Team approach versus ad hoc health services for young people with physical disabilities: a retrospective cohort study.
BACKGROUND
Young people with physical disabilities often have difficulty attaining independence in adult life and consequently need lifelong support from parents and from health-care and social-care services. There are concerns about the organisation and cost-effectiveness of such services and their ability to meet the independence training and serious health needs of these young people. Our aim was to compare a young adult team (YAT) approach with the ad hoc service approach in four locations in England, in terms of their ability to enhance the participation in society of these young people and their cost.


METHODS
We did a retrospective cohort study, in which we interviewed 254 physically disabled young people. 124 healthy controls were given a questionnaire. We interviewed with standardised measures and used logistic regression analysis to test for effects of ad hoc and YAT services. The Mantel-Haenszel chi2 statistic was used to test for differences in resource use between areas in which the YAT and ad hoc services were available.


RESULTS
The absence of pain, fatigue, and stress increased the odds of participation two-fold to four-fold. After adjustment for these factors, young people cared for by multidisciplinary YAT teams were 2.54 times (95% CI 1.30-4.98) more likely than those who used ad hoc services to participate in society. Resource use did not differ between the two service types.


CONCLUSIONS
A YAT approach costs no more to implement than an ad hoc approach, and is more likely to enhance participation in society of young people with physical disabilities.
Bent
N
N
Academic Unit of Musculoskeletal and Rehabilitation Medicine, University of Leeds, Leeds, UK.
Tennant
A
A
Swift
T
T
Posnett
J
J
Scuffham
P
P
Chamberlain
M A
MA
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D012044:Regression Analysis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires