Rehabilitation Activities Profile Research Articles

The integral estimation of health problems and effectiveness of stage rehabilitation in patients after ischemic stroke

To develop a methodology for the integrated assessment of health problems and the effectiveness of stage rehabilitation in patients after ischemic stroke (IS) and risk factors for recurrent stroke. Examinations were made in 101 patients (mean age 59.78±8.63 years) after IS in the middle cerebral arterial bed in the early recovery period. Of them, 62 patients were examined in the early and late recovery periods of stroke. The investigators assessed neurological disorders using National Institutes of Health Stroke Scale (NIHSS), Ashworth Spasticity Scale, dysarthria scale, Medical Research Council Scale and wrist dynamometry, Frenchay Arm Test), Self-Care Rating Scale (Barthel index) and social and living activities (Rehabilitation Activities Profile Scale), psychological status (procedures of Memory for Pictures and Ten Words, Schulte-Platonov Tables, Luscher Color Test, Hospital Anxiety and Depression Scale (HADS), Recovery Locus of Control Scale) questionnaire, functional (stabilography, transcranial magnetic stimulation) and laboratory (lipid profile test) results. The integrated assessment of health problems was defined as the sum of ranks of the signs studied; the effectiveness of stage rehabilitation in patients was defined as the coefficient of the dynamics of the sum of ranks of informative indicator. There was a preponderance of moderate motor impairments; the high incidence of cognitive impairment and paretic hand dysfunctions; a change in the temporal parameters of the nerve impulse through the corticospinal tract; obvious balance dysfunctions; and the relationship between equilibrium and the visual analyzer. The integral indicator of the level of health correlated with clinical and functional findings. After the rehabilitation, severe arm/hand paresis was not detected; paretic arm/hand function improved; the number of patients with moderate paresis declined; impaired vital and social activities reduced significantly; the proportion of patients with low dependence on others was as much as 86%; balance and psychological functions improved; the mean blood pressure reached the target values. An integrated effectiveness evaluation showed that 33, 58, and 9% of patients were discharged with a significant improvement, improvement, and a slight improvement, respectively. The integrated approach to evaluating health problems and the effectiveness of rehabilitation makes it possible to comprehensively estimate (taking into account neurological, psychological, functional disorders, risk factors for recurrent stroke) the harm to a patient's health and activity, which is associated with prior stroke and its reversal due to rehabilitation.

Approaches to the clinical classification of the functional status in patients with stroke

The article presents the results of original investigation that included a detailed clinical analysis of 203 patients with stroke undergoing rehabilitation. The significance of pathogenic type of stroke and localization of the lesion in the brain are demonstrated. <<Rehabilitation subgroups>> are distinguished among the patients with ischemic stroke of hemispheric and stem localization, and hemorrhagic hemispheric stroke. For each ((rehabilitation subgroup) a detailed description of the key indicators of the neurological status, results of cognitive and psychological tests based on general and local rehabilitation scales are presented. The prognostic value of the (rehabilitation activities profile) scale for stroke patients is estimated.

Efficacy of sanatorium treatment to patients with consequences of cerebrovascular disease

To estimate the efficacy of the introduction of Russian standard of the sanatorium treatment of patients with cerebrovascular diseases. We examined 480 neurological patients. Efficacy of treatment was estimated according to conclusions of the physician on the basis of dynamic supervision and the scale "The Rehabilitation Profile of Activity" (Rehabilitation Activities Profile). The general for all patients was physiotherapy exercises and diet therapy. The majority of patients received medical shower (62.9±2.2%), psychotherapy (83.5±1.7%) and used terrainkur (52.1±2.3%). Frequencies of separate methods of treatment effects in groups of patients with positive and negative outcomes did not differ. The reliability of distinction was noted only for frequencies of dry-air bathtubs (36 and 16%), local bathtubs (39 and 14%), medical shower (76 and 52%), sinusoidal modulated currents (36 and 18%), reflex therapy (36 and 18%), massage (58 and 38%), psychotherapy (100 and 76%), naftalan therapy (44 and 24%). The significance of the ratio between sensitivity and specificity of treatment methods is emphasized.

