Rehabilitation In England Research Articles

Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of the UK Rehabilitation Outcomes Collaborative national clinical dataset for rehabilitation centres in England.

BackgroundRehabilitation is effective for multiple sclerosis, but is it value for money?ObjectivesTo evaluate functional outcomes, care needs and cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis (MS).MethodsA multicentre cohort study of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Data included all adults with MS (n = 1007) admitted for specialist inpatient (Level 1 or 2) rehabilitation in England, 2010–2018.Outcome measuresDependency/care needs: Northwick Park Dependency Scale/Care Needs Assessment, Functional independence: UK Functional Assessment Measure (UK FIM+FAM). Cost-efficiency. Patients were analysed in three dependency groups (High/Medium/Low).ResultsAll groups showed significant reduction in dependency between admission and discharge on all measures (paired t-tests: p < 0.001). Mean reduction in care costs/week was greatest in the most dependent patients: High: £519 (95% CI: 447–597), Medium: £148 (76–217), Low: £36 (12–83). Despite longer stays, time taken to offset the cost of rehabilitation was shortest in the most dependent patients: High: 12.9 (12.0–14.1) months; Medium: 29.3 (21.3–51.8); Low: 76.8 (0–36.1). Item-level changes corresponded with clinical experience.ConclusionsSpecialist rehabilitation provided good value for money in patients with MS, yielding improved outcomes and substantial savings in ongoing care costs, especially in high-dependency patients.

Family role in in-patient rehabilitation: the cases of England and Turkey

Purpose This article explores the differences between experiences of family role in in-patient rehabilitation in Turkey and England. Background The literature predominantly assumes family presence in rehabilitation as positive, because it draws upon Western cases, where care is delivered fully by professionals, and patients may feel isolated during hospital stays. Analyses of other contexts provide a more nuanced view. Method This qualitative research included in-depth interviews (Turkey: 42, England: 18) with people with disabilities (n = 39), their families (n = 8) and hospital staff (n = 13); hospital ethnography (Turkey), focus groups (England: 3 groups involving 4 doctors, 5 nurses, 6 therapists), and participant-observation (England: 5 families). Thematic analysis highlights experiences of family involvement across different contexts. Results Families are differently integrated in rehabilitation in England and Turkey. In England, where family presence is regulated and relatively limited, people with disabilities feel more isolated and see family as a major form of support. In Turkey, where family presence is unregulated and intense, they enjoy family as an agent of intra-hospital socialising, but find it disabling when it implies a loss of privacy and individuality. Conclusion Family involvement in rehabilitation should support social interaction but allow people with disabilities to remain independent. Implications for rehabilitation Family involvement in rehabilitation can be both enabling and disabling. Existing literature draws upon rehabilitation practices, where family presence is limited and perceived as positive. An analysis of cases, where families are integral to the health care system (e.g., Turkey), can provide a nuanced view of family integration, which can be both enabling and disabling. Rehabilitation processes and health professionals need to integrate families in ways that will enrich social interaction, but still allow people with disabilities to retain their independence.

\u201cStruggling with practices\u201d \u2013 a qualitative study of factors influencing the implementation of clinical quality registries for cardiac rehabilitation in England and Denmark

BackgroundThe use of clinical quality registries as means for data driven improvement in healthcare seem promising. However, their use has been shown to be challenged by a number of aspects, and we suggest some may be related to poor implementation. There is a paucity of literature regarding barriers and facilitators for registry implementation, in particular aspects related to data collection and entry. We aimed to illuminate this by exploring how staff perceive the implementation process related to the registries within the field of cardiac rehabilitation in England and Denmark.MethodsA qualitative, interview-based study with staff involved in collecting and/or entering data into the two case registries (England N = 12, Denmark N = 12). Interviews were analysed using content analysis. The Consolidated Framework for Implementation Research was used to guide interviews and the interpretation of results.ResultsThe analysis identified both similarities and differences within and between the studied registries, and resulted in clarification of staffs´ experiences in an overarching theme: ´Struggling with practices´ and five categories; the data entry process, registry quality, resources and management support, quality improvement and the wider healthcare context. Overall, implementation received little focused attention. There was a lack of active support from management, and staff may experience a struggle of fitting use of a registry into a busy and complex everyday practice.ConclusionThe study highlights factors that may be important to consider when planning and implementing a new clinical quality registry within the field of cardiac rehabilitation, and is possibly transferrable to other fields. The results may thus be useful for policy makers, administrators and managers within the field and beyond. Targeting barriers and utilizing knowledge of facilitating factors is vital in order to improve the process of registry implementation, hence helping to achieve the intended improvement of care processes and outcomes.

Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales

BackgroundPulmonary rehabilitation (PR) improves exercise capacity and health status in patients with COPD, but many patients assessed for PR do not complete therapy. It is unknown whether socioeconomic deprivation associates...

