Northwick Park Dependency Score Research Articles

Change in care hours, cost, and functional independence following continence and assistive technology intervention in an acquired brain injury population

Purpose After acquired brain injury (ABI) dependence on intervention for continence management is common. This preliminary investigation aimed to (i) quantify toileting care hours and costs in a community-based ABI rehabilitation and disability setting, and (ii) measure change in care needs, costs, and functional independence after intervention with assistive technologies (ATs). Method Pragmatic pre-post intervention pilot study of 14 adults with ABI and toileting disability accessing community-based neurorehabilitation or disability support in Western Australia. Toileting and functional independence were assessed monthly from baseline (T 0) to 3-month follow-up (T 3). Basic and nursing care hours (Northwick Park Dependency Score), cost of care estimates (Northwick Park Care Needs Assessment), functional independence (Functional Independence and Assessment Measure), and cost of consumables were examined pre- and post-intervention with ATs. Multilevel mixed-effects models with bootstrap estimation were conducted. Results Cost of consumables significantly declined (AU$69/week), and functional independence significantly improved following intervention (+23.5 points). There was a non-significant reduction in care needs for toileting (4 h/week) and in the cost of toileting care (AU$633/week). Conclusion Toileting disability substantially impacts care hours and costs. This study provides preliminary evidence that comprehensive continence management is beneficial in reducing costs and supporting people with an ABI to increase their independence. IMPLICATIONS FOR REHABILITATION A comprehensive continence assessment and management plan reduces the number of care hours, cost of care, and cost of continence products in a neurorehabilitation and disability support sample for people with acquired brain injury (ABI). Assistive technologies for continence management are beneficial in supporting people with ABI to increase independence, and reduce costs. Providing comprehensive continence assessment and management plan reduces reliance on staff for continence care, and improves functional independence.

Post-acute rehabilitation effects on functional outcome and discharge disposition of people with severe traumatic brain injury

ABSTRACTObjective: This study’s purpose was to document the effect of post-acute rehabilitation on functional independence of adults with moderate or severe traumatic brain injury (TBI).Methods: Retrospective analysis of admission and discharge scores on the Northwick Park Dependency Score (NPDS) and Mayo-Portland Adaptability Inventory – Fourth Edition (MPAI-4) as well as discharge disposition was performed for 271 adults admitted to post-acute rehabilitation between 2012 and 2017.Results: Discharge disposition was home for 83.39% of cases. Home discharge cases admitted to rehabilitation significantly sooner after injury than supported living discharge cases. Also, home discharge cases achieved significantly better NPDS and MPAI-4 scores both at admission and discharge than supported discharge cases. Analyses split by program duration revealed cases with ≤90 day stays were closer to injury upon admission and had significantly better admission and discharge NPDS and MPAI-4 scores than those with longer stays. Although NPDS and MPAI-4 change scores for home versus supported living discharge did not differ significantly, change scores for home discharge cases with ≤90-day programs were significantly smaller than those with >90-day programs.Conclusion: Findings support the notion that providing intensive post-acute rehabilitation may increase the functional independence of people with moderate or severe TBI.

Northwick Park Dependency Score — a New Scale for Use in Nursing Practice

Introduction. Evaluation of functional limitations in patients with ischemic stroke is essential in planning suitable nursing care. The main aim of all nursing procedures taken is to ensure the safety of patients, to provide the best, individualized care fulfilling patients’ needs and to support recovery process, considering the necessary number of nursing staff and time needed for these procedures. A tool helpful in the process of diagnosis and planning care is the Northwick Park Dependency Score — NPDS.Aim. The aim of the present study is to describe the Polish version of this scale and to assess its usefulness by comparing the NPDS with the Barthel Index — considered the “golden standard” for assessing patient’s disability and dependency.Material and Methods. The study included 100 elderly ischemic stroke patients aged 60 to 99 years (mean 76.1, SD 9.07). To assess patient’s dependency and thus the need of nursing care, the NPDS Scale was used. Functional status of patients was assessed with the Barthel Index, and the neurological state using the NIHSS.Results. Most items in NPDS, are similar to the items of the BI. However, the NPDS includes additional important questions regarding cognitive functions, communication and behavioral dysfunctions. It allows to estimate the number of nursing staff and their scope of competences necessary for providing care as well as time needed for particular nursing activities. There is a strong correlation between individual modules in the NPSD and the BI sales (r ≈ 0.90). Nevertheless, these are not interchangeable. The high correlation coefficient confirms the validity of the Polish version of the NPDS.Conclusions. NPDS is a simple and useful tool in nursing care allowing to plan the activities based on objective indicators. Despite many similarities it is not a substitute for the popular Barthel Scale. Therefore, the NPDS should be promoted in the nursing environment as a possible work tool. (JNNN 2018;7(1):4–11)

