Development and validation of the General Rehabilitation Adherence Scale (GRAS) in patients attending physical therapy clinics for musculoskeletal disorders.

BACKGROUND: Non-adherence to physical therapy ranges from 14 to 70%. This could adversely affect physical functioning and requires careful monitoring. Studies that describe designing and validation of adherence measuring scales are scant. There is a growing need to formulate adherence measures for this population. The aim was to develop and validate a novel tool named as the General Rehabilitation Adherence Scale (GRAS) to measure adherence to physical therapy treatment in Pakistani patients attending rehabilitation clinics for musculoskeletal disorders. METHODS: A month-long study was conducted in patients attending physical therapy sessions at clinics in two tertiary care hospitals in Karachi, Pakistan. It was done using block randomization technique. Sample size was calculated based on item-to-respondent ratio of 1:20. The GRAS was developed and validated using content validity, factor analyses, known group validity, and sensitivity analysis. Receiver operator curve analysis was used to determine cut-off value. Reliability and internal consistency were measured using test-retest method. Data was analyzed through IBM SPSS version 23. The study was ethically approved (IRB-NOV:15). RESULTS: A total of 300 responses were gathered. The response rate was 92%. The final version of GRAS contained 8 items and had a content validity index of 0.89. Sampling adequacy was satisfactory, (KMO 0.7, Bartlett's test p-value< 0.01). Exploratory factor analysis revealed a 3-factor model that was fixed and confirmed at a 2-factor model. Incremental fit indices, i.e., normed fit index, comparative fit index and Tucker Lewis index, were reported > 0.95 while absolute fit index of root mean square of error of approximation was < 0.03. These values indicated a good model fit. The value for Cronbach (α) was 0.63 while it was 0.77 for McDonald's (ω), i.e., acceptable. Test-retest reliability coefficient was 0.88, p < 0.01. Education level was observed to affect adherence (p < 0.01). A cut-off value of 12 was identified. The sensitivity and accuracy of the scale was 95%, and its specificity was 91%. CONCLUSION: The scale was validated in this study with satisfactory results. The availability of this tool would enhance monitoring for adherence as well as help clinicians and therapists address potential areas that may act as determinants of non-adherence.

Efectividad de programas educativo-terapéuticos en Fisioterapia / Effectiveness of educational and therapeutic programs in Physiotherapy

El fisioterapeuta aborda la atención terapéutica desde un punto de vista global, teniendo en cuenta todos sus aspectos. Uno de los objetivos principales del tratamiento en fisioterapia pretende disminuir el dolor; así el fisioterapeuta, desde una perspectiva eduativo-terapéutica, participa en actividades físicas para rehabilitar y mejorar la función de diversos sistemas a través de ejercicios específicos, que serán pautados acorde a las necesidades de cada usuario, organizando las sesiones formativas y terapéuticas en función de su evolución. El objetivo fundamental de esta revisión es dar a conocer el beneficio de los programas educativo-terapéuticos en fisioterapia como herramientas frente al dolor. En esta revisión se han incluido todos los artículos encontrados en las bases de PubMed, ENFISPO y PEDro que cumplieran los parámetros de búsqueda. Las consideraciones finales permiten mostrar que la educación para la salud que aporta el fisioterapeuta tiende a mejorar la salud y la calidad de vida de los usuarios (AU)

The physiotherapist addresses the therapeutic care from a global perspective by taking into account all its aspects. One of the main objectives of physical therapy is to reduce pain. Therefore the physiotherapist develops physical activities from an educational-therapeutic perspective in order to rehabilitate and to improve physical functions in various systems with specific exercises. These exercises will be prescribed according to each patient needs by organizing educational and therapeutic sessions based on their progress. The main objective of this review is to present the benefits of educational and therapeutic programs in physiotherapy as tools against pain. In this review we have included all the papers found in PubMed, ENFISPO and PEDro that meet the search parameters. The final considerations show that the health education given by the physiotherapist tends to improve the health and the patients quality of life (AU)

Atuação da fisioterapia às vítimas da boate kiss: a experiência de um Hospital de Pronto-Socorro / Physical therapy treatment for the victims of nightclub kiss: the experience of an Emergency Hospital

Introdução: Este artigo trata-se de um relato do trabalho desenvolvido pela equipe de fisioterapeutas de um hospital de pronto-socorro aos pacientes vítimas de queimaduras decorrente da tragédia na Boate Kiss. Objetivo: Descrever as práticas de assistências fisioterapêuticas prestadas, de forma a permitir compartilhar experiências realizadas com esse perfil de paciente em nível hospitalar. Método: Por meio de discussões durante as reuniões da equipe de fisioterapia, foram coletados dados a respeito das atuações na assistência às vítimas da Boate Kiss que foram internadas no hospital. Resultados: Descrevemos, nesse trabalho, as principais atividades assistenciais da fisioterapia, de forma que tecemos, entre outras considerações, a necessidade de atuação o mais precoce possível como uma estratégia de evitar complicações tardias. Conclusão: Consideramos, também, que a reabilitação de uma lesão por queimadura é um processo longo e que não termina com a alta hospitalar.