Probation and Rehabilitation in England and Wales, 1876-1962. By Raymond Gard

<i>Probation and Rehabilitation in England and Wales, 1876-1962</i>. By Raymond Gard

Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland

ObjectivesTo determine why so few patients with chronic heart failure in England, Wales and Northern Ireland take part in cardiac rehabilitation.DesignTwo-stage, postal questionnaire-based national survey.Participants and settingStage 1: 277 cardiac...

Detoxification in Rehabilitation in England: Effective continuity of care or unhappy bedfellows?

There is evidence that residential detoxification alone does not provide satisfactory treatment outcomes and that outcomes are significantly enhanced when clients completing residential detoxification attend rehabilitation services (Gossop, Marsden, Stewart, & Rolfe, ; Ghodse, Reynolds, Baldacchino, et al., ). One way of increasing the likelihood of this continuity of treatment is by providing detoxification and rehabilitation within the same treatment facility to prevent drop‐out, while the client awaits a rehabilitation bed or in the transition process. However, there is little research evidence available on the facilities that offer both medical detoxification and residential rehabilitation. The current study compares self‐reported treatment provision in 87 residential rehabilitation services in England, 34 of whom (39.1%) reported that they offered detoxification services within their treatment programmes. Although there were no differences in self‐reported treatment philosophies, residential rehabilitation services that offered detoxification were typically of shorter duration overall, had significantly more beds and reported offering more group work than residential rehabilitation services that did not offer detoxification. Outcomes were also different, with twice as many clients discharged on disciplinary grounds from residential rehabilitation services without detoxification facilities. The paper questions the UK classification of residential drug treatment services as either detoxification or rehabilitation and suggests the need for greater research focus on the aims, processes and outcomes of this group of treatment providers.

Cardiac rehabilitation in England: a detailed national survey

The purpose of this study is to conduct a detailed analysis of cardiac rehabilitation programmes in England to compare actual provision with the recommendations of the National Service Framework and Scottish Intercollegiate Guideline Network guidelines. Questionnaires and interviews were conducted with key staff from one centre in each Strategic Health Authority in England to establish staffing levels, patient throughput, programme details, data collection and funding. There were major discrepancies between programmes and the national recommendations. Perceptions of the service were often at variance within key staff in the trust. Staffing levels, lack of facilities and space were identified as a weakness in many of the programmes. Inadequate exercise sessions, poor record keeping and a failure to tailor the sessions to the patients needs were common. Mean funding was pound288 per patient rehabilitated. For those 30% of eligible patients who enter cardiac rehabilitation in England, the service suffers from inadequate staffing, facilities and space, associated with gross underfunding. If the recommended 85% of eligible patients were included the situation would be much worse. The Department of Health recommendations for cardiac rehabilitation have not been translated into action, with most hospitals giving it low priority compared with other cardiology services. A treatment with demonstrable benefits should at least meet the standards recommended by national guidelines.

Current provision of cardiac rehabilitation in England and Wales

Summary A survey of all programmes known to the British Heart Foundation in England and Wales has been carried out, to identify which professionals are coordinating the service, who is being offered cardiac rehabilitation and any existing exclusion criteria. The survey also explored the nature of funding and any difficulties encountered in obtaining continued financial support (see appendix 1). Within each region, cardiac rehabilitation programmes identified similar difficulties: lack of funding and support from trusts and medical teams, minimal job security or training and education opportunities, ad hoc services run by health professionals in their own time and inequalities of service provision within area health authorities. Key points from the survey are presented in this report which suggests that, currently, cardiac rehabilitation is under-funded and undervalued. Joint funding by hospital and community trusts providing collaboration and integration of service provision should be the way forward.

Community-based rehabilitation in England.

The National Health Service was established in postwar Britain with the main aims of improving the health of the nation and providing free medical care when it was needed. Over the years the service has become increasingly involved in crisis intervention, rather than prevention. The ageing population has placed new demands on the service but the strength of family medicine, together with rehabilitation services, has formed the basis of good community-based rehabilitation. There is still the need to integrate the medically provided service with that of the social services.

Medical rehabilitation: Policy-making in the english health service

This paper describes recent proposals for the development of medical rehabilitation in England, and examines the influence of the medical profession on the fact that they were not accepted into official policy. A central feature of the plan was to establish hospital consultants in rehabilitation. Psychiatrists and geriatricians, who have a substantial commitment to rehabilitation as part of their own specialties, opposed this. Several objections have been raised to the plan, such as doubts about the value of medical rehabilitation, particularly as a hospital specialty; but these objections do not explain the profession's lack of support. This lack of support appears to result either from antagonism to the proposed organization of rehabilitation, which challenges the clinical autonomy of other specialists, or from indifference to the subject as a whole. This case demonstrates the influence of the established leadership of the medical profession on matters of professional practice, despite the attempts of particular interests within the profession and of the Department of Health and Social Security to introduce changes.

Rehabilitation in England and America

Rehabilitation in England and America

Business Rehabilitation in England

Business Rehabilitation in England