U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Cover of Service coordination: support needs and preferences following discharge to outpatient or community rehabilitation services for people with complex rehabilitation needs after traumatic injury

Service coordination: support needs and preferences following discharge to outpatient or community rehabilitation services for people with complex rehabilitation needs after traumatic injury

Rehabilitation after traumatic injury

Evidence review D.4

NICE Guideline, No. 211

.

London: National Institute for Health and Care Excellence (NICE); .
ISBN-13: 978-1-4731-4398-2

Summary of review questions covered in this report

This evidence report contains information on 2 reviews:

D.4a.

What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

D.4b.

What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

Service coordination: Support needs and preferences following discharge to out-patient or community rehabilitation services for people with complex rehabilitation needs after traumatic injury

Review question

This evidence report contains information on 2 reviews relating to support needs and preferences following discharge to out-patient or community rehabilitation services after traumatic injury:

D.4a.

What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

D.4b.

What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

Introduction

The objective of this review was to identify the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services.

Summary of the protocol

Please see Table 1 and Table 2 for a summary of the Population, Phenomenon of interest and Context characteristics of this review in the adult and children and young people populations, respectively.

Table 1. Summary of the adult protocol (PICO table).

Table 1

Summary of the adult protocol (PICO table).

Table 2. Summary of the children and young people protocol (PICO table).

Table 2

Summary of the children and young people protocol (PICO table).

For further details see the review protocol in appendix A.

Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and in the methods chapter (Supplement 1).

Declarations of interest were recorded according to NICE’s 2018 conflicts of interest policy.

Clinical evidence: Adults

Included studies

Twenty-four articles reporting on twenty-two qualitative studies were identified for this review (Abrahamson 2017, Bernhoff 2016, Body 2013, Braaf 2018, Christiaens 2015, Conneeley 2012 & 2013, Doig 2011, Johnson 2016, Keightley 2011, Kersten 2018, Kimmel 2016, Lindahl 2013, McPherson 2018, McRae 2016, Norrbrink 2016, O’Callaghan 2012, Odumuyiwa 2019, Pol 2019, Roberts 2017 & 2018, Singh 2018, Stott-Eveneshen 2017, and Turner 2011).

The studies were carried out in the following countries: The UK (Abrahamson 2017, Body 2013, Conneeley 2012 & 2013, Kersten 2018, Odumuyiwa 2019, Roberts 2017 & 2018), Australia (Braaf 2018, Doig 2011, Johnson 2016, Kimmel 2016, McRae 2016, O’Callaghan 2012, Turner 2011), Belgium (Christiaens 2015), Canada (Keightley 2011, Singh 2018, Stott-Eveneshen 2017), Denmark (Lindahl 2013), Netherlands (McPherson 2018, Pol 2019), and Sweden (Bernhoff 2016, Norrbrink 2016).

See the literature search strategy in appendix B and study selection flow chart in appendix C.

Excluded studies

Studies not included in this review with reasons for their exclusions are provided in appendix K.

Summary of clinical studies included in the evidence review

A summary of the studies that were included in this review are presented in Table 3.

Table 3. Summary of included studies.

Table 3

Summary of included studies.

See the full evidence tables in appendix D. No meta-analysis was conducted (and so there are no forest plots in appendix E).

Results and quality assessment of clinical outcomes included in the evidence review

The quality of the evidence was assessed using GRADE-CERQual. See the clinical evidence profiles in appendix F.

Summary of the evidence

The needs and preferences identified in the data fell under 5 main themes – information, communication, support, goals, and preparation for life after discharge. Underneath these themes were 23 subthemes which are outlined in Table 4. The subthemes were identified for either the accidental injuries subgroup, or the non-accidental injury subgroup, or both. Figure 1 illustrates how each of the themes (and the respective subthemes) sit at a conceptual intersection between a patient need and a service provided. Based on the data, each theme either described a need that implies a corresponding service, or a service preference that implies a corresponding need, or else both.

Figure 1. Needs and preferences thematic map.

