An evaluation of aftercare following discharge from a specialist in-patient rehabilitation service.
OBJECTIVE
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.


METHODS
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.


METHODS
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.
Rusconi
Sue
S
Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK.
Turner-Stokes
Lynne
L
D001930:Brain Injuries / Q000191:economics / Q000534:rehabilitation*; D015331:Cohort Studies; D003153:Community Health Services / Q000592:standards; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009983:Orthopedic Equipment / Q000706:statistics & numerical data; D010351:Patient Discharge; D017060:Patient Satisfaction; D012656:Self-Help Devices / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000191:economics / Q000534:rehabilitation*; D006113:United Kingdom