Importance of outcome measures:

Whilst on a neuro placement, I came across a situation that made me realise the importance of specific outcome measures for each individual patient. My supervisor had just been to a team meeting and came out a little frustrated and upset.

I asked what was wrong and she told me about what had happened at the meeting. The particular patient being discussed had sustained a L sided CVA about 3 months ago, had undergone rehab, then had re-stroked but this time on the R side. He had been at a neuro rehab hospital in the last month, and had just been transferred to our hospital to a smaller rehab program as his prognosis for recovery was not fantastic as he now had 2 sides affected.

The team at our hospital were discussing his rehab and discharge plan. My supervisor had been working with this patient from the beginning, before his 2nd stroke prior to him being transferred to the other neuro rehab hospital, and then after, once he had been transferred back again. She was seeing some small signs of recovery and improvement in his tone and sensation, however not a significant change in his functional ability. It was now about 6 weeks since his 2nd stroke.

My supervisor had gone into the meeting with the thought in mind that this pt would need to go to a high level care facility once DC, and thought that is what the other members of the team had decided too and this meeting was just to clarify the issue. In the meeting, all team members spoke their part, and my supervisor mentioned about he had had early signs of small recovery, none recently and no change in functional status. After that, there were some members of the team who fixated on this point and pushed the idea that because small signs of recovery had been seen, and who’s to say he wouldn’t improve significantly. My supervisor tried to explain his poor prognosis and his realistic outcomes.

She came out feeling frustrated, as she knew this patient was unlikely to improve significantly, and she thought by keeping him in hospital and continuing his fairly intensive rehab (with little improvement) was not going to benefit the patients mental state. She said it’s a difficult call to make whether to continue a patients rehab, as there is always hope for improvement, however with clinical experience you also need to use your judgement as to what is best for the patient. It’s hard for both the physio and the patient to continue something with no improvements.

It made me realise the importance of outcome measures, not only for the patient, but for other team members to see where the patient is at and how there rehab is going. I felt like I was focusing and improving my ability at one day Ax and Rx, whereas I needed to focus on the bigger picture and discharge planning. It also made me realise that so many people are involved with one patient, and it would be good to liase with other teams such as OT’s, who we work more closely with, prior to team meetings to work out if we are on the same page and have the same ideas for the patient. I will definitely keep this in mind, (both the importance of presenting outcome measures and liasing with other people), for the future to avoid the same frustration my supervisor felt.