Figure 1

Needs and preferences thematic map.

Table 4. Summary of themes and subthemes.

Table 4

Summary of themes and subthemes.

Clinical evidence: Children and young people

Included studies

Four qualitative studies were identified for this review (Arshad 2015, Brown 2012, Foster 2019, and Wharewera-Mika 2016).

The studies were carried out in the following countries: UK (Arshad 2015), Australia (Brown 2012, Foster 2019), and New Zealand (Wharewera-Mika 2016).

See the literature search strategy in appendix B and study selection flow chart in appendix C.

Excluded studies

Studies not included in this review with reasons for their exclusions are provided in appendix K.

Summary of clinical studies included in the evidence review

A summary of the studies that were included in this review are presented in Table 5.

Table 5. Summary of included studies.

Table 5

Summary of included studies.

See the full evidence tables in appendix D. As this was a qualitative review, no meta-analysis was conducted (and so there are no forest plots in appendix E).

Results and quality assessment of clinical outcomes included in the evidence review

The quality of the evidence was assessed using GRADE-CERQual. See the clinical evidence profiles in appendix F.

Summary of the evidence

The needs and preferences identified in the data fell under 3 main themes – information, socio-emotional support, and a service approach. Underneath these themes were 12 subthemes which are outlined in Table 6. The subthemes were identified for either the accidental injuries subgroup, or the non-accidental injury subgroup, or both. Figure 2 illustrates how each of the themes (and the respective subthemes) sit at a conceptual intersection. Based on the data, each theme either described a need that implies a corresponding service, or a service preference that implies a corresponding need, or else both.

Figure 2. Needs and preferences thematic map.

Figure 2

Needs and preferences thematic map.

Table 6. Summary of themes and sub-themes.

Table 6

Summary of themes and sub-themes.

Economic evidence: Adults and children and young people

Included studies

In the development of this qualitative review, targeted searches for evidence on cost-effectiveness were planned. The committee was asked to consider whether a recommendation represents a substantial change in practice and results in significant resource impact and if so targeted searches around that area would be undertaken. The committee could not identify a recommendation that would benefit from targeted searches for the supporting economic evidence.

Excluded studies

No economic searches for this qualitative review were undertaken.

Summary of studies included in the economic evidence review

No economic searches for this qualitative review were undertaken.

Economic model

No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation

The committee’s discussion of the evidence

Interpreting the evidence
The outcomes that matter most

This was a qualitative review so the committee were unable to specify in advance the data that would be located. Instead they identified the following example main themes to guide the review and were aware that additional themes may have been identified:

  • Language
  • Information
  • Communication

The quality of the evidence

The evidence was assessed using GRADE-CERQual methodology.

For adults, the evidence was found to range in quality from high to very low quality, with the majority being high and moderate quality. In some cases, the evidence was downgraded due to poor applicability (for example, where the themes were not based on any research from a UK context, and/or had only been identified in studies of populations with only one particular type of traumatic injury). Some downgrading for adequacy occurred when the richness or quantity of the data was low. Other issues resulting in downgrading were in the event of methodological problems that may have had an impact on the findings, e.g. unclear participant recruitment, data collection subject to recall bias, or inadequate data analysis, and/or for incoherence within the findings.

For children and young people, the evidence was found to range in quality from high to very low quality, with the majority being moderate and low quality. The evidence was downgraded due to poor applicability in cases where the themes were not based on any research from a UK context, and/or had only been identified amongst a population affected by only one particular type of traumatic injury. Some downgrading for adequacy occurred when the richness or quantity of the data was low. Other issues resulting in downgrading were in the event of methodological problems that may have had an impact on the findings (e.g. unclear or biased participant recruitment, and data collection subject to social desirability bias), and for incoherence within the findings.

The recommendations were drafted mostly based on the evidence but in some parts supplemented accordingly with the committee’s own expertise.

