Evaluating neurorehabilitation: lessons from routine data collection.

BACKGROUND: Clinical databases are being used increasingly to assess outcomes in healthcare services to provide evidence of clinical effectiveness in routine clinical practice. OBJECTIVES: To explore the benefits of a database for routine collection of clinical outcomes within an inpatient neurorehabilitation setting; determine the effectiveness of inpatient neurorehabilitation in a range of neurological conditions; and determine variables influencing change in functional outcome. METHODS: Over a nine year period, demographic and diagnostic characteristics were collected for the 1458 patients admitted consecutively to a neurorehabilitation unit. The level of function was measured on admission and discharge using the Barthel Index (BI) and Functional Independence Measure (FIM). Patient perception of rehabilitation benefit was evaluated using visual analogue scales (VAS). RESULTS: Of the 1413 patients (mean (SD) age 48 (14.8), range 16 to 87) whose length of stay was more than 10 days (mean 34 (24) range 10 to 184), 282 had stroke, 614 multiple sclerosis, 248 spinal cord injuries, 93 a neuromuscular condition, and 176 other brain pathology. Patients improved in functional ability as measured by both BI and the FIM motor subscale (effect sizes 0.93 to 1.44 and 1.01 to 1.48, respectively). VAS ratings demonstrated high levels of patient perceived benefit. Diagnosis, functional activity score on admission, and length of stay were significant predictors of functional gain, explaining 44% of the variability in the change scores. CONCLUSIONS: Systematic collection, analysis, and interpretation of standardised clinical outcomes data are feasible within routine clinical practice, and provide evidence that inpatient rehabilitation is effective in improving functional level in neurologically impaired patients. These data complement those of clinical trials and are useful in informing and developing clinical and research practice.

Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea.

Clostridium difficile is the main infectious cause of colitis in hospital inpatients. The incidence is increasing, and it is associated with significant mortality, morbidity, and increased length of stay. The main risk factor is use of broad-spectrum antibiotics, and antibiotic restriction is the most effective control measure. We carried out a retrospective case-control study to investigate whether use of proton pump inhibitors (PPI) was an additional risk factor. PPI use within the preceding eight weeks was associated with an increased risk of C. difficile diarrhoea (odds ratio 2.5, 95% CI 1.5-4.2). Reduction of unnecessary PPI use may be an additional strategy to reduce the incidence of this infection.