OP0081 Concepts important to patients with rheumatoid arthritis in rehabilitation and their coverage by rehabilitation tools

BackgroundDespite important improvements in pharmacological care for patients with rheumatoid arthritis (RA), many patients with RA need additional care to achieve and maintain an optimal level of functioning (1). Delivery...

Validity and responsiveness of the Rehabilitation Activities Profile (RAP) in patients with rheumatoid arthritis

Objective: To investigate the internal consistency, validity and responsiveness of the Rehabilitation Activities Profile (RAP; a rehabilitation tool structuring the multidisciplinary team care process) in patients with rheumatoid arthritis. Methods: In 85 rheumatoid arthritis patients admitted to a rheumatology clinic the RAP was applied at admission, at discharge, and six weeks thereafter. Additional assessments included measures of physical and psychological functioning, disease activity and quality of life. The internal consistency of the RAP was determined with Cronbach's alpha. Associations between the RAP and other outcome measures were determined by Spearman rank correlation coefficients. Responsiveness measures included the standardized response mean (SRM), effect size (ES) and responsiveness ratio (RR). Results: Cronbach's alpha of the RAP total score was 0.78. The RAP total score correlated significantly with all other outcome measures. The mean RAP total score improved from 15.2 to 13.2 at discharge (change -2.0; 95% confidence interval (CI) -3.4 to -0.7) and to 11.5 (change -3.7; 95% CI -3.9 to -1.5) six weeks thereafter. The responsiveness of the RAP total score was low (standardized response mean -0.34, effect size -0.30) to high (responsiveness ratio -0.87) at discharge and moderate (standardized response mean -0.54, effect size -0.55) to high (responsiveness ratio -1.56) six weeks thereafter. Conclusions: The RAP appeared to be an internally consistent, valid and responsive measure to reflect limitations on the level of activities and participation in patients with rheumatoid arthritis admitted for multidisciplinary team care.

Manual dexterity and related functional limitations in Hereditary Motor and Sensory Neuropathy. An explorative study

Purpose. To explore impairments in manual dexterity and perceived limitations in upper extremity-related activities in subjects with Hereditary Motor and Sensory Neuropathy (HMSN).Method. Cross-sectional study of 20 HMSN subjects. Manual dexterity was assessed using the Jebsen test of hand function. Perceived limitations were assessed using the Rehabilitation Activities Profile (RAP) and the Disabilities of Arm, Shoulder and Hand questionnaire (DASH).Results. Impaired manual dexterity was found in four out of seven Jebsen sub-tests. Turning over cards, lifting large light and large heavy objects were most impaired, as reflected by median z scores of 5.7, 12.0 and 16.9, respectively. Perceived limitations, as reflected by median and percentile (P25; P75) sum-scores, were 7.5 (3; 11.7) for the RAP domains of personal care (scale 0 – 69) and 6.0 (1.25; 15.5) for the domains of occupation (scale 0 – 42). The median (P25; P75) DASH score (scale 0 – 100) was 13.3 (2.7; 48.1). Jebsen test scores were significantly associated with RAP and DASH scores.Conclusions. Manual dexterity of HMSN subjects, especially requiring the manipulation of flat and of large objects, was impaired and associated with the amount of perceived limitations in upper extremity function. Major limitations were perceived in activities related to upper extremity function by 25% of HMSN subjects. Measurement of manual dexterity and perceived limitations should be incorporated into the evaluation and treatment of HMSN subjects.

