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Teasell R, Flores-Sandoval C, Bateman EA, MacKenzie HM, Sequeira K, Bayley M, Janzen S. Overview of randomized controlled trials of moderate to severe traumatic brain injury: A systematic review. NeuroRehabilitation 2024; 54:509-520. [PMID: 38669488 DOI: 10.3233/nre-240019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND Given the complexity of post-TBI medical, surgical, and rehabilitative care, research is critical to optimize interventions across the continuum of care and improve outcomes for persons with moderate to severe TBI. OBJECTIVE To characterize randomized controlled trials (RCTs) of moderate to severe traumatic brain injury (TBI) in the literature. METHOD Systematic searches of MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO for RCTs up to December 2022 inclusive were conducted in accordance with PRISMA guidelines. RESULTS 662 RCTs of 91,946 participants published from 1978 to 2022 met inclusion criteria. The number of RCTs published annually has increased steadily. The most reported indicator of TBI severity was the Glasgow Coma Scale (545 RCTs, 82.3%). 432 (65.3%) RCTs focused on medical/surgical interventions while 230 (34.7%) addressed rehabilitation. Medical/surgical RCTs had larger sample sizes compared to rehabilitation RCTs. Rehabilitation RCTs accounted for only one third of moderate to severe TBI RCTs and were primarily conducted in the chronic phase post-injury relying on smaller sample sizes. CONCLUSION Further research in the subacute and chronic phases as well as increasing rehabilitation focused TBI RCTs will be important to optimizing the long-term outcomes and quality of life for persons living with TBI.
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Affiliation(s)
- Robert Teasell
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | | | - Emma A Bateman
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Heather M MacKenzie
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Keith Sequeira
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
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Carroll Á, Sukumar P, O’Keeffe A. The impact of road safety strategy and policy on admissions to a national rehabilitation hospital; a 5-year retrospective review and reflection on trauma data. BMC Health Serv Res 2023; 23:175. [PMID: 36810087 PMCID: PMC9942335 DOI: 10.1186/s12913-023-09177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Globally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe. METHODS A retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher's exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports. RESULTS 338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require. CONCLUSION Data linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.
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Affiliation(s)
- Áine Carroll
- School of Medicine, University College Dublin, D04 V1W8, Belfield, Dublin, Ireland. .,National Rehabilitation University Hospital, Rochestown Avenue, Dun Laoghaire, A96 E2H2, Dublin, Ireland.
| | - Prasanth Sukumar
- grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, D04 V1W8 Belfield, Dublin, Ireland
| | - Aisling O’Keeffe
- grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, D04 V1W8 Belfield, Dublin, Ireland
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Shirazikhah M, Roshanfekr P, Takian A, Alizadeh Zarei M, Shirazikhah A, Joghataei MT. Availability of Physical Rehabilitation Facilities for People with Disabilities in Iran: A Comparative Study on Universal Health Coverage. ARCHIVES OF IRANIAN MEDICINE 2022; 25:698-705. [PMID: 37542402 PMCID: PMC10685876 DOI: 10.34172/aim.2022.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/04/2021] [Indexed: 08/06/2023]
Abstract
BACKGROUND Iran, like many other countries, has committed to providing universal and equal access to health care and rehabilitation for people with disabilities by joining the Convention on the Rights of People with Disabilities. Thus, this study aimed to examine the availability of rehabilitation facilities on national and sub-national levels. METHODS This cross-sectional study was conducted between May and December 2019. The data of rehabilitation facilities including infrastructure and rehabilitation workforce in health system settings were obtained using rehabilitation master list. The data were collected from the Vice-Chancellor for the Treatment Ministry of Health and Medical Education, the Rehabilitation of the State Welfare Organization, and Licensing and Planning the Medical Council in the 32 provinces of Iran and analyzed using Excel version 2016. RESULTS On the national level, the following situation was found: in inpatient settings: 1.1 beds per million population; in outpatient settings: physiotherapy 42.6, optometry 16.4, audiology 10.5,occupational therapy 8.2, speech therapy 8.1, orthotic & prosthetic 4.5, physical medicine & rehabilitation 3.8 centers; day-care centers 11.7 and rehabilitation centers 1.3 centers, community-based rehabilitation (CBR): 15.9 units, rehabilitation home care 2 centers, rehabilitation nursing home care 1.6 centers and medical rehabilitation home care 0.3; Long-term care centers: residential care 4.1 centers per million population. Regarding rehabilitation work force: physiotherapists 84, speech therapists 34.8, occupational therapists 32.5, optometrists 31.2, audiologists 27.9, prosthetists and orthotists 10.3 therapists and physical medicine & rehabilitation 5.1 specialists per million populations. On the sub-national level, there were no outpatient rehabilitation centers in 12 of the provinces and the distribution of day rehabilitation centers in the rich provinces was 10 times higher. The number of CBR units, rehabilitation home care and rehabilitation nursing home were 40, 22, and 23 times higher in rich provinces than in poor provinces, respectively and there were no medical rehabilitation home care centers in 21 provinces. Regarding long-term care, the residential care centers in the richest province were 8 times higher. CONCLUSION According to the WHO report and the rehabilitation expert panel, it was concluded that the number of rehabilitation facilities including rehabilitation centers and workforce was limited in Iran and that the available centers were also poorly distributed in the provinces of the country. This made it difficult for people to have fair access to rehabilitation services. It appears that health policymakers should pay special attention to further developing rehabilitation facilities.
