Implementing a new model of residential rehabilitation: findings and future recommendations

Musculoskeletal injury is one of the leading causes of medical discharge in the UK Armed Forces. Residential rehabilitation (RR) courses are part of Defence rehabilitation, for service personnel (SP) who do not respond to treatment at primary care. Historically, it was delivered as a 3-week block model. As a quality improvement project, rolling admissions were introduced aiming to improve access to RR and deliver outcomes that met the requirements of primary care referrers.

Clinical outcomes were assessed for SP with either spinal or lower limb pathology using the Musculoskeletal Health Questionnaire (MSK-HQ) on course admission and discharge and the Medical Deployment Standard (MDS) on admission and 6 months post course. Wait times were also recorded. Outcomes were compared with the block admission using retrospective audit data. Referrer feedback was gathered using a questionnaire pre introduction and post introduction of rolling admissions.

Rolling admissions reduced course wait times from an average of 55 days to 19 days. Of SP who attended a rolling admission course with spinal pathology (n=23), 58% showed an increase in MDS, 65% showed an increase of the minimally important change in MSK-HQ. With lower limb pathology (n=35) 57% increased MDS, 49% increased MSK-HQ. For the block model, of those with spinal pathology (n=30) 43% increased MDS, 67% increased MSK-HQ, with lower limb pathology (n=30) 60% increased MDS, 33% increased MSK-HQ. Referrer feedback improved with rolling admissions with feedback most positive in relation to the model's responsiveness for admitting SP onto the course.

Rolling admission provided similar clinical outcomes as the previous block model in a shorter time frame with lower wait times and better met the needs of referrers. Future study recommendations include longer term follow-up and looking at alternative ways to measure the success of RR within the care pathway.