Needs, problems and rehabilitation goals of young children with cerebral palsy as formulated in the rehabilitation activities profile for children

To describe the content of needs, problems and goals of 41 Dutch children with cerebral palsy using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a classification system. To evaluate the adherence of formulations of needs, problems and goals to specifications of the Rehabilitation Activities Profile for Children. Raw text data were extracted and organized. Two raters independently weighed the entries' quality against the specifications and linked the extracted content to ICF-CY categories. In 12% of the reports no needs, and in 24% no principal goals, were formulated. Needs mostly pertained to the activities-and-participation domain (65%), whereas problems and goals covered all 3 ICF-CY domains. None of the needs were prioritized and 79% met the quality criterion of description of a problem/desire. Twenty-four percent of the problems were described in the activity-and-participation domain and 83% referred to a treatable problem. Fifty-six percent of the goals were formulated in terms of intended result/effect and 63% as child/parent actions. Insight is provided into the content of rehabilitation programmes for children with cerebral palsy. To optimize the quality of the reports, research on reasons for non-adherence to specifications of the Rehabilitation Activities Profile is needed.

The impact of introducing an ICF-based rehabilitation tool on staff satisfaction with multidisciplinary team care in rheumatology: an exploratory study

Objective: To investigate the impact of introducing a rehabilitation tool on multidisciplinary team members' satisfaction with team functioning, team conferences and written information exchange. Design: Pretest posttest design. Setting: Day patient and inpatient wards of a rheumatology rehabilitation clinic. Subjects: Members of two multidisciplinary teams. Interventions: The introduction of an electronic version of the Rehabilitation Activities Profile. Main measures: The Group Environment Scale and questionnaires on satisfaction with team conferences and administrative procedures administered before (T1) and 12 months after (T2) the introduction of the Rehabilitation Activities Profile. Results: The Group Environment Scale cohesion subscale was significantly higher at T2 than at T1 in the day patient setting (mean difference 1.9; 95% confidence interval (CI) 0.3; 3.4), whereas in the inpatient setting the Group Environment Scale cohesion and the order and organization subscales were significantly lower (mean differences -3.0; 95% CI -4.7; -1.3 and -2.7; 95% CI -4.3; -1.1, respectively). Satisfaction with team conferences was significantly higher at T2 compared with T1 in the day patient setting (mean difference total score 0.6; 95% CI 0.3; 1.0), but not in the inpatient setting (mean difference -0.3; 95% CI -0.7; 0.2). In both settings, the proportions of health professionals spending >10 minutes on administrative tasks per patient contact were significantly higher at T2 than at T1. Conclusions: In the day patient setting, the introduction of a rehabilitation tool had a positive effect on team members' satisfaction with team functioning and team conferences, whereas in the inpatient setting the effect was absent or the opposite. In both settings, the time spent on administrative tasks increased.

Effectiveness of the introduction of an International Classification of Functioning, Disability and Health–based rehabilitation tool in multidisciplinary team care in patients with rheumatoid arthritis

To investigate whether the use of an International Classification of Functioning, Disability and Health (ICF)-based instrument to structure multidisciplinary care improves clinical effectiveness and satisfaction in patients with rheumatoid arthritis (RA) admitted for multidisciplinary team care. Consecutive patients with RA admitted to an inpatient or day patient multidisciplinary team care ward were included during a 12-month period before (period I) and after (period II) the introduction of an ICF-based rehabilitation tool (Rehabilitation Activities Profile [RAP]). Patients were assessed at admission, discharge, and 6 weeks thereafter. The primary outcome measure was a patient-oriented measure of functional ability (McMaster Toronto Arthritis Patient Preference Disability Questionnaire [MACTAR]), whereas secondary outcome measures included measures of physical and mental functioning, quality of life, disease activity, and patient satisfaction. Change scores between periods were compared using analysis of covariance. A total of 80 and 85 patients were included in periods I and II, respectively. Concerning the improvement of the MACTAR score and all other secondary clinical outcome measures, there was no significant difference between the 2 periods. Patient satisfaction with care was slightly higher in period II than in period I, with the differences regarding the total score of a multidimensional satisfaction questionnaire and the domains focusing on individual problems and empathy reaching statistical significance. The introduction of the RAP did not change clinical effectiveness but had a modest beneficial impact on patient satisfaction with care in patients with RA admitted for multidisciplinary team care.