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Affiliation(s)
- Marzieh Shirazikhah
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Payam Roshanfekr
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amirhossein Takian
- Director, Department of Global Health & Public Policy, Tehran University of Medical Sciences, Tehran, Iran
- Vice Dean, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Chief of Research, Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Alizadeh Zarei
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Adeleh Shirazikhah
- Office of the Minister’s Adviser on Rehabilitation, Ministry of Health and Medical Education, Tehran, Iran
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Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial. BMC Health Serv Res 2022; 22:185. [PMID: 35151285 PMCID: PMC8840547 DOI: 10.1186/s12913-022-07585-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Traumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.
Methods
One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER).
Results
The mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU.
Conclusions
Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.
Trial registration
ClinicalTrails.gov NCT03092713.
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Lorenz LS, Doonan M. Value and Cost Savings From Access to Multi-disciplinary Rehabilitation Services After Severe Acquired Brain Injury. Front Public Health 2021; 9:753447. [PMID: 34926379 PMCID: PMC8671747 DOI: 10.3389/fpubh.2021.753447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Acquired brain injury (ABI) is a major global public health problem and source of disability. A major contributor to disability after severe ABI is limited access to multidisciplinary rehabilitation, despite evidence of sustained functional gains, improved quality of life, increased return-to-work, and reduced need for long-term care. A societal model of value in rehabilitation matches patient and family expectations of outcomes and system expectations of value for money. A policy analysis of seven studies (2009-2019) exploring outcomes and cost-savings from access to multi-disciplinary rehabilitation identified average lifetime savings of $1.50M per person, with costs recouped within 18 months. Recommendations: Increase access to multi-disciplinary rehabilitation following severe ABI; strengthen prevention focus; increase access to case management; support return-to-work; and systematically collect outcome and cost data.
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Affiliation(s)
- Laura S. Lorenz
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Li LM, Dilley MD, Carson A, Twelftree J, Hutchinson PJ, Belli A, Betteridge S, Cooper PN, Griffin CM, Jenkins PO, Liu C, Sharp DJ, Sylvester R, Wilson MH, Turner MS, Greenwood R. Management of traumatic brain injury (TBI): a clinical neuroscience-led pathway for the NHS. Clin Med (Lond) 2021; 21:e198-e205. [PMID: 33762387 DOI: 10.7861/clinmed.2020-0336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Following hyperacute management after traumatic brain injury (TBI), most patients receive treatment which is inadequate or inappropriate, and delayed. This results in suboptimal rehabilitation outcome and avoidable detrimental chronic effects on patients' recovery. This worsens long-term disability, and magnifies costs to the individual and society. We believe that accurate diagnosis (at the level of pathology, impairment and function) of the causes of disability is a prerequisite for appropriate care and for accessing effective rehabilitation. An expert-led, integrated care pathway is needed to deliver accurate and timely diagnosis and optimal treatment at all stages during a TBI patient's care.We propose the introduction of a specialist interdisciplinary traumatic brain injury team, led by a neurosciences-trained brain injury consultant. This team would engage acutely and for a longer term after TBI to provide accurate diagnoses, which guides subsequent management and rehabilitation. This approach would also encourage more efficient collaboration between research and the clinic. We propose that the current major trauma network is leveraged to introduce and evaluate this proposal. Improvements to patient outcomes through this approach would lead to reduced personal, societal and economic impact of TBI.