Benefits and harms

High quality evidence from the theme ‘Emotional support’ from the adult review showed that trauma can have a detrimental impact on a person’s emotional state, being a period of large change and confusing information. This was strengthened by additional low quality evidence from the theme ‘Child’s emotional and behavioural changes’ from the children and young person population. These findings reinforced the committee’s experience that emotionally supportive healthcare practitioners can have a large influence on a person’s mood and confidence, increasing motivation and engagement with rehabilitation. The committee discussed how this supports their recommendation informed from the psychological interventions after traumatic injury evidence review, stating that all healthcare practitioners can and should provide psychological and emotional support for people after traumatic injury.

Moderate quality evidence from the theme ‘Timely information delivery’ from the adult review found that people may not remember or comprehend information given at certain points in the rehabilitation pathway (for example, if in pain or distress), which can affect their understanding of their rehabilitation options. Rehabilitation may either be limited or fail to progress until the patient understands the potential consequences of their treatment options and are comfortable in their choices. The committee discussed the fact that healthcare professionals should be aware of times when it is not appropriate to discuss rehabilitation needs.

[Rehabilitation] ‘Goals’ was a strong theme identified for support needs and preferences for adults after traumatic injury. Moderate quality evidence from the theme ‘Patient goals’ in the adult population showed that people found clear goals to be very motivating, but also were discouraged if the goals set by healthcare professionals did not align with their own motivations and what they found important in their lives. Moderate quality evidence from the themes ‘Preparation for home while hospitalised’ and ‘Vocational goals’ (also from the adult review) showed that rehabilitation goals are most effective when they are related directly to a person’s daily life. The committee combined this evidence with their own expertise and experiences to recommend that rehabilitation goals should be developed with patients and their family members or carers to ensure that they are patient-centred and reflect what the person wants to achieve with rehabilitation. They should include both short-term and long-term goals because; achieving smaller short-term goals provides a measure of progress and motivation for people while longer-term goals represent a continued purpose. These should be reviewed regularly to make sure they still align with a person’s abilities, preferences and circumstances. The committee also discussed moderate quality evidence from the theme ‘The desire to return to prior functioning’ and low quality evidence from the theme ‘Learning what to challenge and what to accept’, identified in the adult population. The former theme shows that most people wish to return to pre-injury levels of functioning and autonomy, and believe that a higher-intensity level of rehabilitation will allow them to reach it quicker. The latter theme shows that people undergoing rehabilitation face a number of different possible rehabilitation pathways and end-points, which may conflict with others. Therefore, people have to prioritise which goals are most important to them and this may mean having to accept not achieving other goals. Without either progress or acceptance, people can feel dissatisfied and de-motivated.

Therefore, the committee recommended that healthcare professionals involved in rehabilitation goal settings have experience in helping people prioritise which goals are right for them, explaining how their rehabilitation plan can help them achieve these, and understanding the psychological impact of goals on rehabilitation progress.

The committee discussed the large amount of evidence identified on how information and communication can be used to support people during rehabilitation after traumatic injury, combining it with their own experience and expertise. Moderate quality evidence from the themes ‘Clear and accessible language’ and ‘Timely information delivery’ in the adult review showed that people want their healthcare professionals to discuss their injuries and rehabilitation options using clear and jargon-free language, and that this should be delivered at times when they are able to understand and retain this information. Information given when a person is distressed (for example, directly after trauma), cognitively impaired (for example, with the presence of brain injury) or in pain often decreased their ability to remember this information fully and make rehabilitation decisions. Supporting the clear communication finding, the theme ‘Injury-specific information’ was identified in both the adult and children and young people populations (moderate quality evidence in the adult review and high quality in the child and young people review) and showed that people preferred information to be specific to their own injuries in order to reduce confusion and amount of information they have to understand and retain. Moderate quality evidence from the theme ‘Patient-centred communication and care’ in the adult review re-enforced that people want holistic and individualised rehabilitation care, adding that communication with healthcare professionals is especially important in delivering this. This was supported by low quality evidence from the theme ‘Supportive communication with professionals’ in the children and young people populations. This is not simply to do with delivering individualised medical information, but also in the style of communication. The finding showed that people valued staff who are attentive, have good listening skills, and show they are responsive to their individual preferences. Low quality evidence from the theme ‘Consistency of information’ in the adult review and moderate quality evidence from the theme ‘Continuity’ in the children and young people review showed that people found it frustrating when they were provided with conflicting information from multiple healthcare professionals and services, which decreased confidence in their rehabilitation care. The committee agreed with all the above findings, combining it with their own experience and expertise to develop several recommendations of how healthcare professionals should communicate with people undergoing rehabilitation after traumatic injuries, as well as their external support networks. These principles should be applied to all patient communication (including written information), and should be applied to the shared rehabilitation plan. The committee also signposted the NICE guidelines on patient experience in adult NHS services and babies, children and young peoples’ healthcare experiences for more focused information on general communication and information principles, and shared-decision making.

