Evaluation of Outcomes in Brain Injury Rehabilitation
The impetus for this Special Issue came from a series of meetings between clinicians and researchers working in varied UK neurological rehabilitation services. These meetings focused on the need to identify appropriate measures for defining and evaluating different forms of intervention for patients who have suffered a brain injury. The intention was also to identify measures which will ensure good communication between clinicians, purchasers, and service users. It soon became clear from the discussion that there was going to be no single solution to a complex problem. The patient group is very heterogeneous with an enormous diversity of needs and strengths, at different stages of recovery. Patients are offered treatments by teams with different specialisms, resources and constraints.
The papers comprised in this volume vividly delineate the many theoretical and practical issues which must be addressed in any attempts to capture, with sensitivity and accuracy, the critical changes occurring over successive phases of recovery and rehabilitation; they also document the international contributors' experience with a wide range of strategies and specific instruments.
The first five papers address, respectively:
The measurement implications of the World Health Organisation model for conceptualising different dimensions of outcome (Greenwood);
An example of a goal planning approach to rehabilitation, and related evaluation criteria (McMillan, Sparkes);
The development and application of a highly structured Goal Attainment Scaling procedure (Malec);
The creative solutions of a health economics team faced with the near-impossible task of comparing outcomes over a huge range of injury severity, time since injury, and rehabilitation services (Stilwell et al.);
A perspective on the requirements of health service purchasers (McCarthy).
In the second part of the volume, contributors relate their experience, solutions, and findings in four different types of rehabilitation setting (post-acute in-patient in-patient, cognitive-behavioural, out/day-patient, and community) which have correspondingly different foci of assessment.
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acquired brain injury Activities of Daily admission assessment Barthel behavioural Beta-l draft brain injury outpatient brain injury rehabilitation carer Classification of Impairments client centred clinical cognitive Community Outcome Scale comprehensive outcome correlations described developed dimension discharge evaluation example function GAS in rehabilitation GAS scores GAS T-scores Goal Attainment Scaling goal planning goal setting Greenwood handicap head injury health authorities hospital ICIDH ICIDH-2 independent individual injury outpatient programme inpatient inter-rater reliability involved Jane Powell long-term LTGs achieved Malec Maudsley Hospital Mayo brain injury memory notebook mental health National Health Service NEUROPSYCHOLOGICAL REHABILITATION neurorehabilitation number of LTGs Occupational Therapy Organisation outcome measures Participation patient person placement Ponsford postacute brain injury Problem Taxonomy provides psychometric purchasing rehabilitation outcome rehabilitation programme rehabilitation settings reliability reported Rockwood second interview self-awareness social staff STGs Stilwell structure subjects Table therapy tion traumatic brain injury treatment validity World Health Organisation