Reliability and sensitivity to change of measurement instruments used in a traumatic brain injury population

Objective: To compile a minimum data set for the follow-up of traumatic brain injury patients from discharge from hospital to one year post injury to assess functioning and participation in the physical, cognitive and psychosocial domains, and in quality of life. Design: Repeated questionnaire interviews by two observers to establish interobserver reliability of the measurement instruments at discharge and at one year post injury, as well as their sensitivity to change over time in traumatic brain injury patients. Setting: Department of neurosurgery of an academic hospital, department of a rehabilitation centre, and at the patients' homes in the Netherlands. Subjects: The study at discharge included 25 patients aged 18-50 years with a moderate to severe traumatic brain injury (Glasgow Coma Scale score 3-14), whereas the one year post injury study included 14 patients aged 19-51 years. Main (outcome) measures: Physical domain: Barthel Index (BI), Functional Independence Measurement (FIM), Glasgow Outcome Scale (GOS), GOS Extended (GOSE). Cognitive domain: Disability Rating Scale (DRS), Functional Assessment Measurement (FAM), Levels of Cognitive Functioning Scale (LCFS), Neurobehavioural Rating Scale (NRS). Psychosocial domain: Community Integration Questionnaire (CIQ), Employability Rating Scale (ERS), Frenchay Activity Index (FAI), Multi Health Locus of Control (MHLC), Rehabilitation Activities Profile (RAP), Social Support List (SSL), Supervision Rating Scale (SRS), Wimbledon Self Reporting Rating Scale (WSRS). Quality of life: Coop/Wonca Charts (Coop), Rand SF-36 (Rand-36), Sickness Impact Profile-68 (SIP-68). Results: At both discharge and at one year post injury, in the physical domainthe FIM showed excellent squared weighted kappa (SWK ranging from 0.75 to 0.80), and intraclass correlation coefficient (ICC ranging from 0.75 to 0.92), and a relatively small standard error of measurement (SEM 3.22) and smallest detectable difference (SDD 8.92). In the cognitive domain the FAM and the NRS showed excellent SWK, and ICC, and a relatively small SEM and SDD. In the psychosocial domainthe FAI showed excellent SWK (0.89), and ICC (0.87), and a relatively small SEM (2.64) and SDD (7.31). For quality of life, at both discharge and at one year post injury the SIP-68 and the Coop showed excellent SWK (0.87), and ICC (0.89), and a relatively small SEM (3.79) and SDD (10.51). At both time points SWK and ICC ranged from 0.80 to 0.89, SEM ranged from 1.47 to 1.98, and the SDD was 4.07. Conclusions: An example of a reliable minimum data set that is also able to detect changes over time is: the FIM, the FAM and the Coop for the early stages in recovery, extended with the NRS, the FAI, and the SIP-68 later in recovery, thereby covering all relevant domains after traumatic brain injury.

The usefulness of evaluative outcome measures in patients with multiple sclerosis

To select the most useful evaluative outcome measures for early multiple sclerosis, we included 156 recently diagnosed patients in a 3-year follow-up study, and assessed them on 23 outcome measures in the domains of disease-specific outcomes, physical functioning, mental health, social functioning and general health. A global rating scale (GRS) and the Expanded Disability Status Scale (EDSS) were used as external criteria to determine the minimally important change (MIC) for each outcome measure. Subsequently, we determined whether the outcome measures could detect their MIC reliably. From these, per domain the outcome measure that was found to be most sensitive to changes (responsive) was identified. At group level, 11 outcomes of the domains of physical functioning, mental health, social functioning and general health could reliably detect the MIC. Of these 11, the most responsive measures per domain were the Medical Outcome Study 36 Short Form sub-scale physical functioning (SF36pf), the Disability and Impact Profile (DIP) sub-scale psychological, the Rehabilitation Activities Profile sub-scale occupation (RAPocc) and the SF36 sub-scale health, respectively. Overall, the most responsive measures were the SF36pf and the RAPocc. In individual patients, none of the measures could reliably detect the MIC. In sum, in the early stages of multiple sclerosis the most useful evaluative outcome measures for research are the SF36pf (physical functioning) and the RAPocc (social functioning).

