Article

The objective of this study was to explore methods examining patient complexity
and therapy interventions in relation to functional outcomes from an inpatient
multiple sclerosis (MS) rehabilitation program. Retrospective and prospective
data for 24 consecutive inpatients at a tertiary rehabilitation facility assessed
(i) impairment/disability - Expanded Disability Status Scale, Neurological
Impairment Set, (ii) complexity of intervention - Rehabilitation Complexity
Scale, Northwick Park Therapy Dependency Assessment (NPTDA), the type and
duration of therapy, (iii) Function - Barthel Index (BI), functional independence
measure (FIM), (iv) hospital length of stay, discharge destination. The mean
length of stay was 20 days (SD=15.7); male : female ratio was 10 : 14; 11 (46%)
had Expanded Disability Status Scale scores more than 6.5, and all discharged to
community. Over one-half had 'moderate-severe' scores for fatigue, and deficits
in motor function and mood that resulted in significant functional limitation.
Rehabilitation Complexity Scale scores showed substantial complexity with
two-thirds requiring specialized nursing. The NPTDA score (median 22
interquartile range 20-23) showed moderate dependency on admission in the
following domains: physical, cognitive and psychosocial programs and preparing
for discharge. The mean physiotherapy and occupational therapy received was 45.76
and 24.04 min/day, respectively. Functional gains from admission to discharge for
FIM and BI were significant
(P<0.001). There were strong correlations between the
total NPTDA and FIM motor scores (Spearman's rho -0.80) and BI (rho -0.83), but
only weak correlations with the FIM cognitive score (rho -0.33).
In conclusion,
this pilot study provided information about the complex interplay of patient and
process factors, and their interrelationships that impact functional outcomes in
MS rehabilitation. A prospective study is now planned using appropriate tools to
understand the 'black box' of rehabilitation.

Langue : ANGLAIS