Quality assurance in outpatient neurological rehabilitation: measuring the effects of rehabilitation with the competency rating scale

Abstract

So far, there are only few studies concerning the outcome of outpatient neurological rehabilitation in Germany. Considering the statutory obligations of quality assurance there is an urgent need of appropriate instruments to assess the rehabilitation outcome. The aim of this study was to assess the appropriateness of the Competency Rating Scale (CRS), which was used to measure rehabilitation outcome, and to collect data of the effects of outpatient neurological rehabilitation as a measure of rehabilitation outcome. The basis of this study was data collected between 2008 and 2011. During that period the data of all patients of an outpatient neurological rehabilitation center were consecutively collected. There were no exclusion criteria. To measure rehabilitation outcome patients' self ratings with the CRS were used. To check the appropriateness of the CRS the dropout rate and the missing values were analysed. In addition, the patients' self ratings were compared with the data of a near relative rating with the CRS. On examining the entire group of patients, statistically significant improvements over time were found in the motor as well as in the cognitive-psychosocial areas. The analysis of the data with regard to the appropriateness of the CRS showed considerable ceiling effects and a high dropout rate. Differences between the self and the near relative ratings could be detected. For the overall group of patients positive effects of outpatient neurological rehabilitation can be proven. The assessment instrument used in this study is only partially suitable for assessing the outcome of outpatient neurological rehabilitation. The comparison of self and near relative ratings can systematically be used in the therapy process.