Dataset Information

A longitudinal, multicentre, cohort study of community rehabilitation service delivery in long-term neurological conditions.

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.

SUBMITTER: Siegert RJ

PROVIDER: S-EPMC3939653 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

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Publications

A longitudinal, multicentre, cohort study of community rehabilitation service delivery in long-term neurological conditions.

Siegert Richard J RJ Jackson Diana M DM Playford E Diane ED Fleminger Simon S Turner-Stokes Lynne L

BMJ open 20140228 2

<h4>Objectives</h4>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.<h4>Design</h4>A multicentre, prospective, coho ...[more]

PMID: 24583762

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Project description:BackgroundPhysical rehabilitation is often prescribed immediately following a neurological event or a neurological diagnosis. However, many individuals require physical rehabilitation after hospital discharge. The purpose of this scoping review was to determine the amount of physical rehabilitation that individuals living in the community with neurological conditions receive to understand current global practices and assess gaps in research and service use.MethodsThis scoping review included observational studies that 1) involved adults living with a neurological condition, and 2) quantified the amount of rehabilitation being received in the community or outpatient hospital setting. Only literature published in English was considered. MEDLINE, EMBASE, AMED, CINAHL, Cochrane Library, and PEDro databases were searched from inception. Two independent reviewers screened titles and abstracts, followed by full texts, and data extraction. Mean annual hours of rehabilitation was estimated based on the amount of rehabilitation reported in the included studies.ResultsOverall, 18 studies were included after screen 14,698 articles. The estimated mean annual hours of rehabilitation varied greatly (4.9 to 155.1 h), with individuals with spinal cord injury and stroke receiving the greatest number of hours. Participants typically received more physical therapy than occupational therapy (difference range: 1 to 22 h/year). Lastly, only one study included individuals with progressive neurological conditions, highlighting a research gap.DiscussionThe amount of rehabilitation received by individuals with neurological conditions living in the community varies greatly. With such a wide range of time spent in rehabilitation, it is likely that the amount of rehabilitation being received by most individuals in the community is insufficient to improve function and quality of life. Future work should identify the barriers to accessing rehabilitation resources in the community and how much rehabilitation is needed to observe functional improvements.

Project description:BackgroundNeurological conditions and mental health problems are common in children in low- and middle-income countries, but the risk factors and downstream impact of these problems on children with neurological conditions are not reported.ObjectiveTo determine the association of neurological conditions with behavioural and emotional problems in children, the prevalence and risk factors of behavioural and emotional problems, and long-term impact of these conditions.MethodsData on multiple neurological conditions and mental health problems were available for 1,616 children (aged 6-9 years) from Kilifi, Kenya. Neurological conditions were diagnosed using standardised tools and clinical examination. Behavioural and emotional problems assessed using Child Behaviour Questionnaire for Parents. Long-term outcomes were obtained from census data of the Kilifi Health and Demographic Surveillance System. Logistic and linear regression were used to measure associations.ResultsMental health problems were higher in those with any neurological condition compared to those without (24% vs. 12%, p < 0.001). Cognitive (odds ratio (OR) = 2.39; 95% CI: 1.59-3.59), motor (OR = 3.17; 95% CI: 1.72-5.82), hearing (OR = 2.07; 95% CI:1.12-3.83) impairments, and epilepsy (OR = 4.18; 95% CI: 2.69-6.48), were associated with mental health problems. Prevalence of any mental health problem was 15%, with externalizing problems more common than internalizing problems (21% vs. 17%, p = 0.004). Longitudinal follow-up indicated that the disorders affected an individual's future schooling (e.g. OR = 1.25; 95% CI: 0.14-1.46 following cognitive impairments), occupation (OR = 2.44; 95% CI: 1.09-5.44 following mental health problems), and access to household assets (OR = 2.78; 95% CI: 0.99-7.85 following epilepsy).ConclusionsNeurological conditions in school-aged children in Kilifi are associated with mental health problems, and both disorders have long-term consequences. Preventive and therapeutic measures for these conditions are needed to improve outcomes of these children.

Dataset Information

A longitudinal, multicentre, cohort study of community rehabilitation service delivery in long-term neurological conditions.

Objectives

Design

Setting

Participants

Measures

Results

Conclusions

Registration

Publications

A longitudinal, multicentre, cohort study of community rehabilitation service delivery in long-term neurological conditions.

Similar Datasets

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