Measuring outcomes in acute neurorehabilitation in General Hospital setting - our experience

In General Hospital setting, where varieties of patients are included in neurorehabilitation process, set of multidisciplinary functional tests were established, as a routine in daily work. Tests were done by physiotherapists and occupational therapists who were members of rehabilitation team. Our aim was to select the tests which can be used as a routine and are applicable for different neurological impairments in daily work. Tests were applied to inpatients admitted to the Medical, Trauma, Neurology and Neurosurgery wards in the Rashid Hospital, DOHMS, Dubai. Fifty inpatients with different neurological impairments admitted to totally 8 wards, were tested in the beginning of rehabilitation process and on discharge from the hospital. Nine tests were used as standardized tests for measuring motor, cognitive, focal impairment, ADL activities and disability: Motricity Index, Trunk Control Test, Standing Balance score, Functional Ambulation Categories test, Mini Mental State Examination, Canadian Neurological Scale, Action Research Arm test, Bartel Index and Functional Independent Measurements. FIM, Motricity Index and Trunk Control Test were applicable for all tested patients, with required adaptation for different neurological conditions within the same score. Other tests were not applicable for all patients as routine, but there were very useful for certain number of patients as a measurement of functional improvement. It is very important to have proper setup of tests, which are simple, reliable and valid for measuring impairment, disability and handicap and which can be used as standardized part of assessment protocol. Also, they must be applicable for different neurological impairments to monitor treatment progress. Combination of tests performed by different professionals and comprehensive approach of all team members is very important for measuring outcomes in rehabilitation and evaluating patient's impairment and disability. Proper hospital setup, optimal number of staff, good communication and team work are leading to better outcome in neurorehabilitation process.