Opinion

Where you live matters when it comes to rehabilitation

Darren Thiel

By Dr Darren Thiel, from the Department of Sociology at the University of Essex

Designing successful rehabilitation programmes is not just about the needs of the individual according to a new study from the University of Essex.

The neighbourhood that rehabilitation clients live in and the support networks they have around them also need to be taken into consideration, and researchers believe that if this is done it could lead to better outcomes for more people.

Previous studies have shown that  following a referral or stay in hospital those who complete a rehabilitation programme – tailor-made to their specific needs and aimed at providing them with the skills they need to look after themselves – report having a better quality of life, both mentally and physically, than those who are simply provided with ongoing care.

They can do more for themselves, need less support from professional carers and are more likely to stay in their own home, rather than needing to go into hospital or residential care – a win win situation for both the individual and the public purse.

But the success rate of rehabilitation programmes is patchy – with some people doing much better than others. The new study aimed to find out who these people are, and what could be done about it.

Dr Darren Thiel, from the Department of Sociology, explained: “Overall our study shows how deprivation and neighbourhood factors have a significant effect on the relative success of reablement programmes, and this needs to be taken into account when planning and delivering future programmes.

“Despite the aims of rehabilitation to teach clients to be independent and thus reduce the amount of on-going care provided for them, such people cannot always help themselves.

“For example, someone may be re-taught how to cook for themselves following a stroke, but they won’t be able to do that if there are no local shops to buy ingredients, no local public transport, poorly maintained pedestrian pathways, or they don’t know anyone who will do their shopping for them.

“In short, people need supportive social and geographical environments in order to be independent.”

The researchers tracked the outcomes of over 8,000 people who had been offered a restorative rehabilitation programme through Essex County Council between 2008 and 2012.

They considered the person’s individual circumstances and information about the area they lived in – looking at neighbourhood deprivation levels as well as commercial MOSAIC data, which provides s fine-grained analysis by categorising similar people into 66 ‘lifestyle’ types.

They found that 13 weeks after completing a rehabilitation programme 68% of people were deemed to be able to look after themselves. Unsurprisingly, the likelihood of having a successful outcome decreases with age, and those with the most serious health issues are also less likely to manage with no outside help. However, the researchers found that living in a very deprived neighbourhood or one with a high crime rate was also associated with a lower likelihood of success.

“We found some of the largest neighbourhood effects using the MOSAIC classifications that take into account local neighbourhood and socio-economic factors, with one group showing a staggering 21% less chance of success than the ‘best’ performing group. This indicates clearly that geo-social factors have as big effects on recovery as major health conditions. For successful rehabilitation, it is no good focusing solely on the individual and their specific needs and health conditions –  broader social, economic and environmental factors also need to be factored in if everyone is to get the maximum benefit from reablement programmes,“ added Dr Thiel.

The paper, written with Professor Nick Allum and former Essex student Christopher Jacobi, has been published in PLOS ONE.

 

 

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