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Abstract
ObjectivesTo 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.Subjects and Setting186 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%)).MethodsCohort 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.ResultsThe 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.ConclusionsPatients 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.
Highlights
IntroductionGuillain-Barre Syndrome (GBS) and other inflammatory polyneuropathies are a group of disorders that are often associated with significant long-term disability [1,2]
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
Guillain-Barre Syndrome (GBS) and other inflammatory polyneuropathies are a group of disorders that are often associated with significant long-term disability [1,2]
Summary
Guillain-Barre Syndrome (GBS) and other inflammatory polyneuropathies are a group of disorders that are often associated with significant long-term disability [1,2]. GBS is an acute, autoimmune condition, with a natural course fast with high disability and usually episodic immune treatment; Chronic inflammatory demyelinating polyneuropathy (CIDP) has a chronic, autoimmune, natural course, slow with ongoing disability, usually maintenance immune treatment; Critical Illness Neuropathy (CIN) is more a myopathy than a neuropathy; it is an acute, ischemic/degenerative/inflammatory disorder, associated with a prolonged period of critical illness – usually in intensive care settings. Its natural course natural course represents resting disability with slow recovery and cognitive deficits due to the systemic inflammatory/infectious etiology Given this heterogeneity, differences in outcome are expected between these groups
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