J Neurol (2004) 251 : 1094–1097 DOI 10.1007/s00415-004-0488-y ORIGINAL COMMUNICATION Clarence Liu Alan J. Thompson E. Diane Playford Patient dissatisfaction: Insights into the rehabilitation process JON 1488 Introduction Rehabilitation is a process of active change by which a person who has become disabled acquires the knowl- edge and skills needed for optimum physical, psycho- logical and social functioning [15]. Traditionally the im- pact of inpatient rehabilitation has been evaluated using physician-based measures which record levels of dis- ability [10]. However, it is clear that not only do rehabil- itation units have to offer services which result in func- tional gains, but that they must do so in a manner that is acceptable to the patients. The importance of patient satisfaction has been well recognised in other fields of clinical medicine, particularly with studies of stroke units, both in the acute [17, 24] and more long-term set- tings [1, 3, 5, 18, 19, 23]. Users’ satisfaction has been eval- uated in several series on the delivery of rehabilitation services [2, 14, 20], but the determinants of dissatisfac- tion have scarcely been ascertained.We have previously reported that although the majority of patients admitted to the Neurological Rehabilitation Unit at the National Hospital for Neurology and Neurosurgery obtain func- tional improvements, there is poor correlation between traditional physician-based outcomes and patient-rated measures of perceived benefit of rehabilitation [6]. The Received: 18 August 2003 Received in revised form: 12 January 2004 Accepted: 8 March 2004 C. Liu · A. J. Thompson · E. D. Playford National Hospital for Neurology & Neurosurgery London, UK A. J. Thompson · E. D. Playford Institute of Neurology University College London London, UK Dr. E. D. Playford, MD, FRCP () Neurological Rehabilitation Unit National Hospital for Neurology & Neurosurgery Queen Square London WC1N 3BG, UK Tel.: +44-20/7837-3611 Fax: +44-20/7813-0924 E-Mail: d.playford@ion.ucl.ac.uk ■ Abstract Most patients admit- ted for inpatient rehabilitation find it beneficial even when there is lit- tle change in physical disability. The aim of this study was to deter- mine the characteristics of patients who felt that they had not bene- fited from inpatient rehabilitation and to delineate the underlying reasons for this perception. From a database of 331 patients admitted to a neurological rehabilitation unit over a three-year period, we ascertained those with a low score (< 5) on a self-rated visual ana- logue scale (VAS) regarding their perception of the benefit of reha- bilitation.We investigated their dis- ability outcomes, aspects of the re- habilitation process through analysis of integrated care path- ways, and from inspection of the multidisciplinary record identified specific adverse factors which might contribute to dissatisfaction. Low VAS scores were detected in 6 % of patients (n = 19). These did not correlate with baseline demo- graphic factors or disability levels, but were associated with unre- solved external problems regarding community care and accommoda- tion, and conflicts between patients and therapists.We conclude that from the patients’ perspective, suc- cessful inpatient rehabilitation de- pends on adequate attention given to community-based issues and health care professionals recognis- ing patients’ needs. When these two conditions are not fulfilled, pa- tients are more likely to express a lack of satisfaction with their reha- bilitation. ■ Key words patient satisfaction · rehabilitation