The value of the Rehabilitation Activities Profile (RAP) as a quality sub-system in rehabilitation medicine.
OBJECTIVE
To determine whether interdisciplinary team care, using the Rehabilitation Activities Profile (RAP) as a team tool, results in a better rehabilitation outcome.


METHODS
A multilevel prospective cohort study, with a controlled before and after design. Eighteen rehabilitation teams in eight rehabilitation centres in the Netherlands and Belgium participated. Based on the level of implementation of the RAP, we compared three study groups. Consecutive adult patients (n = 933) with stroke, amputation of the lower limb, spinal cord injury, multiple sclerosis, or other neuromuscular disorders, were followed during inpatient or outpatient rehabilitation. Main outcome measures were Barthel Index, RAP-CPM (sum score of the domains communication, personal care and mobility), Nottingham Health Profile (NHP), length of rehabilitation (LOR) and discharge destination (home vs elsewhere).


RESULTS
Overall results show that scores on the Barthel Index, the RAP-CPM and the NHP improved, on average, by 18.4%, 12.7%, and 6.7%, respectively. However, treatment from a rehabilitation team that uses the RAP was associated with a significantly lower Barthel score, and small, non-significant effects on the RAP-CPM and the NHP. Partial use of the RAP resulted in non-significant, lower scores on these measures. With respect to discharge destination and LOR, there were also no significant differences between the three study groups, with the exception of a shorter outpatient rehabilitation period for the group in which partial use was made of the RAP.


CONCLUSIONS
The RAP, at the current level of implementation, does not improve rehabilitation outcome.
Beckerman
Heleen
H
Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. h.beckerman@vumc.nl
Roelofsen
Eline
E
Knol
Dirk
D
Lankhorst
Gustaaf
G
D000203:Activities of Daily Living; D000368:Aged; D001530:Belgium; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011446:Prospective Studies; D018434:Sickness Impact Profile