Functional outcomes and efficiency of rehabilitation in a national cohort of patients with Guillain-Barré syndrome and other inflammatory polyneuropathies.
OBJECTIVE
To describe functional outcomes, care needs and cost-efficiency of hospital rehabilitation for a UK cohort of inpatients with complex rehabilitation needs arising from inflammatory polyneuropathies.


METHODS
186 patients consecutively admitted to specialist neurorehabilitation centres in England with Guillain-Barré Syndrome (n = 118 (63.4%)) or other inflammatory polyneuropathies, including chronic inflammatory demyelinating polyneuropathy (n = 15 (8.1%) or critical illness neuropathy (n = 32 (17.2%)).


METHODS
Cohort analysis of data from the UK Rehabilitation Outcomes Collaborative national clinical dataset. Outcome measures include the UK Functional Assessment Measure, Northwick Park Dependency Score (NPDS) and Care Needs Assessment (NPCNA). Patients were analysed in three groups of dependency based on their admission NPDS score: 'low' (NPDS<10), 'medium' (NPDS 10-24) and 'high' (NPDS ≥ 25). Cost-efficiency was measured as the time taken to offset the cost of rehabilitation by savings in NPCNA-estimated costs of on-going care in the community.


RESULTS
The mean rehabilitation length of stay was 72.2 (sd = 66.6) days. Significant differences were seen between the diagnostic groups on admission, but all showed significant improvements between admission and discharge, in both motor and cognitive function (p<0.0001). Patients who were highly dependent on admission had the longest lengths of stay (mean 97.0 (SD 79.0) days), but also showed the greatest reduction in on-going care costs (£1049 per week (SD £994)), so that overall they were the most cost-efficient to treat.


CONCLUSIONS
Patients with polyneuropathies have both physical and cognitive disabilities that are amenable to change with rehabilitation, resulting in significant reduction in on-going care-costs, especially for highly dependent patients.
Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King's College London, London, United Kingdom.
Roxana
R
Alexandrescu
School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Auckland University of Technology, Auckland, New Zealand.
Richard John
RJ
Siegert
Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King's College London, London, United Kingdom; Regional Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom.
Lynne
L
Turner-Stokes
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D004739:England / Q000453:epidemiology; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology / Q000534:rehabilitation*; D062489:Health Impact Assessment; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011115:Polyneuropathies / Q000453:epidemiology / Q000534:rehabilitation*; D012307:Risk Factors; D012720:Severity of Illness Index