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Affiliation(s)
- Lucia M Li
- Imperial College London, London, UK and UK DRI Care Research & Technology Centre, London, UK
| | - Michael D Dilley
- Atkinson Morley Regional Neuroscience Centre, London, UK and Royal College of Psychiatrists, London, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Jaq Twelftree
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Peter J Hutchinson
- University of Cambridge, Cambridge, UK and Royal College of Surgeons, London, UK
| | - Antonio Belli
- National Institute for Health Research Surgical Reconstruction Research Centre, Birmingham, UK and Institute of Inflammation and Ageing, Birmingham, UK
| | - Shai Betteridge
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Paul N Cooper
- Manchester Centre for Clinical Neurosciences, Manchester, UK
| | | | - Peter O Jenkins
- Epsom and St Helier University Hospitals NHS Trust, London, UK, St George's University Hospitals NHS Foundation Trust, London, UK and Imperial College London, London, UK
| | - Clarence Liu
- Homerton Hospital, London, UK and Barts Health NHS Trust, London, UK
| | - David J Sharp
- Imperial College London, London, UK and UK DRI Care Research & Technology Centre, London, UK
| | | | - Mark H Wilson
- Imperial College Healthcare NHS Trust, London, UK and Imperial College London, London, UK
| | - Martha S Turner
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Richard Greenwood
- National Hospital for Neurology and Neurosurgery, London, UK and Homerton University Hospital NHS Foundation Trust, London, UK
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Covington NV, Duff MC. Heterogeneity Is a Hallmark of Traumatic Brain Injury, Not a Limitation: A New Perspective on Study Design in Rehabilitation Research. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:974-985. [PMID: 33556261 DOI: 10.1044/2020_ajslp-20-00081] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose In both basic science and intervention research in traumatic brain injury (TBI), heterogeneity in the patient population is frequently cited as a limitation and is often interpreted as a factor reducing certainty in the generalizability of research findings and as a source of conflicting findings across studies. Historically, much of TBI research in rehabilitation and cognition has relied upon case-control studies, with small to modest sample sizes. In this context, heterogeneity is indeed a significant limitation. Here, however, we argue that heterogeneity in patient profiles is a hallmark characteristic of TBI and therefore cannot be avoided or ignored. We argue that this inherent heterogeneity must be acknowledged and accounted for prior to study design. Fortunately, advances in statistical methods and computing power allow researchers to leverage heterogeneity, rather than be constrained by it. Method In this article, we review sources of heterogeneity that contribute to challenges in TBI research, highlight methodological advances in statistical analysis and in other fields with high degrees of heterogeneity (e.g., psychiatry) that may be fruitfully applied to decomposing heterogeneity in TBI, and offer an example from our research group incorporating this approach. Conclusion Only by adopting new methodological approaches can we advance the science of rehabilitation following TBI in ways that will impact clinical practice and inform decision making, allowing us to understand and respond to the range of individual differences that are a hallmark in this population.
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Affiliation(s)
- Natalie V Covington
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa C Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Silva MA, Finn JA, Dillahunt-Aspillaga C, Cotner BA, Stevens LF, Nakase-Richardson R. Development of the traumatic brain injury Rehabilitation Needs Survey: a Veterans Affairs TBI Model Systems study. Disabil Rehabil 2021; 44:4474-4484. [PMID: 33756089 DOI: 10.1080/09638288.2021.1900930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery. MATERIALS AND METHODS RNS items were generated following a literature review (January - March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015-2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented. RESULTS Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8-9, and number of unmet needs was 1-2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS. CONCLUSION The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended.Implications for rehabilitationVeterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery.The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury.Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation.
