Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource

The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness

THE PROBLEM

Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19.

HISTORY

Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided using other names (e.g. intermediate care). Patients with complex needs do not fit easily within this system.

SYSTEM FAILURE

After Covid-19, patients have problems that cross existing condition-specific and/or treatment-specific services. Covid-19 has exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services. Consequently, in order to have their needs met, patients either have to engage with two or more separate services or they receive good management for some problems and sub-optimal management for other problems.

THE GOALS

The multitude of small specific services need to coalesce into an integrated service able to meet all the needs of any patient referred. Second, rehabilitation needs to be fully integrated into all healthcare services.

A SOLUTION

The purpose of healthcare is to 'improve our health and well-being . . . to stay as well as we can to the end of our lives'. (NHS constitution) All healthcare services need to consider patients holistically, giving equal attention to disease, disability, and distress. Rehabilitation, acute care, mental health and palliative care services need to work in parallel to achieve this purpose. Healthcare providers, supported by commissioners and rehabilitation experts, could achieve structural and organisational change, meeting the needs of patients.

Promoting the use of outcome measures across disciplines through action research with practitioners in a palliative care setting

Background/Aim

Allied health professionals aspire to become evidence-based practitioners but disparity exists between best practice and clinical practice. One example is outcome measurement; despite being committed to using outcome measures, allied health professionals struggle to use them. This study aimed to explore the process of introducing outcome measures into a practice setting.

Methods

A qualitative action research study was undertaken with allied health professionals working in a hospice setting. The data, collected in three cycles of action, were analysed thematically.

Findings

Three themes emerged: the gap between knowledge and practice, the challenges of measuring outcomes in palliative care, and facilitators to using outcome measures in palliative care. Action research provided a structure to involve therapists in introducing outcome measures within a practice setting.

Conclusions

This study provides insight into how a clinical speciality's discrete characteristics influence the process of selecting outcome measures. In a hospice setting, where people have life-shortening conditions, the challenges for using outcome measures are different to other settings. Action research offers a deep learning opportunity and process, through education, discussion, and critique, to support therapists to select and adopt the outcome measures to use in practice.

Rasch analysis of the participation scale (P-scale): usefulness of the P-scale to a rehabilitation services network

Background

A person’s participation is acknowledged as an important outcome of the rehabilitation process. The Participation Scale (P-Scale) is an instrument that was designed to assess the participation of individuals with a health condition or disability. The scale was developed in an effort to better describe the participation of people living in middle-income and low-income countries. The aim of this study was to use Rasch analysis to examine whether the Participation Scale is suitable to assess the perceived ability to take part in participation situations by patients with diverse levels of function.

Methods

The sample was comprised by 302 patients from a public rehabilitation services network. Participants had orthopaedic or neurological health conditions, were at least 18 years old, and completed the Participation Scale. Rasch analysis was conducted using the Winsteps software.

Results

The mean age of all participants was 45.5 years (standard deviation = 14.4), 52% were male, 86% had orthopaedic conditions, and 52% had chronic symptoms. Rasch analysis was performed using a dichotomous rating scale, and only one item showed misfit. Dimensionality analysis supported the existence of only one Rasch dimension. The person separation index was 1.51, and the item separation index was 6.38. Items N2 and N14 showed Differential Item Functioning between men and women. Items N6 and N12 showed Differential Item Functioning between acute and chronic conditions. The item difficulty range was −1.78 to 2.09 logits, while the sample ability range was −2.41 to 4.61 logits.

Conclusions

The P-Scale was found to be useful as a screening tool for participation problems reported by patients in a rehabilitation context, despite some issues that should be addressed to further improve the scale.

An evaluation of Therapy Outcome Measures (TOMs) in community rehabilitation

Background/Aims:

This study considers the feasibility of using Therapy Outcome Measure (TOMs) in a community rehabilitation therapy team working with patients over 65 years of age.

Methods:

An action research approach was used. Data collection and analysis included completion of the outcome measure scores over a 22-week period through semi-structured individual interviews with the therapy team participants, group reflections and the researcher's reflections.

Results:

Sixty-seven patients were considered in this study, with 26 patient scores included. Nineteen (73%) of those scored for admission and discharge demonstrated sensitivity, with a difference of one score or more. However, the study participants agreed that the TOMs scales and descriptors did not best describe their patient group. They acknowledged that the study had included a small sample size.

Conclusions:

TOMs was agreed to be an ‘OK fit’ for community rehabilitation patients rather than a ‘best fit’. It should be used as part of a variety of outcome measures to evidence the multidimensional aspects of this speciality, where patients have complex needs and therefore require more complex interventions. This study also highlights the need for further research with a larger sample size.