Introduction: This article it is about a report by work done by the team of physiotherapists in a emergency hospital to the burn victims due to the tragedy in Nightclub Kiss. Objective: The objective was to describe the practice of physical therapy, in order to allow to share experiences with this profile of patients at the hospital level. Methods: Through discussions during the meetings of the physiotherapy team, data about the actuations in assisting victims of Nightclub Kiss who were hospitalized in the hospital were collected. Results: We hereby describe in this paper the main assistance activities of physiotherapy so that present work we make among other considerations, the need for action as early as possible as a strategy to prevent late complications. Conclusion: We also consider that the rehabilitation of a burn injury is a long process that does not end with discharge.

Escalas de valoración del dolor en pacientes con demencia. Instrumentos de ayuda para el fisioterapeuta, el médico, el enfermero y el terapeuta ocupacional / Scales to evaluate pain in elderly patients suffering from dementia. Help-tools for the physiotherapist, doctor, nurse and occupational therapist

El propósito de este estudio es conocer el tipo de escalas que están siendo utilizadas para evaluar el dolor en personas mayores con demencia. Se desarrolló una estrategia de búsqueda en las bases de datos MEDLINE, Cochrane Library Plus, PEDro y Dialnet con el fin de captar todos aquellos artículos (ensayos controlados y ensayos controlados aleatorizados) datados de enero de 2000 a enero de 2012. Los criterios de exclusión son: estudios que no mencionen las escalas utilizadas para valorar el dolor y que no sean ensayos controlados (casos clínicos, revisiones…). Finalmente, se incluyeron 13 estudios en esta revisión. Se necesita un mayor número de estudios para valorar la eficacia de las escalas que valoran el dolor en ancianos con demencia. serlos datos disponibles sugieren que la utilización de escalas observacionales puede detectar el dolor en esta tipología de pacientes (AU)

The purpose of this study was to determine which scales are being used to evaluate pain in old people suffering from dementia. A search strategy was developed to retrieve all articles (randomized controlled trials and clinical trials without randomization) published in MEDLINE, Cochrane Library Plus, PEDro and Dialnet and BMC Geriatrics from January 2000 to January 2012. Exclusion criteria were articles that did not use scales for evaluating pain in elderly patients suffering from dementia, and other type of articles (case studies, reviews…). Finally, 13 studies were included in this review. From the results obtained it appears that more studies are needed to confirm the pain scales used for the elderly suffering from dementia. Observational scales may be useful to evaluate pain in these patients (AU)

Implementation and performance evaluation of an emergency department primary practitioner physiotherapy service for patients with musculoskeletal conditions.

OBJECTIVE: The study aims to describe the implementation of a primary practitioner physiotherapy service within a large regional ED and to evaluate its impact on waiting time and length of stay. METHODS: Integration and scope of practice of the physiotherapy service within the ED were described. Retrospective analysis of waiting time and length of stay data for the 3 years, 1 October 2008 to 30 September 2011, was performed. The performance of the physiotherapy service was compared with the Australasian College for Emergency Medicine (ACEM) waiting time guidelines, the Victorian Department of Health length of stay targets and to a similar group of patients seen by medical staff. RESULTS: The primary practitioner physiotherapy service saw 5641 patients of which 33% were less than 18 years old. The most common presentations seen by the service were limb fractures, soft tissue injuries and low back pain. Ninety-two per cent of patients were seen within the ACEM waiting time guidelines, and 91% of patients who went home were discharged within 4 h. Non-randomised comparisons with similar patients seen by medical staff indicated that patients seen by the physiotherapy practitioner service had shorter waiting times and length of stay. CONCLUSIONS: The current study found that patients with musculoskeletal problems seen by a primary practitioner physiotherapy service had improved waiting times and length of stay relative to ACEM and Victorian Department of Health targets, and though constrained by a retrospective non-randomised design, to a similar group of patients seen by medical staff. Further evaluation of the physiotherapy practitioner service is required.