Reliability and validity of the Chinese version of Northwick Park Dependency Score as a care dependency instrument for stroke patients

Objective To translate the English version of Northwick Park Dependency Score (NPDS) and to investigate the reliability and validity of the Chinese version of NPDS as a nursing dependency instrument for stroke patients. Methods The NPDS was Chinesized according to the Brislin's translation model. The expert evaluation method and the pilot investigation were implemented for cross-cultural research. The reliability and validity of the Chinese version of NPDS were tested in a cohort of 259 stroke patients. SPSS 17.0 was used to analyze the data. Results The Chinese version of NPDS consisted of 17 items, and 4 factors were extracted by exploratory factor analysis, which could explain 64.598% of the total variance. The content validity index (CVI) was 0.926. The criterion-related validity of NPDS with nursing hours per patient day and activity of daily life were 0.541, 0.624 respectively (P<0.001) . The Cronbach's coefficient was 0.852, and the inter-rater reliability was 0.975. Conclusions The Chinese version of NPDS has high reliability and validity, and is a valuable nursing dependency instrument for Chinese stroke patients. Key words: Stroke; Care dependency; Reliability; Validity

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

Primary objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury.Research design: A retrospective case note review assessed total rehabilitation unit admission.Methods and procedures: Assessment of 52 consecutive patients with acquired brain/spinal injury and neuropathy in an in-patient neuro-rehabilitation unit of a UK university hospital. Data analysed included: Northwick Park Dependency Score (NPDS), Rehabilitation complexity Scale (RCS), Functional Independence Measure and Functional Assessment Measure FIM-FAM (UK version 2.2), LOS and ACB. Outcome was different in RCS, NPDS and FIM-FAM between admission and discharge.Main outcomes and results: A positive change was reported in ACB results in a positive change in NPDS, with no significant effect on FIM-FAM, either Motor or Cognitive, or on the RCS. Change in ACB correlated to the length of hospital stay (regression correlation = −6.64; SE = 3.89). There was a significant harmful impact of increase in ACB score during hospital stay, from low to high ACB on NPDS (OR = 9.65; 95% CI = 1.36–68.64) and FIM-FAM Total scores (OR = 0.03; 95% CI = 0.002–0.35).Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort.

Functional outcomes and efficiency of rehabilitation in a national cohort of patients with Guillain-Barré syndrome and other inflammatory polyneuropathies.

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.

A Comparison between Two Instruments for Assessing Dependency in Daily Activities: Agreement of the Northwick Park Dependency Score with the Functional Independence Measure

Background. There is a need for tools to assess dependency among persons with severe impairments. Objectives. The aim was to compare the Functional Independence Measure (FIM) and the Northwick Park Dependency Score (NPDS), in a sample from in-patient rehabilitation. Material and Methods. Data from 115 persons (20 to 65 years of age) with neurological impairments was gathered. Analyses were made of sensitivity, specificity, positive predictive value, and negative predictive value. Agreement of the scales was assessed with kappa and concordance with Goodman-Kruskal's gamma. Scale structures were explored using the Rank-Transformable Pattern of Agreement (RTPA). Content validation was performed. Results. The sensitivity of the NPDS as compared to FIM varied between 0.53 (feeding) and 1.0 (mobility) and specificity between 0.64 (mobility) and 1.0 (bladder). The positive predictive value varied from 0.62 (mobility) to 1.0 (bladder), and the negative predictive value varied from 0.48 (bowel) to 1.0 (mobility). Agreement between the scales was moderate to good (four items) and excellent (three items). Concordance was good, with a gamma of −.856, an asymptotic error (ase) of .025, and P < .000. The parallel reliability between the FIM and the NPDS showed a tendency for NPDS to be more sensitive (having more categories) when dependency is high. Conclusion. FIM and NPDS complement each other. NPDS can be used as a measure for severely injured patients who are sensitive when there is a high need of nursing time.

