Measuring the Effectiveness of Neurological Rehabilitation

Neurological rehabilitation aims to reduce the restrictions on an individual’s participation in society. Psychometrically rigorous and clinically relevant outcome measures, used appropriately, enhance the evidence base of rehabilitation. This Thesis assesses routinely used outcome measures at three time points: inpatient, outpatient, and longer-term follow-up. First, a retrospective analysis of the inpatient database of the Neurorehabilitation Unit was carried out to assess the Barthel index (Bl) and Functional Independence Measure (FIM). Second, a prospective study examined the impact of rehabilitation on physical function and emotional wellbeing. Five measures were completed on admission, discharge and three months post­ discharge: the Bl (clinician and patient scored versions), FIM, General Health Questionnaire and Hospital Anxiety and Depression Scale. Finally, the effect of multiple sclerosis (MS) on work retention was assessed in a crosssectional study using a newly developed outcome measure, the Impact on Work Questionnaire. In the first study, the responsiveness of the Bl and FIM total scores ranged from moderate to large. But item level analyses indicated differential item performance, with effect sizes varying from very low to large, associated with large floor and ceiling effects. The second study demonstrated the significant improvements in physical and psychological functioning in patients undergoing rehabilitation. Physical gains persisted after discharge, however, emotional wellbeing deteriorated. The last study revealed that a combination