A cross-sectional assessment of stroke rehabilitation in Nebraska hospitals.

OBJECTIVE: To assess the structure and process of stroke rehabilitation in Nebraska hospitals. DESIGN: Cross-sectional mail survey using the Dillman tailored-design method of administration. SETTING: Hospitals in Nebraska. PARTICIPANTS: Approximately 77% of the 84 Nebraska hospitals that provide stroke rehabilitation are critical access hospitals (CAHs) that are limited to 25 beds. Our study sample of hospitals (N=53) included the 19 hospitals licensed for 47 to 689 beds (non-CAHs) and a stratified random sample of 34 of the 65 CAHs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported stroke rehabilitation team structure and processes, purposes of and barriers to the use of evidence-based standardized assessments, specific assessments used, and access to specialized stroke rehabilitation services and community resources. RESULTS: Thirty-six (68%) of the 53 hospitals responded to the survey. Approximately 61% of the hospitals used an organized team to provide stroke rehabilitation; 8% of the hospitals-all non-CAHs-had a team dedicated to stroke rehabilitation. After adjusting for hospital size, having an organized team was significantly associated with the use of standardized assessments to improve communication, measure progress and outcomes, evaluate effectiveness of practice, and compare patient outcomes across conditions. Access to specialized stroke rehabilitation professionals and services was significantly greater in non-CAHs. CONCLUSIONS: Hospital size and the presence of a team are determinants of the structure and process of stroke rehabilitation in Nebraska hospitals. Further research is needed to determine (1) whether team structure is a determinant of stroke rehabilitation outcomes across the continuum of care settings, (2) the needs of rural stroke survivors, and (3) whether technology can facilitate the use of stroke rehabilitation standardized assessments by rural health care professionals.

An evaluation of a post-acute rehabilitation unit after five years of operations.

INTRODUCTION: The Hospital Organization Guidelines (HOG) recently recommended that Reference Hospitals create Post-Acute Rehabilitation Units (PARU). The authors describe the quality process of a PARU in a University Hospital (UH); this quality process had previously been used in a private rehabilitation hospital. GOALS: The authors wanted to evaluate the organization of the care provided in their PARU and compare the evaluation results with the results expected at the unit's creation five years earlier. METHODS: The evaluation indicators were set when the unit was created. These indicators allowed the evaluation of the appropriateness of admissions, the efficiency of the care path and the response to the patients' rehabilitation and intensive care needs. RESULTS: The appropriateness of admission was found to be coherent with the typology of patients admitted (i.e., brain and spinal cord injured patients just discharged from intensive care units). The brain-injured care path was streamlined. The evaluation results raised several questions about the resources provided and about the different needs of post-acute care and rehabilitation. DISCUSSION AND CONCLUSION: Patient needs must be identified precisely if the weak links of the care path are to be reinforced. The indicators used must be capable of assessing both the quantity and the quality of care. If these indicators lack relevance, or if the health care organization responds incompletely to patient needs, it puts the efficiency of the whole system at stake.

Hospital-based versus home-based proprioceptive and strengthening exercise programs in knee osteoarthritis.

OBJECTIVES: This study aimed to establish the effects of hospital- and home-based proprioceptive and strengthening exercise programs on proprioception, pain, and functional status in patients with knee osteoarthritis (OA). METHODS: Sixty patients with bilateral knee OA were randomly allocated into either a home-based or hospital-based exercise program. Hospital-based exercise group (n=30, mean age 50.23±9.07 years) received functional training program with proprioceptive ability, ice, and home exercises. Home-based exercise group (n=30, mean age 54.4±7.9 years) had a program of ice and home exercises. Treatment programs was conducted 5 days per week for 6 weeks (30 sessions). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Monitorized Functional Squat System-Proprioceptive Test (MFSS), timed performance test (TUG), and visual analogue scale (VAS) for the intensity of pain were used to quantify the variables. RESULTS: Both groups demonstrated significant improvement when pre- and post-treatment results were compared for pain intensity, WOMAC, and TUG test scores (p<0.05). No statistically significant improvement was found in proprioception of the home-based group (p>0.05). Hospital-based group demonstrated significantly greater improvement in MFSS, TUG test, and VAS in activity when compared with the home-based group (p<0.05). CONCLUSION: Both hospital- and home-based exercise programs decreased joint symptoms and improved function in patients with knee OA.

