Prolonged Disorders of Consciousness: Identification Using the UK FIM + FAM and Cohort Analysis of Outcomes from a UK National Clinical Database

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aut.relation.endpage629
aut.relation.issue4
aut.relation.journalDisability and Rehabilitation
aut.relation.startpage620
aut.relation.volume45
dc.contributor.authorTurner-Stokes, Lynne
dc.contributor.authorRose, Hilary
dc.contributor.authorKnight, Alison
dc.contributor.authorWilliams, Heather
dc.contributor.authorSiegert, Richard J
dc.contributor.authorAshford, Stephen A
dc.date.accessioned2023-07-05T22:48:08Z
dc.date.available2023-07-05T22:48:08Z
dc.date.issued2022-02-15
dc.description.abstractPURPOSE: 1: To determine whether Total UK FIM + FAM scores can identify patients in VS/MCS. 2: Using the identified cut-off points, to examine outcomes from specialist rehabilitation. METHODS: Part 1: Retrospective analysis of a consecutive clinical cohort (n = 388) presenting to a single specialist PDOC evaluation programme 2007-2021. FIM + FAM scores were analysed by PDOC diagnosis to define cut-off points for vegetative (VS) and minimally conscious states (MCS). Part 2: Multicentre cohort analysis of prospectively-collected clinical outcomes data from the UK Rehabilitation Outcomes Collaborative database of adults in PDOC registered 2011-2020 (n = 2384 in 68 centres). RESULTS: Cut-off points of ≤31 and 32-35 in FIM + FAM total scores respectively identified patients in VS/MCS-Minus and MCS-Plus. Approximately 365 PDOC patients are admitted to specialist rehabilitation units in England each year. By discharge, 43% have emerged into consciousness and demonstrate a wide range of disability. A few reached full independence, but the majority remained severely dependent. Nevertheless, those who emerged generated mean net life-time savings of over £436,000 (£400 million for this cohort). CONCLUSION: In absence of a dedicated PDOC registry, FIM + FAM scores can identify patients in VS/MCS at population level. Identifying those who emerge and providing timely rehabilitation generates cost-savings well-exceeding the cost of the evaluation/rehabilitation programme. Implications for rehabilitation The UK National Health Service currently collects no systematic data to identify patients in PDOC, so we have no accurate information on how many patients there are, where they are managed or what their outcomes are. In the absence of more direct data, total FIM + FAM scores of < =31 and 32-35 respectively can be used to identify patients in vegetative and minimally conscious states. Of the 365 or so patients admitted to specialist rehabilitation units per year, 43% emerge into consciousness leaving about 150 patients per year in PDOC states that are likely to be permanent. Identifying those who emerge and providing timely rehabilitation generates cost-savings that pay for the entire PDOC evaluation/rehabilitation programme many times over.
dc.identifier.citationDisability and Rehabilitation, ISSN: 0963-8288 (Print); 1464-5165 (Online), Taylor and Francis, 45(4), 620-629. doi: 10.1080/09638288.2022.2037754
dc.identifier.doi10.1080/09638288.2022.2037754
dc.identifier.issn0963-8288
dc.identifier.issn1464-5165
dc.identifier.urihttp://hdl.handle.net/10292/16363
dc.languageeng
dc.publisherTaylor and Francis
dc.relation.urihttps://www.tandfonline.com/doi/full/10.1080/09638288.2022.2037754
dc.rights.accessrightsOpenAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectConsciousness disorders
dc.subjectcost effectiveness
dc.subjecthealthcare economics
dc.subjectpatient outcome assessment
dc.subjectrehabilitation
dc.subjectConsciousness disorders
dc.subjectcost effectiveness
dc.subjecthealthcare economics
dc.subjectpatient outcome assessment
dc.subjectrehabilitation
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectRehabilitation
dc.subjectConsciousness disorders
dc.subjectrehabilitation
dc.subjectpatient outcome assessment
dc.subjectcost effectiveness
dc.subjecthealthcare economics
dc.subjectDEPENDENCY
dc.subjectREHABILITATION
dc.subjectIMPAIRMENT
dc.subjectCARE
dc.subject4201 Allied Health and Rehabilitation Science
dc.subject32 Biomedical and Clinical Sciences
dc.subject3202 Clinical Sciences
dc.subject42 Health Sciences
dc.subjectClinical Research
dc.subjectHealth Services
dc.subject11 Medical and Health Sciences
dc.subjectRehabilitation
dc.subject32 Biomedical and clinical sciences
dc.subject42 Health sciences
dc.subject44 Human society
dc.subject.meshAdult
dc.subject.meshHumans
dc.subject.meshRetrospective Studies
dc.subject.meshConsciousness
dc.subject.meshBrain Injuries
dc.subject.meshActivities of Daily Living
dc.subject.meshConsciousness Disorders
dc.subject.meshPersistent Vegetative State
dc.subject.meshState Medicine
dc.subject.meshCohort Studies
dc.subject.meshEngland
dc.subject.meshHumans
dc.subject.meshPersistent Vegetative State
dc.subject.meshBrain Injuries
dc.subject.meshConsciousness Disorders
dc.subject.meshActivities of Daily Living
dc.subject.meshRetrospective Studies
dc.subject.meshCohort Studies
dc.subject.meshConsciousness
dc.subject.meshAdult
dc.subject.meshState Medicine
dc.subject.meshEngland
dc.subject.meshAdult
dc.subject.meshHumans
dc.subject.meshRetrospective Studies
dc.subject.meshConsciousness
dc.subject.meshBrain Injuries
dc.subject.meshActivities of Daily Living
dc.subject.meshConsciousness Disorders
dc.subject.meshPersistent Vegetative State
dc.subject.meshState Medicine
dc.subject.meshCohort Studies
dc.subject.meshEngland
dc.titleProlonged Disorders of Consciousness: Identification Using the UK FIM + FAM and Cohort Analysis of Outcomes from a UK National Clinical Database
dc.typeJournal Article
pubs.elements-id449221
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