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European Journal of Physical and Rehabilitation Medicine 2021 Nov 26

DOI: 10.23736/S1973-9087.21.07022-2


lingua: Inglese

The Wolfson Assessment Matrix: a potential tool to support clinicians in establishing access to specialized neuro rehabilitation by capturing important prognostic factors

Alessia SAVERINO 1, 2 , Raphael SONABEND 3, Sancho WONG 1, Christopher SYMEON 1

1 Wolfson Neuro Rehabilitation Centre, St George’s Hospital, London, UK; 2 Istituto Clinico Scientifico Maugeri, Genoa, Italy; 3 Department of Statistical Science, University College London, London, UK

BACKGROUND: 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.
AIM: 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.
DESIGN: this is a retrospective observational study.
SETTING: an SRS in the UK.
POPULATION: we included 121 patients affected by a neurological condition consecutively admitted for multidisciplinary rehabilitation.
METHODS: 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.
RESULTS. 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.
CONCLUSIONS: 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.
CLINICAL REHABILITATION IMPACT: 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.

KEY WORDS: Access to health services; Centers, rehabilitation; Neurological rehabilitation

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