Development and external validation of quality indicators for Neurorehabilitation Units: The REHABest Delphi study.

Abstract

ObjectiveTo develop a consensus-based framework of quality indicators for Neurorehabilitation Units.DesignDelphi consensus study with two-phase external validation.SettingExpert consultation and external validation were conducted through online questionnaires.ParticipantsTwelve neurorehabilitation experts participated in the Delphi process. External validation involved 63 independent specialists and a multidisciplinary panel of nine professionals.InterventionDevelopment of quality indicators through a three-round Delphi process following Conducting and REporting DElphi Studies (CREDES) recommendations.Main measuresExpert agreement on candidate indicators, with consensus defined a priori as ≥75%.ResultsAn 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.ConclusionsThe proposed framework provides a structured set of quality indicators that may support quality assessment, accreditation, and continuous improvement in neurorehabilitation services.