Quality standard

Quality statement 5: Neurological rehabilitation

Quality statement 5: Neurological rehabilitation

Quality statement

Adults with brain tumours have access to neurological rehabilitation in the community and as an outpatient or inpatient.

Rationale

Adults with any type of brain tumour often have complex physical, cognitive and psychological needs. Providing access to neurological rehabilitation locally in the community and in hospital, in a setting that can meet their individual needs, will give people the support they might need to have the best quality of life. Access to neurological rehabilitation should be available at every stage of treatment and follow up.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to provide neurological rehabilitation in the community and as an outpatient or inpatient, for adults with brain tumours.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from referral criteria and pathways to neurological rehabilitation services.

Outcome

Health-related quality of life for adults with brain tumours.

Data source: No routinely collected national data for this measure has been identified. Data could be collected from a local quality-of-life survey of adults with brain tumours and their family and carers including patient-reported outcome measures.

What the quality statement means for different audiences

Service providers (such as primary and secondary care services) ensure that there are recognised referral pathways for adults with brain tumours to neurological rehabilitation in the community and as an outpatient or inpatient, at all stages of their care.

Healthcare professionals (such as oncologists, neurosurgeons and keyworkers) are aware of referral pathways to neurological rehabilitation in the community and as an outpatient or inpatient, for adults with brain tumours. Healthcare professionals support adults with brain tumours to access neurological rehabilitation if they need to.

Commissioners (such as integrated care systems and clinical commissioning groups) commission services with sufficient capacity to provide neurological rehabilitation in the community and as an outpatient or inpatient, for adults with brain tumours at all stages of their care.

Adults with brain tumours can get support from neurological rehabilitation services in the community or in hospital to improve any physical, emotional or psychological problems they experience at any stage of their care.

Source guidance

Definitions of terms used in this quality statement

Neurological rehabilitation

Rehabilitation is defined by the World Health Organization as 'a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment'. Functioning and disability are broad terms which are further conceptualised in the International Classification of Functioning, Disability and Health. This framework highlights the relationships and interplay between the following domains:

  • health condition

  • body structure and function

  • activity

  • participation

  • environmental factors

  • personal factors.

Rehabilitation is an overall process composed of individual interventions. These interventions range from the relatively simple, acting at one or a few domains, to complex interventions that may act across several domains. Rehabilitation is not a 'one size fits all' process and aims and goals should be identified and agreed with each person to fully inform personalised treatment and therapy programmes.

Inpatient rehabilitation is delivered through a range of services based within the NHS, the private sector and the voluntary sector. Referral criteria for these services are often specific for disease or condition, symptoms, locality or age group.

In the longer term, rehabilitation may be delivered through hospital or community services, including education-based services. It may also be provided by the private or voluntary sectors. Rehabilitation can involve impairment-focused approaches, for example, to improve mobility, or a less impairment-specific focus towards functional goals (such as managing personal care or preparing a meal). Referral criteria may include diagnosis, age, or time since injury, or may depend on the purpose or setting of the intervention (for example, vocational rehabilitation). [NICE's guideline on rehabilitation for chronic neurological disorders including traumatic brain injury, final scope]

Equality and diversity considerations

Neurological rehabilitation should be available for all adults with brain tumours, including those who may be house-bound or in a nursing home. To ensure equality of access to rehabilitation, measures such as providing transport for people to attend sessions and holding the sessions in different locations should be considered. Rehabilitation should be provided in centres that have access for disabled people.

It is important for providers to make reasonable adjustments to ensure that adults with additional needs, such as physical, sensory and learning disabilities or cognitive impairment, and people who do not speak or read English, or who have communication difficulties, can access neurological rehabilitation services. Healthcare professionals should be aware that adults with brain tumours can develop a disability because of their tumour, the treatment they receive and potential late effects of their treatment. People should have access to an interpreter (including British Sign Language) or advocate if needed. Adults with cognitive impairment may need support and more time to process information.