title: Using reliability of change analysis to evaluate post-acute neuro-rehabilitation.
abstract: BACKGROUND
  It is important to evaluate change in order to re-assure commissioners, staff and patients of the effectiveness of interventions, but also in order to identify areas for improvement.
  
  
  OBJECTIVE
  To consider whether analysis of improvement at the level of the individual, taking into account measurement error, may offer a further valuable way to assess change and inform service development over considering change at the group level in a post-acute neuro-rehabilitation unit.
  
  
  METHODS
  Pre and post intervention Scores on the FIM+FAM Full Scale and Cognitive and Motor subscales were considered for eighteen patients aged between 35 and 81 with mixed diagnoses who attended a post-acute inpatient neuro-rehabilitation unit for treatment.
  
  
  RESULTS
  Statistically significant improvements were achieved on the FIM+FAM Full Scale and Cognitive and Motor subscales in a whole group analysis. Reliable change analyses for each patient within each subscale however identified only half of the sample achieved reliable improvement within the Motor domain and just one person within the Cognitive domain (5.6%).
  
  
  CONCLUSIONS
  Findings are consistent with the emphasis of the rehabilitation unit on physical/motor function, and unsurprising as many of those assessed had multiple sclerosis, an often deteriorative condition. Use of reliable change analysis allowed a more detailed understanding of intervention impact, potentially identifying what services reliably work for whom, thereby informing future planning.
authors.affiliation: University of Surrey, School of Psychology, Guildford, UK.|Sussex Partnership NHS Foundation Trust, Worthing, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Palmer
authors.affiliation: Virgin Care, Department of Psychology, Haslemere, UK.|University of Technology Sydney, Discipline of Clinical Psychology, Sydney, Australia.
authors.forename: Ian I
authors.initials: II
authors.lastname: Kneebone
authors.affiliation: Sussex Partnership NHS Foundation Trust, Worthing, UK.|University of Sussex, School of Psychology, Brighton, UK.
authors.forename: Clara
authors.initials: C
authors.lastname: Strauss
authors.affiliation: Sussex Partnership NHS Foundation Trust, Worthing, UK.
authors.forename: Anna-Marie
authors.initials: AM
authors.lastname: Jones
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000534:rehabilitation*; D000066530:Neurological Rehabilitation / Q000592:standards* / Q000639:trends; D010808:Physical Examination / Q000592:standards / Q000639:trends; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Neurorehabilitation; neurodisability; neurological illness; reliable change analysis