Assessing the impact of a home-based stroke rehabilitation programme: a cost-effectiveness study

<p><b>Background:</b> Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRTs) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible. The objective of this study was to evaluate the cost-effectiveness of the CSRT programme compared with a “Usual Care” cohort.</p> <p><b>Methods:</b> We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35 years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year.</p> <p><b>Results:</b> Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost = −$17,255; incremental effect = 1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care.</p> <p><b>Conclusions:</b> The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods.Implications for Rehabilitation</p><p>Ongoing rehabilitation following stroke is imperative for optimal recovery.</p><p>Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.</p><p>The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.</p><p></p> <p>Ongoing rehabilitation following stroke is imperative for optimal recovery.</p> <p>Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.</p> <p>The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.</p

Defining recovery potential in river restoration: a biological data-driven approach

Scientists and practitioners working on river restoration have made progress on understanding the recovery potential of rivers from geomorphological and engineering perspectives. We now need to build on this work to gain a better understanding of the biological processes involved in river restoration. Environmental policy agendas are focusing on nature recovery, reigniting debates about the use of “natural” reference conditions as benchmarks for ecosystem restoration. We argue that the search for natural or semi-natural analogues to guide restoration planning is inappropriate due to the absence of contemporary reference conditions. With a catchment-scale case study on the invertebrate communities of the Warwickshire Avon, a fifth-order river system in England, we demonstrate an alternative to the reference condition approach. Under our model, recovery potential is quantified based on the gap between observed biodiversity at a site and the biodiversity predicted to occur in that location under alternative management scenarios. We predict that commonly applied restoration measures such as reduced nutrient inputs and the removal of channel resectioning could be detrimental to invertebrate diversity, if applied indiscriminately and without other complementary measures. Instead, our results suggest considerable potential for increases in biodiversity when restoration measures are combined in a way that maximises biodiversity within each water body