• Do physiotherapy staff record treatment time accurately? An observational study

      Bagley, Pamela J.; Hudson, M.; Green, J.R.; Forster, A.; Young, J. (2009)
      OBJECTIVE: To assess the reliability of duration of treatment time measured by physiotherapy staff in early-stage stroke patients. DESIGN: Comparison of physiotherapy staff's recording of treatment sessions and video recording. SETTING: Rehabilitation stroke unit in a general hospital. SUBJECTS: Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment. MAIN MEASURES: Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording. STATISTICAL ANALYSIS: Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements. RESULTS: The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was -6 (9) minutes (95% confidence interval (CI) -9 to -3). The reliability coefficient was 18 minutes and the 95% limits of agreement were -24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73). CONCLUSIONS: Physiotherapy staff's recording of duration of treatment time was not reliable and was systematically greater than the video recording.
    • Older people's care experience in community and general hospitals: a comparative study

      Green, J.R.; Forster, A.; Young, J.; Small, Neil A.; Spink, Joanna (2008)
      Community hospitals are an important component of the post-acute care pathway for older people. The objective of this study was to describe and contrast patients' and carers' experiences of community and general hospitals. Interviews with patients and carers revealed similarities in the perceptions of care between the two settings. These included appreciation of staff sensitivity, a sense of security, encouragement of independence and lack of activity. The community hospital was appreciated for its location, atmosphere, accommodation, greater sense of freedom, quality of food and staff attitudes. UK health policy promotes the development of community hospitals. This should be progressed in a way that retains key strengths of the specific service they offer.
    • The patient experience of community hospital - the process of care as a determinant of satisfaction.

      Small, Neil A.; Green, J.R.; Spink, Joanna; Forster, A.; Lowson, K.; Young, J. (Blackwell Publishing, 2006)
      Aims and objectives; We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored. Design A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice. Results Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home-based atmosphere. The formal, or 'hard', process of rehabilitation was not well understood by patients. They were primarily concerned with 'soft' or process issues ¿ where and how care was delivered. Conclusions We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.
    • Postacute Care for Older People in Community Hospitals: A Multicentre Randomised, Controlled Trial

      Young, J.; Green, J.R.; Forster, A.; Small, Neil A.; Lowson, K.; Bogle, S.; George, J.; Heseltine, D.; Jayasuriya, T.; Rowe, J. (2007)
      OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care. DESIGN: Randomized, controlled trial. SETTING: Seven community hospitals and five general hospitals in the midlands and north of England. PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness. INTERVENTION: Multidisciplinary team care for older people in community hospitals. MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services. RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26–6.28; P=.03). The results for the secondary outcome measures were similar for the two groups. CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.