There was high quality evidence from the theme ‘Support extended to families’ in the adult population that showed that, after traumatic injury and during rehabilitation, people view their families and carers as vital components of the care network. They appreciate when support is extended to these people. This was supported by moderate quality evidence from the theme ‘Parents’ own emotional challenges’ from the child and young people review, which showed that parents face their own emotional challenges after a child’s traumatic injury and they may need support to discuss and process their feelings. The committee discussed that they have made a variety of recommendations to involve family and carers in discussions, rehabilitation planning and preparation after discharge. However, they also acknowledge the important role that family and carers play in successful rehabilitation outcomes, often filling in service gaps and taking on a large caring role when discharged into the community. The committee agreed that this can have a physical and emotional impact on family members and carers, which should not be overlooked. Therefore, they recommended that carers should be advised of the support that is available to them (rather than supporting people undergoing rehabilitation after traumatic injuries) and signposted to the NICE guideline on supporting adult carers for more detailed information and recommendations.

Following on from recommendation 1.7.7 about providing a detailed verbal and written handover before discharge into the community (which was developed from evidence in other co-ordination reviews), the committee discussed what information should be included (beyond that covered by the rehabilitation plan) to best support a person’s ongoing rehabilitation. High quality evidence from the theme ‘Peer support’ (in the adult population) and moderate quality evidence from the theme ‘Peer support groups’ (in the children and young people populations) showed that peer support is good source of information on lived experiences and inspiration for people. Supplementing this with low quality evidence from the theme ‘Available services and support’ from the adult review and moderate quality evidence from the theme ‘About services available’ in the children and young people review, the committee agreed that information on local groups, online forums and national charities be included in the handover. Moderate evidence from the theme ‘Support with making discharge and post-discharge arrangements’ in the adult report showed that people may find it difficult to engage with outpatient and community rehabilitation services and that they therefore appreciate assistance in contacting them and completing associated paperwork. This was supported by low quality evidence from the theme ‘Accumulative strain from having to engage with multiple services’ in the children and young people populations. This theme showed that parents would appreciate more support and guidance when engaging with multiple services, which might include how to receive accommodations from their own employers. In the committee’s experience, this is not something that rehabilitation units have extra resources to provide. However, they did agree that it was an important aspect to continuity of rehabilitation and recommended that information be provided on housing, benefits and independent advice organisations. Moderate quality evidence from the theme ‘Delays’ in the adult review showed that waiting time and delays in starting community rehabilitation services often leads to distress and de-motivation in people. While the committee discussed that it is not possible to prevent delays, they agreed that people should be informed of the likely time period before their next community rehabilitation appointment, in order to set expectations. Again, the committee used the high quality evidence from the theme ‘Support extended to families’ in the adult review to recommend that the handover include advice for family members and carers on what to expect once people are back at home. This was supplemented by low quality evidence from the theme ‘Strain upon family cohesion’ from the children and young people review. This finding shows that a large amount of strain is felt by the entire family unit after a child’s traumatic injury. Co-parents can face additional stressors on their relationship, and siblings may have to adjust to less time and attention from their parents. The committee discussed that information to family and carers should address this possible change in family dynamics, and include support avenues available to them, in order to ensure that they are not overlooked. The committee used their experience and expertise to highlight several other important areas for the rehabilitation handover, in order to ensure that information is holistic and comprehensive.

