Measuring the effectiveness of neurological rehabilitation
Neurological rehabilitation aims to reduce the restrictions on an individual's participation in society. Psychometrically rigorous and clinically relevant outcome measures, used appropriately, enhance the evidence base of rehabilitation. This Thesis assesses routinely used outcome measures at three time points: inpatient, outpatient, and longer-term follow-up. First, a retrospective analysis of the inpatient database of the Neurorehabilitation Unit was carried out to assess the Barthel index (BI) and Functional Independence Measure (FIM). Second, a prospective study examined the impact of rehabilitation on physical function and emotional wellbeing. Five measures were completed on admission, discharge and three months post-discharge: the BI (clinician and patient scored versions), FIM, General Health Questionnaire and Hospital Anxiety and Depression Scale. Finally, the effect of multiple sclerosis (MS) on work retention was assessed in a cross- sectional study using a newly developed outcome measure, the Impact on Work Questionnaire. In the first study, the responsiveness of the Bl and FIM total scores ranged from moderate to large. But item level analyses indicated differential item performance, with effect sizes varying from very low to large, associated with large floor and ceiling effects. The second study demonstrated the significant improvements in physical and psychological functioning in patients undergoing rehabilitation. Physical gains persisted after discharge, however, emotional wellbeing deteriorated. The last study revealed that a combination of MS-related problems, environmental restrictions and poor vocational support impact on work retention in people with MS. Following patients through the rehabilitation process, in the form of three distinct studies, has afforded a unique view of the effect of rehabilitation in neurological conditions. Furthermore, the examination of routinely used measures has provided guidance on the application of these in future research. Choosing the most appropriate measures and analytical techniques provides richer data, facilitates accurate evaluation of rehabilitation interventions, and ultimately improves patient care.