Measurement of decline of functioning in persons with amyotrophic lateral sclerosis: Responsiveness and possible applications of the Functional Independence Measure, Barthel Index, Rehabilitation Activities Profile and Frenchay Activities Index

It is important not only to monitor the functional change during the course of ALS, but also to determine whether or not the available help is sufficient. This study was performed to determine which generic assessment instrument is most appropriate. A multicentre cohort of patients with ALS was followed for one year. At baseline, six months, and 1 year four instruments were used: Functional Independence Measure (FIM), Rehabilitation Activities Profile (RAP), Barthel Index (BI), and Frenchay Activities Index (FAI). The responsiveness of the measures was examined using effect sizes and standardized response mean statistics. Seventy-three patients at baseline, 63 after six months and 43 after one year were assessed. If calculated on the group that completed all three assessments, the FIM, BI, and RAP showed moderate effect sizes and standardized response means over a period of six months and large effect sizes over 12 months. Based on their responsiveness FIM, BI, and RAP can be used to evaluate limitations in activities and care needs of persons with ALS and to evaluate treatment results in trials. The FIM was the most responsive instrument, although the BI might be easier to use in clinical practice.

The value of the Rehabilitation Activities Profile (RAP) as a quality sub-system in rehabilitation medicine

Purpose: To determine whether interdisciplinary team care, using the Rehabilitation Activities Profile (RAP) as a team tool, results in a better rehabilitation outcome.Method: A multilevel prospective cohort study, with a controlled before and after design. Eighteen rehabilitation teams in eight rehabilitation centres in the Netherlands and Belgium participated. Based on the level of implementation of the RAP, we compared three study groups. Consecutive adult patients (n = 933) with stroke, amputation of the lower limb, spinal cord injury, multiple sclerosis, or other neuromuscular disorders, were followed during inpatient or outpatient rehabilitation. Main outcome measures were Barthel Index, RAP-CPM (sum score of the domains communication, personal care and mobility), Nottingham Health Profile (NHP), length of rehabilitation (LOR) and discharge destination (home vs elsewhere).Results: Overall results show that scores on the Barthel Index, the RAP-CPM and the NHP improved, on average, by 18.4%, 12.7%, and 6.7%, respectively. However, treatment from a rehabilitation team that uses the RAP was associated with a significantly lower Barthel score, and small, non-significant effects on the RAP-CPM and the NHP. Partial use of the RAP resulted in non-significant, lower scores on these measures. With respect to discharge destination and LOR, there were also no significant differences between the three study groups, with the exception of a shorter outpatient rehabilitation period for the group in which partial use was made of the RAP.Conclusion: The RAP, at the current level of implementation, does not improve rehabilitation outcome.

Quality of life after hip fracture: a comparison of four health status measures in 208 patients

Objectives: We compared four health status measures for the evaluation of quality of life after hip fracture. Methods: Two hundred and eight elderly hip fracture patients were followed up to 4 months after hospital admission. We used two interviewer-administered instruments (the Rehabilitation Activities Profile (RAP) and the Barthel Index (BI)) that focus on functional status, and two self-assessment instruments (the Nottingham Health Profile (NHP) and the COOP/WONCA charts) that additionally include psychological and social health domains. The score distribution, internal consistency, construct validity, and sensitivity to change were investigated. Results: At 4 months only 18% of surviving patients had reached the same level of functioning as before the fracture and, compared with reference values, lower scores of health status were found in the areas of physical mobility and emotional reactions. The number of comorbidities at hospital admission was the most important prognostic factor for recovery of health status at 4 months. The RAP and the BI both performed well in the assessment of functional status in regard to score distribution, internal consistency and construct validity. In contrast to the BI, the RAP also assessed instrumental activities of daily living and perceived problems with existing disabilities. The generic health status measures produced no added value in the assessment of functional status. The NHP covered a wider range of psychological health dimensions (emotion, pain, energy, and sleep) and had better psychometric properties than COOP/WONCA. None of the four instruments performed well in assessing social functioning. Conclusions: To assess health status after hip fracture, we recommend the RAP for functional status and the NHP for changes in emotion, pain, and energy. These instruments detected poor recovery in functional and emotional status at 4 months after fracture.

