PURPOSE: To evaluate the aftercare of patients discharged from specialist rehabilitation unit with respect to use of equipment and follow-up by therapy and care services and to assess change in dependency and care needs. DESIGN: Cross-sectional survey of a consecutive cohort of patients discharged from a regional rehabilitation unit with reference to the British Society of Rehabilitation Medicine (BSRM) standards for rehabilitation services. SUBJECTS AND METHODOLOGY: Fifty-three subjects with neurological disability were discharged during a 15-month period. Structured interviews conducted by telephone with the patient (n = 22) or carer (n = 31) between 8 and 21 (mean 15) months after discharge. Dependency and care needs were assessed using the Northwick Park Dependency Score (NPDS) and Care Needs Assessment (NPCNA) RESULTS: Approximately half the patients improved in dependency and care needs between discharge and follow-up, but a quarter deteriorated. Fifty-one (96%) were referred for continuing therapy of which 39% expressed dissatisfaction. There was a significant relationship between inadequate therapy follow-up and increased dependency (Chi Squared p = 0.002). However, where care packages were revised downwards this generally reflected improvement in independence and therefore reduced need. Fourteen (26%) discontinued use of equipment early after discharge since they found it unacceptable or unhelpful. Seventeen (38%) of this population experienced late seizures. CONCLUSIONS: Specialist rehabilitation in this group of severely disabled brain injured patients with complex needs can result in sustained improvement of function with resultant reduced care needs. However, appropriately skilled community-based services are required to maintain and build on the benefits, and are currently lacking in many districts. In particular, psychological support was notably absent. A possible relationship between late onset seizures and the use of anti-depressant medication requires further exploration, which is currently underway.
PURPOSE: To evaluate the aftercare of patients discharged from specialist rehabilitation unit with respect to use of equipment and follow-up by therapy and care services and to assess change in dependency and care needs. DESIGN: Cross-sectional survey of a consecutive cohort of patients discharged from a regional rehabilitation unit with reference to the British Society of Rehabilitation Medicine (BSRM) standards for rehabilitation services. SUBJECTS AND METHODOLOGY: Fifty-three subjects with neurological disability were discharged during a 15-month period. Structured interviews conducted by telephone with the patient (n = 22) or carer (n = 31) between 8 and 21 (mean 15) months after discharge. Dependency and care needs were assessed using the Northwick Park Dependency Score (NPDS) and Care Needs Assessment (NPCNA) RESULTS: Approximately half the patients improved in dependency and care needs between discharge and follow-up, but a quarter deteriorated. Fifty-one (96%) were referred for continuing therapy of which 39% expressed dissatisfaction. There was a significant relationship between inadequate therapy follow-up and increased dependency (Chi Squared p = 0.002). However, where care packages were revised downwards this generally reflected improvement in independence and therefore reduced need. Fourteen (26%) discontinued use of equipment early after discharge since they found it unacceptable or unhelpful. Seventeen (38%) of this population experienced late seizures. CONCLUSIONS: Specialist rehabilitation in this group of severely disabled brain injured patients with complex needs can result in sustained improvement of function with resultant reduced care needs. However, appropriately skilled community-based services are required to maintain and build on the benefits, and are currently lacking in many districts. In particular, psychological support was notably absent. A possible relationship between late onset seizures and the use of anti-depressant medication requires further exploration, which is currently underway.
Authors: Seok Hun Kim; David E Huizenga; Ismet Handzic; Rebecca Edgeworth Ditwiler; Matthew Lazinski; Tyagi Ramakrishnan; Andrea Bozeman; David Z Rose; Kyle B Reed Journal: J Neuroeng Rehabil Date: 2019-08-28 Impact factor: 4.262