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This area of work involves the development of multi-disciplinary integrated care pathways (ICPs). The ICPs are based on systematic reviews of the published evidence, to manage symptoms in the context of severe brain injury. Their purpose is not only to improve management, but also to form a basis for monitoring and assessment on which to measure the effectiveness of interventions prospectively.
The benefits of this approach to patient care have been determined through a rolling process of audit. An additional aspect has been the design and evaluation of instruments for assessing both pain and depression in patients with communication deficits.
Shoulder pain is a common and distressing problem for many patients with neurological conditions such as stroke. It may not immediately be evident in people with communication impairments who have difficulty conveying information about pain. To improve management of this problem, we have introduced documentation in the shape of a proforma and associated evidence based guidelines which:
Three rounds of audit have been carried out to assess performance on 18 quality standards. We have found that introducing the proforma has improved standards of documentation and demonstrated a positive outcome in over half of our patients.
A key output of this work is an information pack designed for rehabilitation professionals and which is available on request from the Regional Rehabilitation Unit. The pack includes:
Further outputs include publications in peer-reviewed journals and presentations to rehabilitation professionals, both locally and at national and international conferences.
A number of retrospective studies have been conducted using both retrospective and prospective data. On the Regional Rehabilitation Unit at Northwick Park Hospital we have developed an integrated care pathway (ICP) for botulinum toxin intervention and have then been able to use data from this to inform the future development of a more holistic spasticity management ICP. The ICP therefore provides a systematic method of recording the process and outcome of intervention in a consistent manner.