For purposes of comparison and replication it is important to detail aspects of the rehabilitation service utilised: the rehabilitation approach, the service process, the composition of staff, and the nature and duration of services offered. These are described below:
i) The rehabilitation approach
This was based on a model of comprehensive care (La Rocca et al 1994) which considers that rehabilitation management extends beyond symptomatic
treatment, and emphasises the achievement of the best possible quality of life for the person within the limits of their disease (McGrath and Davis 1992; Schapiro and Langer 1994). While no two centres practice or deliver
comprehensive care in an identical way (Thompson et al 1994), the literature demonstrates a commonality of practice between centres, with the key
elements identified as:
1. a multidisciplinary team approach
2. interventions tailored to meet the individual’s needs, and 3. a patient centred functional goal setting approach.
(Scheinberg et al 1981; Erickson et al 1989; Schapiro 1990; ABN Working Party Report 1992; La Rocca and Kalb 1992; Mertin 1994; Thompson 1996a). Each of these key elements formed an integral part of the rehabilitation
programme undertaken by the patients in the treatment group (for a more detailed review refer to Section 1.3.1).
ii) The service process
The routine clinical process undertaken at the NRU has been documented in some detail (Johnson and Thompson 1996; Rositter and Thompson 1995a; Freeman et al 1996a). It is schematically represented in Figure 4.2.
Fig 4.2 Schematic representation of the assessment, selection and rehabilitation service provided by the NRU, NHNN.
1. I Inpatient j i R e fe rra ls i i O utpatient
A s s e s s m e n t
X
All p a tie n ts a re a s s e s s e d by a m dt and adv ic e is given on th e m ost suitable route o f m a n a g e m e n t
N H N N Lo cal
o u tp a tie n t o u tp a tie n t A dm it N R U
i, I
O th er C ontinue
reh ab ilitatio n h o sp ita l
cen tre c a re
Join t a s s e s s m e n t m e e tin g Initial a s s e s s m e n t is e x te n d e d & th e patient m e e ts h is/h e r trea tin g te a m
R eh ab ilitatio n in terv e n tio n & continuous re v ie w
G o a l setting including p ro p o s ed disc h a rg e d a te
D is c h a rg e s u m m a ry & jo int th e r a p y rep o rt
C o m m u n ity te a m : n u rs e s & th e ra p is ts G e n e ra l p ra ctitio n er R e fe rrin g co n sultan t T h e ra p is ts : o u tp a tie n ts P a tie n ts c a n be r e -r e fe rr e d or re v ie w e d d e p e n d in g on th e ir c h a n g in g n e e d s
Hi) Staffing establishment
The staffing establishment is in line with the ideal compositions and
staff:patient ratios recommended for neurological teams by the Association of British Neurologists (ABN Working Party Report 1992, p. 13). The Consultant is a Neurologist who has a special interest in neurological disability. Junior
medical staff include a Senior Registrar and a Senior House Officer. Sixteen whole time equivalent qualified Nurses and five Auxiliary Nurses are
supervised by a full time Ward Sister with the Clinical Nurse Manager having overall responsibility for Nursing Services. Therapy staff include: four
Physiotherapists (two senior II, one senior I, one superintendent III); four Occupational Therapists (two senior II, one senior I, one head III) and one Occupational Therapy Assistant; one point five Speech and Language
Therapists (one head III, 0.5 senior I); one Clinical Psychologist; and one half time Social Worker.
iv) Nature and duration of services offered
The core generic services identified by the Royal College of Physicians in 1987 (Section 1.3.1, Table 1.2) are integral to the comprehensive multidisciplinary service offered. Additionally a comprehensive range of specialist services are available including: dietetics, urological services, orthotics and splinting
services, communication aids assessment, and environmental controls service.
On average, all patients participate in two 45 minute sessions of physiotherapy and one session of occupational therapy per day. Speech and language
nurses involvement, in ensuring carryover of newly acquired skills into
everyday function, is considered an essential component of the rehabilitation service (Johnson 1995).
Integrated Care Pathways (Rossiter and Thompson 1995a,b), are used
routinely to document and monitor the clinical care provided for all MS patients at the NRU. While this information is not utilised in this study, it is readily available for purposes of replication or comparison.