation(s)
- Ian I. Kneebone
- Surrey Community Health, Leatherhead, UK
- University of Surrey, Guildford, UK
| | - Samantha L. Hull
- Surrey Community Health, Leatherhead, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Rhona McGurk
- Surrey Community Health, Leatherhead, UK
- University of Southampton, Southampton, UK
- Solent NHS, Portsmouth, UK
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