Comparison of the outcomes of two different exercise programs on frozen shoulder.

OBJECTIVES: The aim of the study was to compare the effects of two different exercise programs on pain, range of motion (ROM), and functional results in frozen shoulder. METHODS: Twenty-two female and 7 male patients [mean age 52.1 years (range 38-65 years)] were randomly allocated into two groups: 14 in the first group and 15 in the second group. The patients were treated for 6 weeks (30 sessions) at hospital under the supervision of physical therapist. Both groups were treated with transcutaneous electrical nerve stimulation, cold pack, and nonsteroidal antiinflammatory drugs; and were given glenohumeral ROM exercises. The scapulothoracic exercises were performed only by the second group. Functional results were assessed using the modified Constant score, pain was assessed using visual analog scale (VAS), and ROM was measured with a goniometer. Assessments were performed before treatment and repeated at 6 and 12 weeks of treatment. RESULTS: In both groups, the Constant score and ROM were increased, and VAS was decreased at the end of 6 and 12 weeks. The modified Constant score was not significantly different between the groups before and after treatment. VAS score was better in the second group at 6 weeks (p<0.01). Improvement in ROM was significantly better in the second group at 12 weeks (p=0.005). CONCLUSION: In addition to glenohumeral ROM exercises, scapulothoracic exercises contribute to decreasing pain and increasing ROM in patients with frozen shoulder.

Higiene de manos de los fisioterapeutas: prevención de infecciones nosocomiales / Hand hygiene in physiotherapists: prevention of nosocomial infections

Introducción: se entiende por infección nosocomial aquella que se adquiere en el hospital y que no estaba presente ni en período de incubación cuando el paciente ingresó. Las infecciones nosocomiales producen una alta morbimortalidad en los pacientes e incrementan los costes relacionados con los cuidados sanitarios. En una unidad de fisioterapia, se produce un aumento en el número de sesiones de tratamiento, y una limitación de la mejora funcional conseguida tras la finalización de éste.Objetivo: destacar la importancia de la correcta higiene de manos, tanto por su alta eficacia como por su bajo coste, como medida de prevención de la transmisión de microorganismos patógenos.Material y métodose realiza una búsqueda bibliográfica en las bases de datos de PubMed, PEDro y en The Cochrane Library.Conclusiones: la desinfección higiénica de manos con soluciones hidroalcohólicas es la más efectiva para reducir la contaminación bacteriana de las manos(AU)

Introduction:Nosocomial infection is defined as that acquired in the hospital that was not present in either the incubation stage or on admission. Nosocomial infection causes high morbidity and mortality in patients and an increase in health care costs. This causes a rise in the number of treatment sessions and places a limitation on the functional improvement achieved after its completion in a physiotherapy unit.Objective: To draw attention on the importance of appropriate hand hygiene due to its high effectiveness as well as its low cost in order to prevent transmission of pathogenic microorganisms.Material and methodA research of the literature was carried out through PubMed, PEDro, and The Cochrane library.Conclusions: Hand disinfection with an alcohol-based solution is the most effective measure to remove bacterial hand contamination(AU)

Organización de la actividad asistencial del fisioterapeuta en salas de Atención Primaria / Organization of care activity of the physiotherapist in primary care sites

Objetivo: conocer el tiempo dedicado a la actividad asistencial en salas de fisioterapia del Área de Gestión Sanitaria Norte de Almería. Métodos: estudio observacional descriptivo de la actividad asistencial realizada en tres salas de fisioterapia de las Zonas Básicas de Salud de Serón, Albox y Los Vélez durante el mes de febrero de 2006. Se cuantificó el tiempo dedicado a las distintas actividades asistenciales en dichas salas. Se diferenció por actividad asistencial efectiva (tratamiento individual, grupal y tratamiento domiciliario), actividades de formación y tareas de organización, según indica la Guía de Procedimientos de Fisioterapia en Atención Primaria. Se cuantificaron también otras actividades no incluidas en la cartera de servicios del fisioterapeuta. Resultados: del total del tiempo trabajado durante el mes de febrero en las tres Zonas Básicas de Salud (18 días), el mayor porcentaje correspondió a la actividad asistencial efectiva con un 86,37% de la jornada laboral (aproximadamente 6 horas diarias). Para actividades organizativas el porcentaje de tiempo dedicado diariamente fue del 6,89%. El tiempo dedicado a las actividades no incluidas en la cartera de servicios fue de 6,74%. Conclusiones: se ha encontrado que tanto las actividades realizadas por el fisioterapeuta como los tiempos empleados para las mismas no se corresponden en general con lo recomendado, siendo el tratamiento individual el que mayoritariamente ocupa la jornada laboral. Se dedica tiempo a actividades que no son propias del fisioterapeuta de Atención Primaria y que sería más conveniente utilizar en actividades formativas, de prevención y promoción de la salud(AU)

