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Pam Enderby: Professor, Institute of General Practice and Primary Care, Northern General Hospital, Sheffield, UK.
Alexandra John: Research Associate at the Institute of General Practice and Primary Care, Northern General Hospital, Sheffield, UK.
Anthony Hughes: Statistical Consultant, Speech and Language Therapy Research Unit, Frenchay Hospital, Bristol, UK.
Brian Petheram: Director at the Speech and Language Therapy Research Unit, Frenchay Hospital, Bristol, UK.
Introduction
Over many decades it has been assumed that the National Health Service allowed equal access and benefit to patients with similar disorders. More recently there has been a growing acknowledgement that this is not the case and that there is considerable geographical variation in the numbers and types of patients who access services, along with variation in treatment type, course, intensity and outcome. Whilst some studies have been able to gather data which can reflect these variations (Roberts, 1995), little information has become available that can allow consideration of variations in service delivery of physiotherapy, occupational therapy and speech and language therapy.
The NHS Executive in the revised Performance Assessment Framework (NHS Executive, 1999) advocates the development of mechanisms to develop benchmarking of comparable organisations to improve monitoring and accountability. Study of variation can be illuminating, can indicate avenues for fruitful research and could impact on clinical governance and guideline development. Variation in health service delivery has commonly been studied by examining differences in the processes of the delivery of care rather than the effects of that care on individual clients. Thus, it has then been difficult to draw conclusions as to whether a variation is of any consequence. This study has collected information on the outcomes of patients with common disabling conditions in order to explore the hypotheses that, in different geographical areas, therapy (physiotherapy in this case) is provided according to the abilities and needs of the patient, that this therapy produces similar improvements in patients, and that patients are discharged with similar profiles.
The Therapy Outcome Measure
Rehabilitation is multifaceted. The goals of therapy programmes frequently cluster into four areas. These are associated with identifying, maintaining and reducing the disorder; improving a person's functioning ability and independence; assisting in overcoming barriers to playing a full and appropriate social role; and ameliorating the emotional sequelae (Enderby, 1992). Most research into...