Consistent use of outcome measures across specialist centres is vital to assess the effectiveness of interventions and guide policy development. It is important to have a global yardstick to compare outcomes. However, as noted by Gilbody et al (Reference Gilbody, House and Sheldon2002), this often does not happen.

The sequelae of brain injury are complex and rehabilitation programmes implemented to treat brain-injured individuals are multi-faceted. In response, the Health of the Nation Outcome Scales - Acquired Brain Injury (HoNOS-ABI) was designed and introduced in 1999. Courtenay (Reference Courtenay2002) proposed that the under-utilisation of outcome measures resulted from lack of training and limited availability. The HoNOS-ABI has been made widely available in the UK.

In order to evaluate the use and application of the scale nationally, we distributed a questionnaire by e-mail to consultant psychiatrists at twenty major brain injury units across the UK. There was a 35% response rate; one of the respondents used a specialised HoNOS-ABI designed for children and another two employed the scale regularly. None of the others used the scale as part of routine clinical practice, and perhaps the lack of response from others indicates the same.

There appears to be a large hiatus between the discussion of outcome measures in research literature and the application of scales in routine clinical practice. Could it be that different scales are utilised across centres? The clinical effectiveness of outcome measures can only be maximised if they are all standardised across the nation.