Comparison of Rehabilitation Outcomes for Long Term Neurological Conditions: A Cohort Analysis of the Australian Rehabilitation Outcomes Centre Dataset for Adults of Working Age

Abstract

ObjectiveTo 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.DesignAnalysis of a large Australian prospectively collected dataset for completed IPR episodes (n = 28,596) from 2003-2012.MethodsDe-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.ResultsMean 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.ConclusionAll 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.

Effects of a rehabilitation program for individuals with chronic spinal cord injury in Shanghai, China

“…However, the gains in skills were not consistent across all domains, and some family and social skill items still needed further attention. The results were consistent with a previous study in Australia [16], which described significant motor FIM score improvement in inpatient rehabilitation for adults of SCI. Of course, the fact that scores did not change for eating, grooming, walking, and using stairs is to be expected [16,30].…”

“…The results were consistent with a previous study in Australia [16], which described significant motor FIM score improvement in inpatient rehabilitation for adults of SCI. Of course, the fact that scores did not change for eating, grooming, walking, and using stairs is to be expected [16,30]. More research is needed to understand how to improve these scores further within the SIBR and CBR settings.…”

“…There has been extensive research into SCI rehabilitation in developed countries [16,17]. However, existing research on SCI rehabilitation in China focuses on acute or sub-acute hospital-based interventions [18][19][20], and little research has examined the effectiveness of CBRs in China [21,22]; to the best of our knowledge, the effects of an SIBR service for individuals with chronic spinal cord injury (CSCI) have not yet been studied in China.…”

Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes

“…The improvements made by heart and/or lung transplant recipients in the present study compare favorably with published rehabilitation outcomes of other patient populations. An average FIM gain of 22 points is considered a clinically important change, and is comparable in magnitude to improvements reported by national rehabilitation databases for large patient cohorts with debility and neurologic conditions . Similarly, mobility improvements in the present study well exceeded minimal clinically important differences reported for cardiopulmonary populations: 6MWT gains greater than 50 m are typically considered significant in most disease states (here, improvements averaged 79.6 m); and Berg Balance Scale improvements of greater than 7 points are considered clinically meaningfull (here, improvements averaged 18.2 points).…”

The Process of Patient Engagement in Outpatient Cardiac Rehabilitation Programs

“…One questionnaire measured goal engagement and goal satisfaction, which accounted for a number of factors: how well goals matched patient priorities for rehabilitation; the extent to which patients agreed with the goals; the extent of choices available regarding goals; and the extent to which patients felt involved with/in charge of the goal-setting process. This questionnaire consisted of one item with a Likert-type scale ranging from excellent to none (Turner-Strokes et al, 2015).…”