Objective: Know the time dedicated to care activity in the physiotherapy rooms of the North Health Care Management Area of Almeria.Methods: Observational, descriptive study of the care activity performed in threephysiotherapy sites of the Basic Health Zones of Seron, Albox and los Velez during themonth of February 2006. Time dedicated to the different care activities in said sites wasquantified. It was differentiated by real care activity (individual and group treatment andhome treatment), training activities and organization tasks as indicated by thePhysiotherapy Procedures Guidelines in Primary Care. Other activities not included inthe list of physiotherapeutic services were also quantified.Results: The greatest percentage of time worked during the month of February in thethree Basic Health Zones (18 days) corresponded to real care activity, this accounting for86.37% of the work day (approximately 6 hours daily). The percentage of time dedicated toorganizational activities daily was 6.89%. Time dedicated to activities not included in thelist of services was 6.74%.Conclusions: It was found that both the activities performed by the physiotherapist andthe times used for them do not correspond in general with that recommended, individualtreatment being that which mostly occupies the work day. Time is dedicated to activitiesthat are not characteristic of the primary care physiotherapist and that could be betterused in training activities, prevention activities and health promotion activities(AU)

Process of care and mortality of stroke patients with and without a do not resuscitate order in the West Midlands, UK.

OBJECTIVE: . To compare the process of care of stroke patients with and without a do not resuscitate (DNR) order. DESIGN: Retrospective case note review with prospective follow up of mortality. SETTING: Seven acute hospitals, with stroke units, in the West Midlands, UK. PARTICIPANTS: A random sample of patients (n = 702) admitted to hospital with acute stroke over a twelve month period. MAIN OUTCOME MEASURES: Case mix and process of care measures derived from the intercollegiate stroke audit package. Thirty day and one year mortality. RESULTS: About one-third (34%, 238/702) of stroke patients had DNR orders. The thirty-day mortality for DNR patients was 67% (160/238) versus 10% (46/449) for patients without DNR orders. DNR patients had significantly worse case-mix profile than non-DNR patients - median age 81 y vs 75y; fully conscious 36% vs 79%, able to walk 1% vs 21% and no loss of power in either arm 5% vs 24% (all p < 0.0001). DNR patients were more likely to be assessed early by a speech and language therapist (77% vs 59%, p < 0.001), but less likely to receive the majority of their care in a stroke/rehabilitation unit (20% vs 57%, p < 0.0001), or be cared for on a stroke unit or by a stroke team (42% vs 70%, p <0.0001), or had a description of the site of the cerebral lesion (31% vs 38%, p = 0.05) or be given aspirin (30% vs 42%, p = 0.007). CONCLUSIONS: Stroke patients with a DNR order are not receiving optimum care in that they are not being cared for on stroke units or by specialist teams. This may reflect the inadequate provision of specialist stroke services in the UK.

Programa de prevención terciaria a través del ejercio físico para adultos mayores - Aplicado en la Unidad de Fisioterapia de la Caja de Salud de la Banca Privada Regional La Paz / Program for tertiary prevention through the physical ejercio for older adults-Applied in the Unit of Fisioterapia de la Caja se Salud of Regional Private Banking La Paz

El presente trabajo del programa de prevención terciaria a través del ejercicio físico para adultos mayores- aplicado en la Unidad de Fisioterapia de la Caja de Salud de la Banca Privada Regional La Paz. El presente estudio, se realizará en la Caja de Salud de la Banca Privada, una institución de la seguridad social, certificad hay acreditada prestadora de servicios con alta capacidad y competencia profesional en el campo de la salud, con infraestructura hay servicios hay servicios acordes a las necesidades de su población. Motivados principalmente por el crecimiento demográfico de los adultos mayores. Se puede evidenciar una congestión, en los diversos servicios asistenciales médicos de la salud pública y la seguridad social a nivel nacional, por el persistentes incremento de las personas adultas mayores...

Development and application of a quality control procedure for short-wave diathermy units.