Validation of the Memory and Behavior Problems Checklist-1990R for use in acquired brain injury

Objective: The Memory and Behavior Problems Checklist-1990R (MBPC-1990R) is a carer-rated measure of (a) problem behaviours and (b) corresponding carer reaction. Although originally developed and validated for dementia, its items are relevant to acquired brain injury (ABI). This study evaluated its validity in this population.Design: Cross-sectional study.Methods: In a national postal survey carried out to inform service planning, 222 family carers of adults with TBI (49%), strokes (26%), infections (18%), other (7%) completed the MBPC-1990R, Head Injury Behaviour Scale (HIBS), Barthel Index (BI), Northwick Park Dependency Score (NPDS), Carer Burden Interview (CBI), WHOQOL-BREF and GHQ-28.Results: MBPC-1990R problems correlated well with HIBS problems (r = 0.70), as did MBPC-1990R carer reaction with HIBS distress (r = 0.78) and CBI (r = 0.73) scores, indicating good convergent validity. Discriminant validity was inferred from absent/weak correlations between MBPC-1990R problems and both BI (r = −0.02) and NPDS (r = 0.24); likewise between MBPC-1990R carer reaction and WHOQOL-BREF physical, psychological, social, environmental sub-scales (r = −0.32 to −0.41) and GHQ-28 scores (r = 0.35). Factor analysis revealed excessive, cognitive, aggressive and passive/low mood sub-scales, which showed good internal consistency and varied across ABI groups.Conclusions: The MBPC-1990R is supported as a measure of problem behaviours and carer reaction in ABI. Further validation in ABI groups is recommended.

The criterion-related validity of the Northwick Park Dependency Score as a generic nursing dependency instrument for different rehabilitation patient groups

Objective: To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (CDS). Design: Cross-sectional study. Setting: Centre for Rehabilitation of the University Medical Center Groningen, The Netherlands. Subjects: Patients after stroke, spinal cord injury, multitrauma, head injury, amputation, rheumatoid arthritis, diabetes mellitus, lung diseases, tuberculosis and coronary artery disease. One hundred and fifty-four patients were included. Measures: The Northwick Park Dependency Score (NPDS), the Barthel Index (BI) and the Care Dependency Scale (CDS). Results: The correlation (rho) between the NPDS and the BI for all groups was -0.87; R 2=0.76 (n=154). Per patient group rho varied from -0.70 (R 2=0.49) to -0.93 (R 2=0.86). The overall correlation between the NPDS and CDS was larger than the criterion of rho=0.60 (r=-0.74; R 2=0.55) but was <0.60 in the rheumatoid arthritis and tuberculosis group. The overall correlation between BI and CDS exceeded the criterion (r=0.75; R 2=0.56). Conclusions: The NPDS is a generic nursing dependency instrument that can be used as a valid measure across various patient groups in rehabilitation.

Efficiency of specialist rehabilitation in reducing dependency and costs of continuing care for adults with complex acquired brain injuries

Objectives: To examine functional outcomes from a rehabilitation programme and to compare two methods for evaluating cost efficiency of rehabilitation in patients with severe complex disability. Subjects and setting: Two...

Reliability and validity of the Northwick Park Dependency Score (NPDS) Swedish version 6.0

