Wolfson Neuro Rehabilitation Center, St George's Hospital, London, UK -
Maugeri Clinical Scientific Institute, Genoa, Italy -
Eur J Phys Rehabil Med. 2022 Apr;58(2):161-170. doi: 10.23736/S1973-9087.21.07022-2. Epub 2021 Nov 26.
Specialized Rehabilitation Services (SRSs) are designed to offer intensive multidisciplinary rehabilitation to patients with complex needs, who are expected to make significant functional gains in their ADLs over a relatively limited period of time. Although national guidelines offer a guidance on how to band patients by complexity, there is no consensus on how to screen patients with regard to rehabilitation prognosis.
The aim of this study was to improve the selection of patients admitted to an SRS, defining transparent and equitable prognostic criteria to guide clinicians' decision making.
This is a retrospective observational study SETTING: an SRS in the UK.
We included 121 patients affected by a neurological condition consecutively admitted for multidisciplinary rehabilitation.
Rehabilitation Complexity Scale Extended is used to describe rehabilitation complexity. A short list of potential barriers to rehabilitation was analysed to predict the functional outcome measured by the Functional Independent Measure and the Barthel Index.
Older age, a heavier burden of co-morbidities, pre-morbid cognitive difficulties or dementia and a lower function level at admission were the most important variables to predict a lower functional gain.
We have used this list of barriers to create the Wolfson Assessment Matrix as a potential support tool to guide clinicians navigating through the different rehabilitation service options when assessing complex patients for eligibility to an SRS.
SRSs are highly expensive services representing a possible step along the rehabilitation pathway for patients with complex needs. A tool such as the Wolfson Assessment Matrix would represent a step forward to help consistency in decision making regarding appropriateness for SRSs. It would also help to set realistic long-term goals with patients and families and support Health Services in the further development of alternative rehabilitation settings.
专门的康复服务（SRS）旨在为有复杂需求的患者提供强化多学科康复，这些患者有望在相对较短的时间内在日常生活活动中获得显著的功能改善。尽管国家指南提供了如何根据复杂性对患者进行分类的指导，但对于如何筛选康复预后患者尚无共识。
本研究旨在改善 SRS 收治患者的选择，制定透明和公平的预后标准来指导临床医生的决策。
这是一项在英国 SRS 中进行的回顾性观察研究。
我们纳入了 121 名连续接受多学科康复治疗的神经系统疾病患者。
使用康复复杂性扩展量表（Rehabilitation Complexity Scale Extended）来描述康复的复杂性。分析了一系列潜在的康复障碍，以预测功能性独立测量和巴氏指数测量的功能结局。
年龄较大、合并症负担较重、发病前认知困难或痴呆以及入院时功能水平较低是预测功能改善较低的最重要变量。
我们使用了这组障碍来创建沃尔夫森评估矩阵（Wolfson Assessment Matrix），作为潜在的支持工具，以帮助临床医生在评估有资格接受 SRS 治疗的复杂患者时，在不同的康复服务选择中进行决策。
SRS 是非常昂贵的服务，代表了复杂需求患者康复途径中的一个可能步骤。像沃尔夫森评估矩阵这样的工具将是向前迈出的一步，有助于在 SRS 适宜性方面的决策制定保持一致性。它还有助于与患者和家属设定现实的长期目标，并支持卫生服务部门进一步开发替代康复环境。
