Neuro-rehabilitation

Australian Experience
The 4th World Congress
for NeuroRehabilitation

J E (Ben) Marosszeky
Tara Stevermuer
Janette Green
REHABILITATION - PATIENT’S PERSPECTIVE

A PATIENT’S VIEW OF REHABILITATION

Recovering from sever drug induced cerebellar ataxia

Neuro-rehabilitation - Australia
The information presented herewith is made
possible by using data held by the

Australasian Rehabilitation Outcomes Centre

AROC
 Neurorehabilitation - Australia
What is AROC?
• AROC is a joint initiative of the Australian
rehabilitation sector (providers, payers, regulators
and consumers)
• The Australasian Faculty of Rehabilitation Medicine
of the RACP is the auspice body and data custodian
• The Centre for Health Service Development (CHSD)
at the University of Wollongong is the data manager
and responsible everyday running of AROC
 Neurorehabilitation - Australia
What is AROC?
• Established as a not-for-profit self-funding
centre with its own management board,
attached to CHSD
• Operating since July, 2002
• Over 200,000 episodes of rehabilitation have
been received from 110 of the 130 known
rehabilitation facilities operated either by the
public or private sector
 Neuro-rehabilitation - Australia
AROC has five roles...
1. A national ‘data bureau’ that receives and
manages data on the performance of
rehabilitation services in Australia.
2. The national ‘benchmarking centre’ for
medical rehabilitation.
3. The national certification centre for the
Functional Independence Measures (FIM)
(instruments designed to measure functional
needs and outcomes).
 Neurorehabilitation - Australia
AROC has five roles...
4. An education and training centre for the FIM
and other rehabilitation outcome measures.
5. A research and development centre that
develops research and health service
development proposals and seeks external
funding for its research agenda.
 Neuro-rehabilitation – Australia

Number of episodes of care in last 3 years

Impairment Percent
Frequency
Groups %

Stroke 12803 54.7

Brain 3306 14.1
Neuro 5135 21.9
Spine 2172 9.3
Total 23416 100

This constitutes 23.6% of all episodes

 Neurorehabilitation - Australia
Impairment Years
Groups 2002 -2003 2003-2004 2004-2005 Total

Stroke 3931 4125 4747 12803

Brain 776 991 1539 3306
Neuro 1490 1610 2035 5135
Spine 644 650 878 2172
Total 6841 7376 9199 23416

EPISODES

5000
4000
bers

2002-2003
3000
um

2003-2004
2000
N

2004-2005
1000
0
Stroke Brain Neuro Spine
Impairme nts
 Neurorehabilitation - Australia
AGE of Patients
95% Confidence Interval
Impairment
Mean for Mean
Groups
Low er Bound Upper Bound
Stroke 73.8 73.6 74.0
Brain 53.1 52.4 53.9
Neuro 68.1 67.6 68.5
Spine 56.7 55.9 57.6
 Neurorehabilitation - Australia
GENDER

Impairment Male Female Not stated Total

Groups n % of total n reported
Stroke 6506 51% 6188 109 12803
Brain 2121 64% 1174 11 3306
Neuro 2508 49% 2595 32 5135
Spine 1365 63% 804 3 2172
Total 12500 53% 10761 155 23416
 Neuro-rehabilitation – Australia

Number of Episodes by Sector

Impairment Sector of treating facility Public/Private
Groups Public Private %
Stroke 8523 58.3% 4280 48.7% 66.6%
Brain 2359 16.1% 947 10.8% 71.4%
Neuro 2129 14.6% 3006 34.2% 41.5%
Spine 1612 11.0% 560 6.4% 74.2%
Total 14623 100% 8793 100.0%
 Neuro-rehabilitation – Australia

Beginning of rehab episode from

Usual Other Another Own Hospital Other Not stated Total
Accom than usual hosp
Stroke 1299 43 7443 3693 187 138 12803
Brain 255 19 1928 619 257 228 3306
Neuro 1260 33 2767 899 78 98 5135
Spine 450 7 1129 316 224 46 2172
3264 102 13267 5527 746 510 23416
% 13.9% 0.4% 56.7% 23.6% 3.2% 2.2% 100.0%
 Neurorehabilitation - Australia

Pre - Hospital Accomodation

Impairment Private Nursing Transitional
Hostel Community Boarding Other Total
Groups residence home Care
Stroke 9603 299 45 12 4 2 170 10135
Brain 2465 52 17 3 0 0 51 2588
Neuro 3431 100 10 6 0 3 36 3586
Spine 1480 18 1 0 1 1 34 1535
Total 16979 469 73 21 5 6 291 17844
% 95.2% 2.6% 0.4% 0.1% 0.0% 0.0% 1.6% 100.0%

Not stated = 23.8%

 Neurorehabilitation - Australia

Pre-Hospital Living arrangements

Alone Spouse Spouse Family Community Other not stated Total
& family
Stroke 1037 1769 89 236 46 30 6396 9603
Brain 223 519 30 149 61 6 1477 2465
Neuro 504 954 57 120 26 14 1756 3431
Spine 139 228 32 82 18 12 969 1480
Total 1903 3470 208 587 151 62 10598 16979
% 11.2% 25.1% 1.3% 62.4% 100.0%