To translate, to test inter-rater and intra-rater reliability and concurrent validity of the Basic Care Needs (BCN) section of the Northwick Park Dependency Score (NPDS). Test-retest reliability and validity testing. Observed data were collected by the staff (nursing staff, occupational therapists). Three rehabilitation units. Forty inpatients between 16 and 65 years of age with brain injury were included. Inter-rater and intra-rater reliability was calculated by percentage agreement (PA) and unweighted kappa measure. Concurrent validity was examined by computing Goodman-Kruskal's gamma, a nonparametric statistic for degree of association between the BCN score and the total score of the Functional Independence Measure (FIM). Inter-rater reliability showed a good percentage agreement between nursing staff. Between nursing staff and occupational therapists the percentage agreement was lower especially in one item. Intra-rater reliability showed a good percentage agreement for all assessors. Concordance was good with a gamma--0.83 and an asymptotic error (ase) of 0.04, for nursing staff and for occupational therapists -0.87, ase 0.04. The BCN section of NPDS was found to be inter-rater and intra-rater reliable, to have concurrent validity. Further studies are needed on clinical utility. The instrument can be used for assessment of dependency for individual patients with brain injury, and information when transferring between different caregivers. Further studies need to investigate the sensitivity of the instrument.

Care needs and point prevalence of post-acute patients in the acute medical wards of an Italian hospital

Background: Despite considerable literature identifying large numbers of post-acute patients in acute medical wards, their needs have not been clearly described. Such information is required to plan alternative services. Objective: Identify the size of and care needs of the post-acute population within the group of patients receiving acute medical care in an Italian General Hospital. Setting: Five medical wards of a District General Hospital in Northern Italy Design: Point prevalence survey. Data were collected on all 211 patients using the most recent Italian version of the Appropriateness Evaluation protocol, Barthel Index, and the Northwick Park Dependency Score. Length of stay up to the data collection (index) day and total length of stay were identified and pre- and post-discharge dependence was assessed. Results: The mean of the length of stay of the patients up to the index day was 12 days. Fourtyfour percent of patients were assessed as inappropriate. The mean age was 70 years. They were moderately physically dependent and stayed in hospital for a further 8 days after the day of the survey. The family met most of the care needs both before and after admission to hospital. Inappropriate patients differed little from the appropriate patients in terms of their care needs, which were relatively high. Conclusion: There is scope for the development of alternatives to acute care in the Italian health service but the intensity on non-medical care needs is not discernibly lower than for acute care. Prospective identification of patients who might require such services using tools that focus on needs other than medical needs remains problematic.

An evaluation of aftercare following discharge from a specialist in-patient rehabilitation service

Purpose: To evaluate the aftercare of patients discharged from specialist rehabilitation unit with respect to use of equipment and follow-up by therapy and care services and to assess change in dependency and care needs.Design: Cross-sectional survey of a consecutive cohort of patients discharged from a regional rehabilitation unit with reference to the British Society of Rehabilitation Medicine (BSRM) standards for rehabilitation services.Subjects and methodology: Fifty-three subjects with neurological disability were discharged during a 15-month period. Structured interviews conducted by telephone with the patient (n = 22) or carer (n = 31) between 8 and 21 (mean 15) months after discharge. Dependency and care needs were assessed using the Northwick Park Dependency Score (NPDS) and Care Needs Assessment (NPCNA)Results: Approximately half the patients improved in dependency and care needs between discharge and follow-up, but a quarter deteriorated. Fifty-one (96%) were referred for continuing therapy of which 39% expressed dissatisfaction. There was a significant relationship between inadequate therapy follow-up and increased dependency (Chi Squared p = 0.002). However, where care packages were revised downwards this generally reflected improvement in independence and therefore reduced need. Fourteen (26%) discontinued use of equipment early after discharge since they found it unacceptable or unhelpful. Seventeen (38%) of this population experienced late seizures.Conclusions: Specialist rehabilitation in this group of severely disabled brain injured patients with complex needs can result in sustained improvement of function with resultant reduced care needs. However, appropriately skilled community-based services are required to maintain and build on the benefits, and are currently lacking in many districts. In particular, psychological support was notably absent. A possible relationship between late onset seizures and the use of anti-depressant medication requires further exploration, which is currently underway.

