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. 2011 Jun;11(3):299. doi: 10.7861/clinmedicine.11-3-299a

What reductions in dependency cost result from treatment in an inpatient neurological rehabilitation unit for people with stroke?

Nosa Akporehwe 1, Kerstin Akporehwe 2, Rajib Purkayastha 1
PMCID: PMC4953338  PMID: 21905317

Editor – We read with keen interest, the very timely study of O'Connor et al (Clin Med Feb 2011 pp 40–3). It was reassuring to note the significant reduction in dependency, dependency costs and improvement in functional ability as measured using the median Barthel index in stroke patients who have undergone goal-oriented multidisciplinary inpatient neurological rehabilitation. This is pertinent in the current financial climate where commissioning of healthcare is about to be radically transformed from primary care trusts to GP consortia with no robust evidence, including pilot study, to back such a monumental change within the NHS.

Although the study did not mention the formal follow-up of the cohort of stroke patients in a dedicated outpatient clinic and community therapy team after inpatient rehabilitation, we wonder if the team has any data regarding further improvement in physical ability or further reduction in dependency and dependency costs subsequent to follow-up in a dedicated outpatient clinic in conjunction with outpatient or community therapy input.

It is possible that any additional data to support further gains after inpatient rehabilitation, either by a dedicated community team led by rehabilitation medicine physicians or by general practitioners with an interest in stroke or neurological disability, would in no small measure help drive home the message of the beneficial impact of both inpatient and outpatient input in stroke patients by all and sundry, including commisioners. The potential savings on scanty resources and the improvement of the quality of life of stroke patients cannot be overemphasised.

Clinical Medicine. 2011 Jun;11(3):299–300.

What reductions in dependency cost result from treatment in an inpatient neurological rehabilitation unit for people with stroke?

Rory O'Connor 1, Clarissa Martyn-Hemphill 2, Catriona Mcnicol 2, Rory Morrison 2

Editor – We would like to thank Akporehwe et al for their interest in our study. Recently, we had the opportunity to investigate the reduction in dependency and care costs associated with a newly established goal-orientated multidisciplinary community stroke rehabilitation team. This team comprises consultant physicians in rehabilitation medicine, occupational and physical therapists, speech and language therapists, dieticians, and psychologists.

We collected data on dependency using the Northwick Park Dependency Score (NPDS)1 in a cohort of stroke survivors participating in the rehabilitation programme (45 males, 26 females; median age 71 years, interquartile range (IQR) 39–96 years). The median length of the rehabilitation programme was nine weeks (IQR 8–13 weeks).

The interim analyses are presented in Table 1 and demonstrate both substantial improvements in independence, and reductions in care costs. We would strongly encourage other rehabilitation teams to collect and collate data for commissioners to demonstrate the effectiveness of multidisciplinary rehabilitation programmes.

Table 1.

Dependency and care costs on admission and discharge.

graphic file with name 299tbl1.jpg

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Reference

  • 1.Turner-Stokes L Tonge P, Nyein K, et al. The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation.. Clin Rehabil 199812304–18 10.1191/026921598669173600 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Medicine are provided here courtesy of Royal College of Physicians

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