Functional Outcomes and Efficiency of Rehabilitation in a National Cohort of Patients with Guillain - Barré Syndrome and Other Inflammatory Polyneuropathies

Abstract

ObjectivesTo 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 Setting186 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%)).MethodsCohort 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.ResultsThe 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.ConclusionsPatients 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.

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

“…The literature contains a number of other analyses from large multi-centre rehabilitation datasets–notably held by Uniform Data Systems in the USA which is undoubtedly the largest in the world. Previous reports (including other published analyses of the AROC dataset) have tended to focus on single conditions, such as stroke[ 2 , 17 , 18 ], traumatic brain injury[ 3 ], spinal cord injury[ 19 , 20 ] multiple sclerosis[ 21 , 22 ] or Guillain-Barré Syndrome[ 23 , 24 ]. These have either provided a general description for benchmarking information[ 2 , 3 , 22 , 23 ] or compare outcomes across different rehabilitation settings[ 17 ] or for different racial and ethnic groups[ 18 ].…”

Systematic literature review of burden of illness in chronic inflammatory demyelinating polyneuropathy (CIDP)

“…All humanistic burden studies were real-world studies, and included data derived from analyses of trial patient cohorts, clinical patient examinations, or surveys of patient member organisations [7][8][9][24][25][26][27]. The studies included populations from the UK (n = 2), Netherlands (n = 1), Germany (n = 1), and multinational (n = 1) studies, while the geographies of two studies were not reported [7][8][9][24][25][26][27]. Humanistic burden studies reported on the patient impact of CIDP on health-related quality of life (HRQoL), functioning, psychosocial welfare, productivity, pain, and fatigue [7-9, 24, 25].…”

Manifestaciones neurológicas periféricas en la infección por Sars-CoV-2: enfoque desde la Medicina Física y la Rehabilitación

“…No se conocen tampoco datos de estudios imagenológicos musculares, histopatológicos o electromiográficos específicos, dado que se ha reducido el número de estudios por la alta tasa de contagio de la infección 38 . Aún más grave es el impacto que estas manifestaciones tienen en pacientes con comorbilidad neuromuscular de base, como aquellos pacientes con diagnóstico de esclerosis lateral amiotrófica (ELA), atrofia muscular espinal, neuropatías hereditarias, miopatías metabólicas y distrofias musculares, quienes tendrían un riesgo aumentado de padecer manifestaciones severas por la infección Covid-19 39 .…”

“…Los servicios de rehabilitación también se han visto afectados por la pandemia del Covid-19, lo cual conlleva cambios radicales, tanto en la organización, como en los métodos operativos y de ejecución de las actividades, sin olvidar la incidencia en la rentabilidad de estos 39 .…”

“…desenlace de las complicaciones, lo que se traduce en una mejor funcionalidad, independencia y calidad de vida, así como un menor número de reingresos hospitalarios y costos para el sistema de salud39,42 . Se puede considerar que la rehabilitación después del Covid-19 se asemeja a las intervenciones ofrecidas en rehabilitación geriátrica en quienes han sido afectados por una enfermedad o lesión40 .…”