F-3-17-07
THE NORTHWICK PARK CARE NEEDS ASSESSMENT (NPCNA) - A DIRECTLY COSTABLE OUTCOME IN REHABILITATION
Lynne Turner-Stokes, Kyaw Nyein, Di Halliwell
(Regional Rehabilitation Unit, Northwick Park Hospital. London. UK)
The Northwick Park Dependency Score (NPDS) has been shown to be valid and is simple and practical to use, and was designed specifically to inform care needs in the community and facilitate discharge planning. The purpose of this study was to develop a conversion formula to translate the NPDS into a care needs assessment, and to evaluate this as a directly costable measure of outcome in rehabilitation.
Methods: For each task a set of assumptions was developed to reflect the number of people, the time taken, and the frequency of help required. Tasks were collected into a daily timetable and minimum and maximum allocations made for each time slot. From this a care package can be identified and costed. In a prospective comparative study in 40 consecutive patients admitted to our unit, time-tables of care needs were drawn up using a) the NPDS-derived Care Needs Assessment (NPCNA) and b) detailed structured interview with an independent assessor. The care package required to meet those care needs was then proposed by a community care planner who was blind to the method of care needs assessment.
Results: Assessment of the total weekly hours of care showed a high correlation between the two methods (rho .89) with no consistent bias. There was also excellent correlation in the category of care package allotted (rho .94) and the weekly cost of care (rho .94).
Conclusion: The NPCNA provides a simple and quick estimate of care needs in total care hours, or a timetable of care from which a care package can be directly planned and costed. It could now be used to assess the effectiveness of rehabilitation in reducing the cost of continuing care in the community.
F-3-17-08
PROFILES OF INDIVIDUAL FUNCTIONAL INDEPENDENCE MEASURE ITEMS DURING REHABILITATION IN ACUTE SPINAL CORD INJURED PATIENTS
J.W. Middleton, G. Truman, T. Geraghty, D.S. Smith (Moorong Spinal Unit, Royal Rehabilitation Centre & Rehabilitation Studies Unit, The University of Sydney, Sydney, Australia)
Purpose: The purpose of this study was to evaluate the validity of the Functional Independence Measure (FIM) and its ability to measure improvement in function during rehabilitation for a spinal cord injured (SCI) population.
Method: Admission and discharge FIM individual item and total scores were collected in 124 acutely injured patients admitted to the Spinal Unit for rehabilitation over a 3 year period.
Results: Significant effects (ANOVA) were found for both neurological level and degree of impairment (complete or incomplete) in the tetraplegic and paraplegic groups for discharge and FIM change scores for all motor items except toileting, bladder control, locomotion and stair climbing. However, no significant effects existed for FIM cognitive items.
Conclusion: Within certain limitations, the FIM demonstrated criterion based validity and an ability to measure functional change during rehabilitation in acute SCI patients.
