Hoensbroek Rehabilitation Center Albère Köke
Content Rehabilitation Foundation Limburg (SRL) Patient profiles Benefits medical rehabilitation Outcome measurement Summary / conclusions
Hoensbroek Maastricht Valkenburg (children) Heerlen
Rehabilition Foundation Limburg Rehab Center Sports Health Center Auditive system and speech Center Vocational Center Department Rehabilition Atrium Hospital Heerlen Adults Hoensbroek Rehabilitation Center Children Franciscusoord Valkenburg Department Rehabilitation Maastricht Hospital
SRL core bussiness Comprehensive rehabilitation programs for adults and children Diagnostic/advice/treatment hearing/speech problems Re-integration work Education (children / professionals) Research
Mission SRL wants to guide disabled people back to independent participation in society by combined high quality care Interdisciplinary ICF model Client centered care Evidence based In cooperation Transparant
Patientprofiles in HRC (adults) Cardiac (heart attack, post surgery) Spinal Cord Injury Amputation/trauma Chronic Pain Stroke Brain injury
Patients treated in HRC 2008 106 beds / 436 employees 731 clinical patients 2843 outpatients Individual / group Therapy hours: Clinic 64590 Outpatient department 62400 Payment by Health Insurance Average clinical days: 47
Patientgroups Clinical N Outpatients N Clinical days Cardiac 200 285 28 Spinal cord 105 270 64 Amputation/ trauma 80 189 56 Chronic Pain 93 540 30 Stroke 120 272 68 Brain injury 124 277 57
Professionals HRC Rehabilitation physicians: 17 Physical therapist: 38 Occupational therapist: 29 Social workers: 7 Psychologist: 9 Sport-instructors: 5 Speech therapist: 7
Benifits Client: improvement in activities and participation; quality of life; self management; autonomy Funder: cost effective high quality care Community: re-integration into work and social life, less medical shopping/costs
Outcome measurement Not systematically defined or measured in most teams/units Stroke Team is developing a core set Team Chronic Pain implemented standard outcome measurement
Outcome measurement chronic pain Based on the Dutch Core Set Painrehablitation 2007 Consists anamnestic questions and standard meaurements Patiens description and treatment evaluation Initiative on Methods, Measurements, and Pain Assessments in Clinical Trials (IMMPACT) 2003, 2005 etc ICF core set low back pain 2004 ICF core set chronic widespread pain 2004
Outcome Domains Dutch Pain and fatigue Physical functioning Emotional functioning core set Participant ratings of global improvement and satisfaction with treatment Symptoms and adverse events Participant disposition (withdrawal and adherence to the treatment regimen) Participation (family life, social life, recreational activities, work) Patient individual goals Medical consumption
Measurements Pain and fatigue numeric score 0-11 Physical functioning SF36 physical functioning MPI- interference Emotional functioning SF36 mental health Participation Pain Disability Index Working ability Index Patient Individual Goals Patient Specific Functional Scale Canadian Occupational Performance Measure Medical consumption several questions Patients rating of improvement / satisfaction numeric score 0-11 5 point Likert scales Patients disposition drop out rates Adverse events open questions
Extra measurement pain HRC Screening/diagnostic set Anxiety depression HADS/BDI Negative beliefs PCS/TSK (+ for evaluation) Personality disorders VKP Evaluation: Acceptance CPAQ Self efficcay CPSS Expectations VAS
Timing measurements T0 start pain rehabilitation program T1 end of treatment T2 3 months follow up T3 12 months follow up
Implementation I Report published and send to all rehabilitation centers and hospitals Article in the Dutch Pain Journal (NTPP) Presentations on symposia/conferences www. revalidatiebijpijn.nl
Implementation II WEBbased systems for data is developed 8 rehabilitation center + 4 hospitals will participate in a national implementation project To establish benchmarks and norm data
Summary /Conclusion Outcome measurements in HRC are not common in all teams In the stroke unit a set is under construction Outcome measurement in chronic pain contains only self reported questionnaires by patients Dicipline measures, activity monitoring, perfomnace measures under construction (in field of chronic pain) Goal SRL is to implement standardized outcome measurements in all teams
Kwaliteit van leven SF 36 90 80 70 60 50 40 30 20 10 0 FF SF RPF RPE MG VI PYN AG azm pijn Cardio MS Depressie Kanker
Kwaliteit van leven SF 36 90 80 70 60 50 40 30 20 10 0 FF SF RPF RPE MG VI PYN AG azm HRC Friesland Cardio MS Depressie Kanker
Kwaliteit van leven SF 36 90 80 70 60 50 40 30 20 10 0 FF SF RPF RPE MG VI PYN AG azm HRC Friesland Cardio MS Depressie
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