Information relates to patients admitted from private residence

 Neurorehabilitation - Australia
OUTCOME MEASURES

• FUNCTIONAL ENABLING
– FIM DISCHARGE SCORE
- FIM RATE OF CHANGE (GAIN/WEEK)

• LENGTH OF STAY

• RATE OF RETURNING TO COMMUNITY LIVING

 Neurorehabilitation - Australia

Valid FIM score

Yes No Total

Stroke 12290 513 12803

Brain 3003 303 3306
Neuro 4994 141 5135
Spine 2056 116 2172
22343 1073 23416
% 95.4% 4.6% 100.0%
 Neurorehabilitation - Australia
FIM Admission Score
95% Confidence Interval
Impairment
Mean for Mean
Groups
Low er Bound Upper Bound
Stroke 75.9 75.5 76.4
Brain 76.8 75.8 77.9
Neuro 85.9 85.2 86.5
Spine 80.7 79.7 81.7
 Neurorehabilitation - Australia

FIM Discharge Score

95% Confidence Interval
Impairment
Mean for Mean
Groups
Low er Bound Upper Bound
Stroke 95.1 94.6 95.6
Brain 95.8 94.7 96.8
Neuro 99.5 98.8 100.1
Spine 94.1 93.0 95.2
 Neurorehabilitation - Australia
Length of stay
Impairment 95% Confidence Interval
Groups Mean for Mean Median
Low er Bound Upper Bound
Stroke 26.9 26.5 27.2 21
Brain 27.3 26.5 28.0 21
Neuro 20.4 20.0 29.8 16
Spine 33.3 32.1 34.6 23
 Neurorehabilitation - Australia

Length of stay for Stroke

1,000

800
No. Episodes

600

400

200

Mean = 26.88
Std. Dev. = 19.391
0 N = 12,434
0 20 40 60 80
Days
 Neurorehabilitation - Australia
Length of stay for Brain

300

250

200
No. Episodes

150

100

50

Mean = 27.25
Std. Dev. = 21.878
0 N = 2,983
0 20 40 60 80
Days
 Neurorehabilitation - Australia
Length of stay for Neuro

700

600

500
No. Episodes

400

300

200

100
Mean = 20.4
Std. Dev. = 15.316
0 N = 5,044
0 20 40 60 80
Days
 Neurorehabilitation - Australia
Length of stay for Spine

200

150
No. Episodes

100

50

Mean = 33.3
Std. Dev. = 27.364
0 N = 1,855
0 20 40 60 80
Days
 Neurorehabilitation - Australia

FIM gain/week
95% Confidence
Interval for Mean
Mean
Lower Upper
Bound Bound
Stroke 5.0 5.0 5.0
Brain 4.9 4.8 4.9
Neuro 4.7 4.6 4.7
Spine 2.8 2.8 2.8
 Neurorehabilitation - Australia

Brain Impairment Group

N % Age LOS FIM Adm FIM Disch
Non-traumatic 630 19.1% 61.1 26.3 76.2 93.0
Traumatic 1,328 40.2% 44.2 31.1 74.5 96.2
Other 1,348 40.8% 58.3 24.4 79.5 96.6
Other = not classified as open or closed
 Neurorehabilitation - Australia

Spinal Impairment Group

N % Age LOS FIM Adm FIM Disch
Non-traumatic 911 41.9% 61.2 29.0 83.3 97.5
Traumatic 811 37.3% 48.3 44.6 75.2 87.2
Other 450 20.7% 62.9 24.8 86.6 101.1
Other = not classified as para- or quadriplegia
 Neurorehabilitation - Australia

At the Episode end

Usual Interim Acute Own

Care type Other Death Not stated Total
Accom accom care risk

Stroke 9818 712 436 1507 61 170 83 16 12803

Brain 2282 198 59 481 24 245 7 10 3306
Neuro 4302 205 88 435 25 56 20 4 5135
Spine 1469 52 70 320 9 236 6 10 2172
17871 1167 653 2743 119 707 116 40 23416
% 81.3% 2.8% 11.7% 0.5% 3.0% 0.5% 0.2% 100.0%
 Neurorehabilitation - Australia

Post-Hospital accommodation
Impairment
Groups Private Nursing
Hostel Community Boarding Transitional Other Total
residence home
Stroke 2872 155 2 41 350 21 372 3813
Brain 1027 36 1 24 85 11 144 1328
Neuro 1566 94 1 24 103 7 125 1920
Spine 456 8 2 2 23 4 88 583
Total 5921 293 6 91 561 43 729 7644
80.5% 9.2% 0.6% 9.8% 100.0%
Available for 32.6% of total sample
 Neurorehabilitation - Australia
This information suggests that the Australian in-patient
rehabilitation programs meet the internationally achieved best
practice standards.

The establishment of AROC will enable the Australian rehabilitation

services to develop benchmarks for all impairment groups and
more importantly monitor the benefits to changes of treatment and
service delivery.

We are also working diligently to promote the recently formed

International Rehabilitation Outcomes Network (IRON) to improve
the ability to share the benefits of practice and service
developments for the benefit for our patients.
Invite you to the AROC
Website