Short-wave diathermy (SWD) is a form of radiofrequency (RF) radiation, operating at 27.12 MHz, that is used therapeutically by physiotherapists. Although this form of therapy is widely available, the management of the equipment is not often addressed by either physiotherapists or by medical physics/clinical engineering. A quality control protocol for SWD units, examining power output and electrical and mechanical condition, was developed and applied to 20 units used in clinical practice. In addition, an environmental assessment of where the units were used was also included. Results showed that the power output was generally stable (coefficient of variation range 0-8.8%) and reproducible (coefficient of variation range 0-6.8%). When the outputs from 12 similar units were compared, it was found that the relationship between the units' intensity settings and power output measurements was non-linear. Two units with mechanical timers were found to have inaccuracies that could contribute, under a 'worst-case' scenario, to a dosage error of up to 45%. Environmental analysis found that all treatment plinths in use contained metal parts, which could constitute a fire hazard, and no department examined was equipped with an RF screened room, a facility that would ensure that other persons in the vicinity were not exposed to excessive stray radiation.

Analysis of ultraviolet phototherapy and photochemotherapy resources in Ireland.

BACKGROUND: Ultraviolet (UV) phototherapy is widely used and very successful in the treatment of skin conditions. As such a safe and efficient service is essential. At present, there are no standard Irish guidelines regarding the operation, calibration or inspection of UV equipment nor is there an Irish policy on staff/patient safety or training issues. AIM: To survey all known phototherapy centres in Ireland. METHODS: A postal questionnaire was sent to all known phototherapy centres in Ireland addressed to the consultant dermatologist or the physiotherapist-in-charge. It was divided into six sections: Instrumentation, Quality Assurance, UV meters, equipment maintenance, patient/staff safety and training. Comments on current practice were invited. Non-respondents were contacted by telephone, in some cases the survey was mailed a second time. RESULTS: This study demonstrated a substantial quantity of suboptimal equipment in use and a lack of consensus regarding quality assurance inspection and UV meter calibration frequency. CONCLUSIONS: Guidelines must be established for calibration of UV equipment and standardisation of phototherapy protocols in Ireland.

Physiotherapy in Mount Hagen General Hospital: an audit of activity over a six-month period.

There is a lack of a sustainable physiotherapy service in most hospitals in Papua New Guinea. Many clinicians, managers and senior administrators appear unaware of the benefits that such a service can provide. This survey uses an audit tool, a modified Körner form, to evaluate the impact of a physiotherapy service within a provincial hospital during a six-month period. The audit measures number of patients seen, types of diagnosis, time spent with individual patients and number of treatment sessions provided. 571 patients were seen in the 6 months, of whom 308 were outpatients and 263 were inpatients. Inpatients received an average of 3 hours of treatment per patient, outpatients received 1 hour. Most patients seen were those who suffer disability as a result of their condition and who would traditionally have a poor prognosis without physiotherapy intervention. The most common conditions seen were neurological disability in adults and children, conditions requiring orthopaedic rehabilitation, burns, arthritic conditions and those requiring respiratory physiotherapy techniques. The physiotherapy department at the hospital was the only establishment in the district able to provide a rehabilitation service for these patients. Hence physiotherapy greatly improved the services available to the most sick and disabled patients within the community. The fact that outpatient follow-ups proved problematic for so many patients suggests that patients should be kept in hospital until their rehabilitation needs have been fully met.

Clinical standards for inpatient specialist rehabilitation services in the UK.

OBJECTIVE: To develop a set of clinical standards for specialist inpatient rehabilitation services in the UK and to undertake a preliminary survey of consultants who provide those services. DESIGN: The proposed set of standards was developed by group consensus followed by an iterative consultation process. A postal survey was conducted on behalf of the British Society for Rehabilitation Medicine (BSRM) amongst its consultant members in the UK (n = 163), who were asked to assess their services in relation to these standards, and to comment on the standards themselves, their usefulness and applicability. RESULTS: The response rate was 61%, of which 81 respondents ran an inpatient rehabilitation service. Overall, the standards appeared to be acceptable to most, and mainly struck the right level, being attained by the majority of services. Specific suggestions were incorporated into the revised standards. Further work is required to establish agreed outcomes that are systematically measured and recorded: only half the respondents (50%) routinely recorded a standardized outcome measure, and only a quarter (26%) routinely reviewed patients to record long-term outcome. CONCLUSIONS: Clinical standards have been developed for specialist inpatient rehabilitation services in the UK. The BSRM proposes to adopt these standards for a test period of 2-3 years in the first instance. It is likely that they will require further refinement with time, and modification is required to adapt them to different subspecialities and settings.