Development and implementation of the Rehabilitation Activities Profile for children: impact on the rehabilitation team.

To describe the changes in functioning of the rehabilitation team induced by the Rehabilitation Activities Profile for children (Children's RAP), an instrument designed to improve interdisciplinary communication in paediatric rehabilitation. Multiple case-study design. Seven paediatric rehabilitation teams. A two-year project to develop and implement the Children's RAP. During the project, data were gathered from observations, documents and informal interviews. After the project, formal interviews were held with team members and parents, and a focus group meeting with representatives of the teams was organized. Data were analysed by the method of analytic induction. The analysis was checked by an independent researcher. The preliminary results and conclusions were discussed in detail with participating teams. Development and implementation, as well as the changes induced by the project, varied between teams. Changes were observed for individual team members, for the team as a whole and for the children and their parents. However, changes for individual team members occurred relatively quickly, in comparison with the other changes. To achieve an optimal interdisciplinary team approach all changes are necessary. Therefore, we postulated four hierarchical steps in the development of an interdisciplinary team approach: (1) process-oriented approach, (2) result-oriented approach, (3) problem-oriented approach, and (4) interdisciplinary team approach. It took a considerable amount of time to achieve the interdisciplinary team approach by implementing the Children's RAP. However, the first steps are not only rewarding in themselves, but also prerequisites for further improvement.

Simultaneous development and implementation of the Children's Rehabilitation Activities Profile: a communication instrument for pediatric rehabilitation

Purpose : To describe the methods used for the development and implementation of the Rehabilitation Activities Profile for Children (Children's RAP), an instrument to structure information for team conferences. Methods : Our strategy consisted of nine steps: (1) survey in clinical practice; (2) literature search; (3) formation of a national study group; (4) development of specifications and a national draft; (5) development of local drafts; (6) integration of local drafts; (7) consultation of users and experts; (8) national conference; and (9) assessment of user experience. Results : The final version of the Children's RAP consists of three sections: (1) basic information about the child and its proxies; (2) present situation and needs of the child and its proxies; and (3) conclusions of the team conference. User satisfaction ranged from adequate to good. The Children's RAP is currently used in 53% of the Dutch pediatric rehabilitation centres. Conclusion : The methods used guarantee an optimal involvement of users, experts and literature. With these methods it was possible to develop an instrument which is widely accepted and implemented in clinical practice.

Value of measuring perceived problems in a stroke population

Functional status assessments mainly concentrate on difficulty in performance and/or dependency on other people. Very few assessments document the perceived problems of the patient regarding the assessed activities. This study evaluates the added value of measuring perceived problems using a parallel assessment method: the Rehabilitation Activities Profile. The study population consisted of 57 stroke patients living at home, six months after stroke. Thirty-three were receiving therapy (physiotherapy or rehabilitation day care). The patients indicated that they perceived a number of problems, especially on the items 'walking', 'using transport', 'leisure activities' and 'relation with friends/acquaintances'. The perceived problem scores did not relate in a uniform way to the disability scores. The perceived problem scores were dichotomized. The proportions of persons with perceived problems showed statistically significant differences between the therapy group and the nontherapy group for 15 out of 21 items (p &lt;0.02). The cumulative relative frequency distributions showed that the therapy group indicated significantly more problems than the nontherapy group (p &lt;0.01). It was concluded that it is at least as important to measure perceived problems as it is to measure disabilities.