THE NORTHWICK PARK DEPENDENCY SCORE AND ITS RELATIONSHIP TO NURSING HOURS IN NEUROLOGICAL REHABILITATION

To evaluate the reliability and validity of the Northwick Park Dependency Score as a measure of nursing dependency. Inpatients in a specialist neurological rehabilitation unit. The Northwick Park Dependency Score was measured by 2 assessors and compared with nursing hours. The Barthel ADL Index and the Short Orientation Memory and Concentration test were also compared with the Northwick Park Dependency Score. Time to score the Barthel ADL Index and Northwick Park Dependency Score was recorded. Statistical analysis was carried out using Spearman's Rank Correlation Coefficient. There was a high correlation between the Northwick Park Dependency Score total scores of the 2 observers (rho = 0.80, p < 0.005) and a correlation of rho = 0.87 between the Northwick Park Dependency Score total score and nursing time. There was a high negative correlation between the Northwick Park Dependency Score and the Barthel ADL Index. The Northwick Park Dependency Score is a valid and reliable way to assess nursing dependency. However, total scores can obscure relevant detail and individual raters differ. The Barthel ADL Index is equally related to nursing dependency.

Measuring nursing needs of stroke patients in clinical rehabilitation: a comparison of validity and sensitivity to change between the Northwick Park Dependency Score and the Barthel Index

To compare the content and convergent validity and the sensitivity to change of the Northwick Park Dependency Score (NPDS) to that of the Barthel Index in patients with stroke. Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands. Inclusion of consecutive patients with stroke. Measurements at admission and every four weeks until final measurement at discharge. Administration by nurses of NPDS, Barthel Index and nurses' global ratings of nursing dependency. Thirty-one patients were included and 123 measurements were obtained. Median Barthel Index scores at admission and discharge were 11.2 and 17.8 respectively. At discharge, 58.6% of all patients obtained the best possible Barthel Index score, against 31.1% for the Basic Care Needs section and 87.1% for the Special Nursing Needs sections of the NPDS. Spearman correlations between NPDS and Barthel Index were very strong (0.82-0.92) at each measurement. Both the NPDS and the Barthel Index showed strong relationships with the global rating of nursing dependency (-0.82 and 0.70 respectively) and showed good sensitivity to change, Z-values for differences between admission and discharge were 4.06 (p < 0.001) for the NPDS and 4.20 (p < 0.001) for the Barthel Index. Most (9/12) nurses involved in this study judged the NPDS to provide better, more precise and complete information about the actual need for care of the patients. Validity and sensitivity to change of the NPDS were not superior to those of the Barthel Index but most nurses preferred the NPDS for future use.

The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation.

Disability scores, such as the Functional Independence Measure (FIM) and Barthel Index, have been shown to correlate with care needs but cannot be used to assess them directly, as they do not indicate the number of people required to help with a task, nor the time taken. The Northwick Park Dependency Score (NPDS) is an ordinal scale that can be used to assess impact on nursing time. It takes 3-5 minutes to complete. Together with a short set of additional questions, it may be used directly to assess care needs in the community and to facilitate discharge planning. To develop and evaluate the NPDS for use in a rehabilitation setting. (1) DEVELOPMENT: Following a survey of existing instruments, tasks were selected on the basis of their impact on nursing time and divided into Basic Care Needs (BCN) and Special Nursing Needs (SNN). Cut-off points were devised to reflect the number of helpers needed and time taken. Following evaluation of the NPDS version 5, minor changes were made to produce version 6 which was re-evaluated on a smaller scale. (2) EVALUATION: Inter-rater and intra-rater reliability were tested in a cohort of 23 inpatients using five senior nurses. Analysis included assessment of degree of association, significant differences, absolute agreement, and agreement +1 level. Although there is no gold standard, the BCN section should correlate inversely with independently assessed Barthel scores. Re-evaluation of version 6 was undertaken using the same method of analysis in a cohort of 21 patients using three senior nurses. On initial evaluation inter-rater reliability testing showed an excellent level of association in total composite score between each pair of nurses (rho = 0.73-0.92, p <0.01) and agreement +1 level for individual items ranged from 73 to 100%. Significant disagreements were in six items. On re-evaluation following minor modification, high levels of association were still seen for total BCN, SNN and composite scores both between and within raters, with very satisfactory levels of agreement for individual items. The BCN section of the NPDS showed good inverse correlation with Barthel scores (rho = 0.91, p <0.01). The NPDS is simple and practical to use in a busy setting. It is shown to be reliable and valid in its assessment of nursing dependency on the ward. Its translation into a directly costable measure of continuing care needs in the community now requires evaluation.