Program evaluation of a physical medicine and rehabilitation unit: a new approach

Rehabilitation units must meet the increasing demand for empirical documentation of the quality of care patients receive. Hospitals wanting to do program evaluations will find few published materials providing norms by which to judge the adequacy of the functional outcomes achieved by their rehabilitation patients. The purpose of this research was to develop an approach to program evaluation that would serve the accreditation needs and would be relatively inexpensive to implement. Sixty-nine consecutive admissions for cerebral vascular accidents (CVA) were assessed on activities of daily living (ADL) and cognition using a behaviorally defined procedure called the "Level of Rehabilitation Scale" that was developed for program evaluation purposes. Nurses and spouses of patients were interviewed to obtain the observations that were rated. Further ratings on ADL and cognition were made at discharge. Those at home 6 weeks and 4 1/2 months after discharge were assessed on the same scales and on home-relevant activities. Experience with the instrument showed that ratings of function can be made in a reliable and valid fashion. The research provides the beginning of the accumulation of improvement norms for CVA inpatients and documents maintenance of improvement 4 1/2 months after discharge. Hospitals and rehabilitation units can utilize these norms and this method of program evaluation economically using nonclinically trained staff.