Evaluating neurorehabilitation: lessons from routine data collection

J Neurol Neurosurg Psychiatry, 2005 · DOI: 10.1136/jnnp.2004.035956 · Published: May 1, 2005

Simple Explanation

Clinical databases are increasingly used to assess healthcare outcomes and provide evidence of effectiveness in routine practice. This study explores the benefits of using a clinical database to collect outcome data within an inpatient neurorehabilitation setting. The study also aims to determine the effectiveness of inpatient neurorehabilitation for neurological conditions and factors influencing functional outcome changes.

Study Duration

9 Years

Participants

1458 patients admitted consecutively to a neurorehabilitation unit

Evidence Level

Not specified

Key Findings

1
Patients in the neurorehabilitation unit showed improvements in functional ability, as measured by the Barthel Index (BI) and Functional Independence Measure (FIM).
2
Patient-rated visual analogue scales (VAS) indicated high levels of perceived benefit from the rehabilitation process.
3
Diagnosis, functional activity score on admission, and length of stay were significant predictors of functional gain.

Research Summary

This study demonstrates that systematic collection, analysis, and interpretation of standardised clinical outcomes data are feasible within routine clinical practice. Inpatient rehabilitation is effective in improving functional level in neurologically impaired patients. The data from this study can inform and develop clinical and research practice.

Practical Implications

Informing Clinical Practice

Databases provide a focus for monitoring caseload, enabling systematic accrual of information about less common conditions.

Research Applications

Databases offer valuable objective data for sample size calculations in clinical trials and facilitate quick assessment of patient recruitment feasibility.

Service Development

Easy access to data on disability severity and patient-reported problems can facilitate the development of performance-oriented and accountable rehabilitation systems.

Study Limitations

1
The Barthel Index (BI) showed a significant ceiling effect, potentially underestimating change for approximately 10% of the sample.
2
Disparities exist between changes recorded by objective functional measures and patient-reported outcomes.
3
Only 44% of the variance in functional outcome could be accounted for by the model used in the study.

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