High quality evidence from the theme ‘Pre-discharge home visits’ in the adult population showed that people transferring back into the community find spending limited periods of time (for example, a day or weekend) at home prior to discharge helps to set expectations of life after leaving inpatient care and provide a gradual decrease in level of support. It also allows them to identify specific problems or challenging areas to address before being fully discharged home. This finding was supported by low quality evidence from the finding ‘Experiencing discontinuity’ in adults, which described that abrupt transitions between settings can lead to people feeling abandoned by healthcare services. The committee agreed that home visits can be beneficial, but that it is not always possible. For example, settings may not have resources available to arrange overnight home visits in a supported and safe way. The committee therefore recommended that joint inpatient and community team home visits should be conducted with rehabilitation patients before discharge, where possible. This allows possible issues to be identified and planned around accordingly. The committee highlighted that this is particularly helpful for people who will have significant ongoing needs, who are transitioning from a highly supported or long term rehabilitation setting. The committee agreed that overnight or weekend visits should be considered if there are any concerns about how people will manage at home after discharge. While there are some cases in which this might not be appropriate, (for example, the home is not currently suitable for their physical needs or the person does not feel comfortable) the committee agreed that an extended period spent in the home environment will better identify rehabilitation areas to concentrate on before discharge. However, the committee stressed that home visits should not be organised without considering the safety aspects. Healthcare professionals should involve service users in conversations about home visits. These discussions should include potential risks and a plan of how to deal with them. This is especially important if people live alone, as they may not have anyone available to assist them (for example, in the case of falls).

Moderate quality evidence from the theme ‘Support with making discharge and post-discharge arrangements’ in adults showed that people appreciated assistance with organising services for discharge and beyond. The committee discussed that these processes can often be complex, involving a lot of time and paperwork. Traumatic injuries (for example, decreased concentration span due to cognitive impairment) can be a barrier to this. The committee therefore recommended that relevant healthcare professionals, social care practitioners and education practitioners (as appropriate) should be informed, and that the person’s eligibility for funded social care support including for families and carers should be established. Moreover, the NHS continuing healthcare checklist should also be used to establish the person’s eligibility for a full continuing healthcare assessment before discharge. Low quality evidence from the theme ‘Support with reintegration into school’ from the children and young people review showed that injured children and their parents appreciated having a service that can communicate with schools and teachers about educational support needs. In order to encourage this, the committee recommended that healthcare professionals should establish eligibility for emergency education funding for short- term support at school and for funded support using an education, health and social care plan. The committee also agreed to refer to the NICE guideline on transition between inpatient hospital settings and community or care home settings for adults with social care needs.

Moderate quality evidence from the theme ‘Rehabilitation in the home versus in a hospital setting’ from the adult review showed that people appreciated rehabilitation in their home setting, allowing them to feel in control and address any issues they may encounter in the community. The committee discussed that this finding is supported by low quality evidence from the theme ‘Accessibility’ in the adult population and moderate quality evidence from the theme ‘A range of relevant and locally available services’ in the children and young people populations. These findings show that people may be concerned if rehabilitation appointments require regular and far travel. Additional evidence on appointment flexibility and overcoming barriers to rehabilitation was also identified in other co-ordination reviews. However, they were aware that not everyone feels comfortable with using technology, has access to equipment for virtual appointments or has a home environment suitable for rehabilitation exercises. Therefore, they recommended considering arranging distance appointments where appropriate, but that healthcare professionals should be mindful that this might not always be the most suitable solution for everybody.