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Affiliation(s)
- Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Jacob A Finn
- Extended Care and Rehabilitation (EC&R) Patient Service Line, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Bridget A Cotner
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Lillian F Stevens
- Mental Health Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,TBI Center of Excellence (TBICoE), James A. Haley Veterans' Hospital, Tampa, FL, USA
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García-Álvarez D, Sempere-Rubio N, Faubel R. Economic Evaluation in Neurological Physiotherapy: A Systematic Review. Brain Sci 2021; 11:265. [PMID: 33669731 PMCID: PMC7922314 DOI: 10.3390/brainsci11020265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 12/31/2022] Open
Abstract
This systematic review was carried out to compile and assess original studies that included economic evaluations of neurological physiotherapy interventions. A thorough search of PubMED, Cochrane and Embase was developed using keywords such as health economics, neurological physiotherapy and cost analysis, and studies published during the last six-year term were selected. A total of 3124 studies were analyzed, and 43 were eligible for inclusion. Among the studies analyzed, 48.8% were interventions for stroke patients, and 13.9% were focused on Parkinson's disease. In terms of the countries involved, 46.5% of the studies included were developed in the UK, and 13.9% were from the USA. The economic analysis most frequently used was cost-utility, implemented in 22 of the studies. A cost-effectiveness analysis was also developed in nine of those studies. The distribution of studies including an economic evaluation in this discipline showed a clear geographic dominance in terms of the pathology. A clear upward trend was noted in the economic evaluation of interventions developed in neurological physiotherapy. However, these studies should be promoted for their use in evidence-based clinical practice and decision-making.
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Affiliation(s)
- David García-Álvarez
- Physiotherapist, Faculty of Physiotherapy, Universitat de València, 46010 Valencia, Spain;
| | - Núria Sempere-Rubio
- Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain;
- Clinical Biomechanics Research Unit (UBIC), Department of Physiotherapy, Universitat de València, 46010 València, Spain
| | - Raquel Faubel
- Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain;
- Joint Research Unit in Biomedical Engineering, IIS La Fe-Universitat Politècnica de València, 46026 Valencia, Spain
- PTinMOTION, Physiotherapy in Motion, Multispeciality Research Group, Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain
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Shirazikhah M, Mirabzadeh A, Sajjadi H, Joghataei MT, Biglarian A, Shahboulaghi FM, Raei M, Sarmadi S. Health services coverage: Physical access to rehabilitation facilities in Tehran compare with the country. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:4. [PMID: 33688513 PMCID: PMC7933624 DOI: 10.4103/jehp.jehp_515_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE According to the World Health Organization, estimates about 1,800,000 people lived with disability in Tehran. Against there is little evidence of physical access to rehabilitation facilities in Tehran. This study is aimed to assess the physical access to physical rehabilitation facilities in Tehran and compare it with the country. METHODS This is a cross-sectional study conducted since January to April 2017. We used a master facilities list of rehabilitation facility that developed in Iran to collect the information. The samples of this study included all existing physical rehabilitation centers in Tehran province. Data analysis was done using the SPSSr version 21.0 (SPSS Inc., Chicago, IL). RESULTS The results showed that rehabilitation facilities existed at different levels, including inpatient (10.51), outpatient (224.28), community based (36.72), and long-term care (4.96)/1,000,000 populations. Rehabilitation services are provided by rehabilitation professional including: Physical medicine and rehabilitation specialists (8.7), physiotherapists (132.89), occupational therapists (57.4), speech therapists (42.11), and audiologists (48.84) (in 1,000,000 populations). CONCLUSION Tehran needs to increase the physical access to rehabilitation facilities and compared with country was disproportionate physical access to facilities in most cases. It is necessary to establish an interdisciplinary referral system between different rehabilitation providers.
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Affiliation(s)
- Marzieh Shirazikhah
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arash Mirabzadeh
- Department of Psychiatry, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Homeira Sajjadi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Taghi Joghataei
- Department of Anatomy and Neuroscience, Cellular and Molecular Research Center, Tehran, Iran School of Medicine, Iran Medical University, Tehran, Iran
| | - Akbar Biglarian
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi Shahboulaghi
- Department of Nursing, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Raei
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sahar Sarmadi
- Medical Student, University of Pécs Medical School, Pécs, Hungary
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Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom. J Head Trauma Rehabil 2020; 34:205-214. [PMID: 30801440 PMCID: PMC6687405 DOI: 10.1097/htr.0000000000000473] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Objectives: To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care. Setting/Participants: TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010–2018. Design: A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Main Measures: Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings. Results: The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786). Conclusions: Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.
