The evidence, that the implementation of quality assurance systems in neurologic and trauma rehabilitation is able to improve patients´ functional health status is low. Indicators for outcome measurement should be assessed- not only for quality assurance reasons. Neurologic rehabilitation aims at improving the functional health status of patients as well as reintegrating patients in social participation. Therefore a variety of instruments for assessing functional health outcomes, activity and participation of patients have been developed and validated. The comprehensive and multi-dimensional assessment of patients´ health status is the basis of allocation decisions, standardised planning in rehabilitation as well as coming up to the patients´ and the health care providers´ expectations. The selection of appropriate measuring instruments makes significant contributions to improved patient care and its treatment outcomes.
The first part of this project aims at identifying instruments for classifying disease severity in patients with neurologic or trauma rehabilitation and assessing them according to test quality criteria. As an example, chose two specific diagnostic groups (stroke and traumatic brain injury)
We identified 2527 publications by systematic literature search and hand search. 167 full text articles met our inclusion criteria and were included in further analyses.
In stroke patients, specific instruments for classifying the severity of the disease show better test quality than generic instruments. We recommend the National Institut of Health Stroke Scale (NIHSS), the Beck Depression Inventory (BDI), the Frenchay Activities Index (FAI), the Stroke Impact Scale (SIS) and the Stroke Specific Quality of Life Scale (SSQOL) according to test quality criteria. In patients with traumatic brain injury specific instruments do not necessarily perform better than generic instruments. We recommend the Disability Rating Scale (DRS) and the Community Integration Questionnaire (CIQ).
Instrument selection is not only dependant of test quality (and feasibility and acceptability issues), but also of the purpose the measurements should serve in the system. Generic instruments can be used across different diseases, while additionally other criteria have to be assessed disease specific (modular composition of generic and disease specific instruments).
For a choice of measurement instruments in neurological and trauma rehabilitation in Austria, aims of measurements have to be defined. It has to be clarified, whether and in which way measurements for quality assurance and outcome evaluation will be implemented and if it will be connected to reimbursement.