High quality evidence from the theme ‘An identifiable point of contact’ in the adult population and moderate quality evidence from the theme ‘A point of contact’ in the children and young people populations showed that people appreciated having an identified point of contact to give information and support during the rehabilitation process. The committee agreed that at discharge from hospital, people and their family or carers should be provided a single point of contact (for example, a clinical nurse specialist) for information, help and advice for a limited time period (for example, 3 months). This is because at discharge the person, their family or carers may require injury specific information, information about local rehabilitation services, follow-up or an advocate within acute and community services, which can be provided by a single point of contact. This finding was supported by several themes in other co-ordination reviews. The committee discussed that a central point of contact was very helpful in developing relationships with patients and their families, leading to a better rapport and increased trust in rehabilitation services. However, they discussed the practical limitations of applying this within the inpatient setting. Concerns were raised about patients assuming that they could contact a named healthcare professional at any time, regardless of shifts and annual leave. However, the committee highlighted that a central point of contact will be particularly important when patients transfer from inpatient to outpatient settings, when care is being handed over to community healthcare teams. This contact can be a team or service within a hospital, which will give support to patients and flexibility in staffing. They recommended that the hospital point of contact be available to patients for a limited period of time after discharge in order to improve continuity of care during this period. The committee gave an example of 3 months which was designed to encompass the transition period while still providing a stimulus to ensure healthcare is properly transferred to the appropriate setting.

High quality evidence from the theme ‘Staff with specialist knowledge’ showed that adults were discouraged from accessing community healthcare services for their rehabilitation needs. Community services are seen to have insufficient specialist expertise about their specific rehabilitation requirements, which affected the confidence of patients in accessing their facilities. This finding was supported by evidence from the co-ordination from inpatient to outpatient rehabilitation services evidence review. The committee discussed that the reason for this lack of specialist knowledge is not normally due to a lack of interest from healthcare staff. Rather, there is a lack of opportunities for them to gain expertise and practical experience with rare injuries, particularly where specific rehabilitation services are not available. Therefore, the committee recommended for health care professionals to have access to the training, advice and peer support needed to confidently provide rehabilitation services after complex trauma. This does not have to be provided in person, but can be delivered by virtual communication (for example, video conferences or e-mail). By increasing the number of healthcare professionals trained in specialist trauma rehabilitation, there is a greater likelihood that continuity within healthcare teams is possible.

Finally, the committee discussed the 2 remaining themes identified in this review. Very low quality evidence from the theme ‘Culturally familiar support staff’ in the adult population showed that people may prefer to receive support from healthcare professionals from the same cultural background. Very low quality evidence from the theme ‘Male specific emotional and support needs’ in the children and young people population showed that fathers may have a particularly hard time with their emotions after a child’s trauma, finding it more difficult to request support. Due to the quality of the evidence, the very specific populations both themes were identified in, and the feasibility issues of implementing recommendations, the committee decided not to make any recommendations in either area.

Cost effectiveness and resource use

There was no existing economic evidence in this area.

The committee explained that most of the recommendations in this area, e.g. agreeing on small steps/goals so that clinicians can monitor progress; advice and guidance are documented in the person’s rehabilitation plan, passport, prescription or other records to promote consistency; skilled and competent multidisciplinary team; the timing of discussions; in pre-discharge involving the person in discussing the possible risks and how to manage them if they live alone represent principles of good practice for most service, and they do not expect these recommendations to result in additional resources to services.

The committee explained that basic psychological and emotional support is currently available across their services. Anyone within multidisciplinary teams usually delivers such support. The committee acknowledged that there might be additional training needs. However, services should be able to draw on existing expertise within their wider services.

The committee also discussed a single point of contact (e.g. a clinical nurse specialist) at discharge from the hospital to provide people and their family/carers with information, help and advice. It was explained that anyone could do this with a clinical background and that it doesn’t have to be one particular person. This would be offered only for a limited time and are not expected to result in a resource impact on services.

The committee explained that the recommendation on continued follow-up after discharge from a hospital or community-based rehabilitation programmes represents standard practice. People are generally followed in an outpatient hospital department. The committee also discussed video conferencing and explained that an individual might have remote follow-up care/rehabilitation with their initial rehabilitation specialist.

