S G M Edwards, E D Playford, J C Hobart, A J Thompson
Edwards S G M, Playford E D, Hobart J C, Thompson A J.
Comparison of physician outcome measures and patients' perception of benefits of inpatient neurorehabilitation
BMJ 2002; 324 :1493
doi:10.1136/bmj.324.7352.1493
Neurorehabilitation outcome measures and patients' perception of benefit
Edwards et al raise some important and complex issues surrounding
outcome measurement in neurorehabilitation 1. This interesting paper
highlights the significant difference between patients’ and clinicians’
views on outcomes following neurorehabilitation. Including patients and
their families in goal setting and measuring outcomes is likely to aid the
rehabilitation process. Clinician rated outcome measures may fail to
measure rehabilitation goals that are important to patients and their
families.
Conversely, of equal importance perhaps is how an independent rater may
view the outcome of the rehabilitation process. It has perhaps become
essential to include family members or carers in the rehabilitation
process and the measurement of outcome to ascertain the broader areas of
health influenced by rehabilitation. Several brain injury outcome
measures exist that include equivalent-form patient and relative ratings 2
- 3. These scales may have benefits over traditional outcome measures.
Additional ratings are obtained from individuals who spend more time than
clinicians with the patient. While there are potential issues relating to
subjectivity and bias, family members do know the patient well, including
their pre-morbid characteristics. It is perhaps also a way of including
service users more actively in the process of identifying early obstacles
to successful rehabilitation outcomes.
Obtaining an equivalent-form relative outcome rating may, in addition,
provide valuable information regarding a patient’s self-awareness or
insight about the remaining impairments, handicaps and disabilities
following neurorehabilitation. Impaired self-awareness, common after
brain injury, is an important factor that may further influence the
measurement of the benefits of rehabilitation. Patients with poor self-
awareness may underestimate or overestimate their difficulties,
potentially influencing the measurement of rehabilitation outcome 4.
It is unlikely that a clinician rated outcome measure in isolation will be
able to measure or reflect comprehensively the complex factors that may
potentially influence outcome following neurorehabilitation.
Edwards et
al’s paper highlights the importance of using ratings other than that of
the clinician or rehabilitation staff and specifically to obtain the
opinion of the recipient of the rehabilitation intervention 1. It is of
great importance for any health service provider to obtain the views of
service users regarding the effectiveness of what was provided by the
service. Indeed, service user input should perhaps not be limited to
patients; carers may be able to provide feedback of specific relevance to
neurorehabilitation programmes.
1. Edwards, S. G. M., Playford, E. D., Hobart, J. C., Thompson, A. J.
Comparison of physician outcome measures and patients’ perception of
benefits of inpatient neurorehabilitation. BMJ 2002; 324: 1493. (22
June.)
2. Teasdale, T. W., Christensen, A-L., Willmes, K. et al. Subjective
experience in brain-injured patients and their close relatives: A European
Brain Injury
Questionnaire study. Brain Injury 1997; 11 (8): 543 – 563.
3. Powell, J. H., Beckers, K., Greenwood, R. J. Measuring progress and
outcome in community rehabilitation after brain injury with a new
assessment instrument – the BICRO-39 scales. Brain Injury Community
Rehabilitation Outcome. Arch Phys Med Rehabil 1998; 79 (10): 1213 – 1225.
4. Prigatano, G. P., Altman, I. M. Impaired awareness of behavioural
limitations after traumatic brain injury. Arch Phys Med Rehabil 1990; 71:
1058 – 1064.
Competing interests: No competing interests