Acute neurorehabilitation versus treatment as usual

Abstract

Several clinical and government reviews have recommended specialised rehabilitation services for those recovering from neurological insult or neurosurgical intervention. Despite this, provision of ‘rapid access’/acute neurorehabilitation units is extremely limited in the UK. In some areas, millions of people have no access to such facilities. Numerous articles have indicated that delayed access to neurorehabilitation in the acute recovery stage may worsen clinical outcomes and increase length of stay for patients. However, there has been a lack of studies directly comparing clinical outcomes between matched samples of patients in acute neurorehabilitation units versus patients receiving treatment-as-usual. In a study believed to be the first of its kind, this paper: (A) Describes the rationale and evidence base for acute neurorehabilitation. (B) Provides a comparison of clinical outcome scores Functional Independence Measure/Functional Assessment Measure (FIM-FAM) and also length of stay times for both of the aforementioned groups. The results show that all outcome areas except the ‘communication’ domain saw clinically and statistically significant improvements in the acute neurorehabilitation group. Length of stay was significantly reduced in the acute neurorehabilitation group. The case for reviewing the provision of acute neurorehabilitation units is now even more urgent and difficult to ignore.

Keywords::

• acute
• comparison
• head injury
• neurorehabilitation
• outcomes

Acknowledgements

The authors kindly acknowledge Dr Krystyna Walton, Consultant in rehabilitation Medicine on ward C2 for bringing the study data to our attention.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.