Staff satisfaction with team conferences: development of a questionnaire

The Rehabilitation Activities Profile (RAP) is part of RAP-TEAM which is a novel method for structuring multidisciplinary team conferences. As such, RAP-TEAM is intended to facilitate interdisciplinary team work in rehabilitation medicine. Before the effects of RAP-TEAM in team conferences can be studied, an assessment method had to be chosen. A questionnaire was considered the most appropriate. The present study describes the develop ment of this questionnaire and its psychometric evaluation. Questions were drafted from three sources: literature, team conference observations, and discussion with professionals from various disciplines. Questions were divided among five dimensions: (1) problem analysis, (2) planning intervention, (3) evaluation, (4) organization, and (5) common viewpoint. For psychometric evaluation the questionnaire was completed by 39 professionals of various rehabilitation disciplines. After analysis of homogeneity (values of Cronbach's alpha range from 0.70 to 0.84), the predesigned dimension structure of the questionnaire was studied. The predesigned dimension structure could not be confirmed. Only one new dimension appears to be present which is post hoc defined as 'a professional's satisfaction with team conferences'. Homogeneity of this singular dimension is 0.92. Face and content validity of questions were established during construction of the questionnaire. Response to the ques tionnaire was not biased by social desirability. It is concluded that the ques tionnaire can be used to study the effects of RAP-TEAM.

Responsiveness of the Rehabilitation Activities Profile and the Barthel Index

The goal of this study was to compare the responsiveness for clinically meaningful change over time of a newly designed functional status scale, the Rehabilitation Activities Profile (RAP), with the more frequently used Barthel Index (BI). Four techniques for the quantification of responsiveness were utilized: effect sizes, p-values, t-statistics and ROC curves. The patient's return home was chosen as external criterion. An inception cohort of stroke patients was followed during 26 weeks. All patients still hospitalized on the 14th day after stroke were included. The functional assessments took place at 2, 3, 4, 8, 12, and 26 weeks after stroke. The patients were visited at the hospital, home, nursing home, or rehabilitation center. Of the 125 patients included in the study, 18 patients died during the observation period, 2 patients were lost to follow-up, and 1 patient refused to cooperate after 12 weeks. After 26 weeks, 104 patients remained for analysis. Three time periods were discerned: 2 to 12 weeks (early response), 12 to 26 weeks (late response), and 2 to 26 weeks after stroke (overall response). The effect sizes of the RAP were consistently higher on all three time periods than those of the BI. The p-value of the overall response mean change score of the RAP appeared to discriminate between patients returning home and those not returning home, whereas the BI failed on this point ( p = 0.004 vs. 0.496). Using t-statistics, the RAP showed a higher efficiency in expressing change on all time periods (relative efficiency = 1.42, 1.77, and 1.43, respectively). The receiver operating characteristic surface area of the RAP score was higher than the area of the BI score (0.74 and 0.59, respectively for the early response period). In conclusion, all results seem to indicate that the RAP is more responsive than the BI when returning home is chosen as an external criterion.

Introducing an innovative method in team conferences

An innovative method to structure multidisciplinary team conferences in rehabilitation medicine was developed: Rehabilitation Activities Profile report system (RAP-TEAM). Experiences with introduction of RAP-TEAM and the study of its effects on the satisfaction of professionals are described. RAP-TEAM was introduced in three teams. RAP-TEAM did not influence the satisfaction of professionals in two teams; satisfaction in the third team even decreased. Nevertheless, professionals report more benefits than disadvantages of RAP-TEAM. Several possible explanations for these results and the methodological problems with this kind of evaluation study are discussed. The most important explanation is that introduction of an innovative method should be allowed sufficient time before it could become effective. Recommendations for a successful introduction of innovative changes are made. All people concerned must be aware that a process of change is not simple, and needs the full attention of all.