Development and external validation of quality indicators for Neurorehabilitation Units: The REHABest Delphi study
Jacobo Formigo-Couceiro, Clara Pérez-Esteve, José María Climent-Barberá, Carlos Cordero-García, Raquel Cutillas-Ruiz, Esther Duarte, Francisco Javier Juan-García, María Lourdes López De Munaín, Rosa Martín-Mourelle, Antonio Montoto-Marqués, Serafín Rodríguez-Palero, Pedro Ignacio Tejada-Ezquerro, Emilio Ignacio-García, Helena Bascuñana-AmbrósObjective
To develop a consensus-based framework of quality indicators for Neurorehabilitation Units.
Design
Delphi consensus study with two-phase external validation.
Setting
Expert consultation and external validation were conducted through online questionnaires.
Participants
Twelve neurorehabilitation experts participated in the Delphi process. External validation involved 63 independent specialists and a multidisciplinary panel of nine professionals.
Intervention
Development of quality indicators through a three-round Delphi process following Conducting and REporting DElphi Studies (CREDES) recommendations.
Main measures
Expert agreement on candidate indicators, with consensus defined a priori as ≥75%.
Results
An initial qualitative expert-generation phase produced 38 candidate indicators. These were subsequently refined through three Delphi rounds, during which indicators were retained, merged, reformulated, added, or disaggregated according to expert consensus and accreditation level. The final framework comprised 50 indicators categorized into structure (21), process (13), and outcome (16) domains. External validation confirmed the relevance and clarity of the framework, although implementation challenges were identified in centres with heterogeneous resources.
Conclusions
The proposed framework provides a structured set of quality indicators that may support quality assessment, accreditation, and continuous improvement in neurorehabilitation services.