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Stolwyk RJ, Gooden JR, Kim J, Cadilhac DA. What is known about the cost-effectiveness of neuropsychological interventions for individuals with acquired brain injury? A scoping review. Neuropsychol Rehabil 2019; 31:316-344. [PMID: 31769336 DOI: 10.1080/09602011.2019.1692672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this scoping review was to examine the literature related to economic evaluations of neuropsychological rehabilitation in individuals with acquired brain injury (ABI). PsychINFO, Medline, EMBASE, Cochrane and CINHAL databases were searched in accordance with formal scoping review methodology. Studies were included if published between 1995 and 2019 with a study population of adults aged 18 years or more with any ABI aetiology and there was reported data on resource use, costs or comparative economic analyses as part of an outcome study for rehabilitation interventions. Case studies and trial protocols were excluded. Of 3575 records screened, 30 articles were identified as meeting the inclusion criteria. The majority of studies documented cost savings from provision of various models of multidisciplinary inpatient or outpatient rehabilitation. However, these benefits were estimated without a control group. Eight studies included a cost-effectiveness analysis, and in three, the intervention was reported to be cost-effective compared to the control, one of which saved $9,654 per treated patient. Overall, few eligible studies were identified. Those that included a cost-effectiveness analysis yielded mixed evidence for interventions to be considered cost-effective for ABI. Recommendations for how to incorporate cost-effectiveness analyses into intervention studies are discussed.
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Affiliation(s)
- Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - James R Gooden
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Duarte A, Bojke C, Cayton W, Salawu A, Case B, Bojke L, Richardson G. Impact of specialist rehabilitation services on hospital length of stay and associated costs. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1027-1034. [PMID: 29282588 PMCID: PMC6105206 DOI: 10.1007/s10198-017-0952-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Provision of specialist rehabilitation services in North Yorkshire and Humberside may be suboptimal. Local commissioning bodies need to prioritise investments in health care, but previous studies provide limited evidence to inform the decision to expand existing services on the basis of cost-effectiveness. We examine the impact of specialist rehabilitation services in the subregion on hospital length of stay (LoS) and associated costs compared to routine care. METHODS Comparison of hospital LoS and associated costs in centres with greater access (Hull) and limited access (i.e. routine care, York and Northern Lincolnshire), to specialist rehabilitation services for patients with complex disabilities following illness or injury, using Hospital Episodes Statistics data. RESULTS Average LoS and duration costs by Healthcare Resource Group (HRG) were lower for the majority of patients with greater access to specialist rehabilitation compared to routine care. Difference in LoS between groups widened with level of complexity within each HRG. For the more frequent HRG codes, the LoS difference was as high as 34 days longer for York compared to Hull and £7900 more costly. CONCLUSION Rehabilitation patients within York and Northern Lincolnshire areas appear to have longer LoS and higher associated costs compared to those admitted to the Hull Trust. This analysis suggests that specialist rehabilitation may be cost saving compared to routine care and supports the case for expansion of the existing services to improve coverage in the area.
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Affiliation(s)
- A Duarte
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
| | - C Bojke
- Faculty of Medicine and Health, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
| | - W Cayton
- Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - A Salawu
- Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
- Hull York Medical School, Hull, HU6 7RX, UK
- Department of Health, Sports and Exercise Science, University of Hull, Hull, HU6 7RX, UK
| | - B Case
- NHS Vale of York Clinical Commissioning Group, York, YO1 6GA, UK
| | - L Bojke
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - G Richardson
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
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Rosenbaum AM, Gordon WA, Joannou A, Berman BA. Functional outcomes following post-acute rehabilitation for moderate-to-severe traumatic brain injury. Brain Inj 2018; 32:907-914. [DOI: 10.1080/02699052.2018.1469040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Amy M. Rosenbaum
- Traumatic Brain Injury Rehabilitation Department, Park Terrace Care Center, Rego Park, NY, USA
| | - Wayne A. Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antigone Joannou
- Traumatic Brain Injury Rehabilitation Department, Park Terrace Care Center, Rego Park, NY, USA
| | - Brady A. Berman
- Traumatic Brain Injury Rehabilitation Department, Park Terrace Care Center, Rego Park, NY, USA
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