Siegert, R. J., Jackson, D. M., Playford, E. Diane, Fleminger, S. and Turner-Stokes, L. (2014) A longitudinal, multicentre, cohort study of community rehabilitation service delivery in long-term neurological conditions. BMJ Open, 4 (2). e004231. doi:10.1136/bmjopen-2013-004231 ISSN 2044-6055.

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Abstract

Objectives Part A: To pilot the use of a register to identify and monitor patients with complex needs arising from long-term neurological conditions. Part B: To determine the extent to which patients’ needs for health and social services are met following discharge to the community after inpatient rehabilitation; to identify which factors predict unmet needs and to explore the relationship between service provision and outcomes at 12 months.
Design A multicentre, prospective, cohort study surveying participants at 1, 6 and 12 months using postal/online questionnaires and telephone interview.
Setting Consecutive discharges to the community from all nine tertiary, specialist, inpatient neurorehabilitation services in London over 18 months in 2010–2011.
Participants Of 576 admissions 428 patients were recruited at discharge: 256 responded at 4 weeks, 212 at 6 months and 190 at 12 months.
Measures Neurological Impairment Scale, The Needs and Provision Complexity Scale, The Northwick Park Dependency Scale, Community Integration Questionnaire, Zarit Burden Inventory.
Results n=322 (75%) expressed willingness to be registered, but in practice less than half responded to questionnaires at 6 and 12 months (49% and 44%, respectively), despite extensive efforts to contact them, with no significant differences between responders and non-responders. Significant unmet needs were identified within the first year following discharge, particularly in rehabilitation, social work support and provision of specialist equipment. Dependency for basic care and motor and cognitive impairment predicted services received, together accounting for 40% of the variance. Contra to expectation, patients whose rehabilitation needs were met were more dependent and less well integrated at 12 months post discharge than those with unmet needs.
Conclusions Registration is acceptable to most patients, but questionnaires/telephone interviews may not be the most efficient way to reach them. When community resources are limited, service provision tends to be focused on the most dependent patients.
Registration The study was registered with the NIHR Comprehensive Local Research Network: ID number 7503

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Neurological nursing -- Management, Brain damage -- Patients -- Rehabilition, Home care services
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	28 February 2014
Dates:	Date Event 28 February 2014 Published 24 January 2014 Accepted 1 October 2013 Submitted
Volume:	4
Number:	2
Number of Pages:	15
Article Number:	e004231
DOI:	10.1136/bmjopen-2013-004231
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Funder:	National Institute for Health Research (Great Britain). Health Services and Delivery Research (NIHR HS&DR)
Grant number:	08/1809/235
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