The committee discussed the recommendation around videoconferencing and explained that this is already standard practice in some services. The committee also discussed that an individual might have follow-up care/rehabilitation with their initial rehabilitation specialist with videoconferencing. The committee member with an experience of trauma discussed that the use of technology might mean that rehabilitation is more accessible, i.e. not having to drive to appointments, some people cannot leave home, etc. Also, it allows individualised support with the original team.

The committee explained that the recommendation on training, teaching or advice to general rehabilitation staff by healthcare professionals with specialist knowledge of specific injuries and complex rehabilitation needs might result in a cost increase. The committee explained that support/training local therapists would take only half a day to a full day instead of a consultant’s continuous support. The committee was of the view that this would be cost-saving. The committee also discussed potentially utilising videoconferencing to deliver such training, teaching or advice.

The committee discussed the recommendations around pre-discharge, i.e. overnight or weekend visits home and joint inpatient and community team home visits, and the potential resource impact. The committee explained that this happens now and would apply only to a small number of people.

Recommendations supported by this evidence review

This evidence review supports recommendations 1.1.3, 1.2.10, 1.3.1 to 1.3.3, 1.4.2, 1.5.8, 1.6.4, 1.6.7, 1.7.9, 1.7.10, 1.8.10 to 1.8.14, 1.8.18, 1.8.20, 1.8.21 and 1.10.14 in the NICE guideline.

References

    Evidence for adults

    • Abrahamson 2017

      Abrahamson, Vanessa, Jensen, Jan, Springett, Kate, Sakel, Mohamed, Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community: a qualitative study, Disability and rehabilitation, 39, 1683–1694, 2017 [PubMed: 27557977]

    • Bernhoff 2016

      Bernhoff, K., Bjorck, M., Larsson, J., Jangland, E., Patient Experiences of Life Years After Severe Civilian Lower Extremity Trauma With Vascular Injury, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 52, 690–695, 2016 [PubMed: 27637376]

    • Body 2013

      Body, Richard, Muskett, Tom, Perkins, Mick, Parker, Mark, Your injury, my accident: talking at cross-purposes in rehabilitation after traumatic brain injury, Brain Injury, 27, 1356–63, 2013 [PubMed: 24070204]

    • Braaf 2018

      Braaf, Sandra, Ameratunga, Shanthi, Nunn, Andrew, Christie, Nicola, Teague, Warwick, Judson, Rodney, Gabbe, Belinda J., Patient-identified information and communication needs in the context of major trauma, BMC health services research, 18, 163, 2018 [PMC free article: PMC5842544] [PubMed: 29514689]

    • Christaens 2015

      Christiaens, Wendy, Van de Walle, Elke, Devresse, Sophie, Van Halewyck, Dries, Benahmed, Nadia, Paulus, Dominique, Van den Heede, Koen, The view of severely burned patients and healthcare professionals on the blind spots in the aftercare process: a qualitative study, BMC health services research, 15, 302, 2015 [PMC free article: PMC4521491] [PubMed: 26231290]

    • Conneeley 2012 and 2013

      Conneeley, A. L., Transitions and brain injury: A qualitative study exploring the journey of people with traumatic brain injury, Brain Impairment, 13, 72–84, 2012
      Conneeley, Anne Louise, Exploring vocation following brain injury: a qualitative enquiry, Social Care and Neurodisability, 4, 6–16, 2013

    • Doig 2011

      Doig, Emmah, Fleming, Jennifer, Cornwell, Petrea, Kuipers, Pim, Comparing the experience of outpatient therapy in home and day hospital settings after traumatic brain injury: patient, significant other and therapist perspectives, Disability and Rehabilitation, 33, 1203–14, 2011 [PubMed: 20977391]

    • Johnson 2016

      Johnson, Rae A., Taggart, Susan B., Gullick, Janice G., Emerging from the trauma bubble: Redefining ‘normal’ after burn injury, Burns : journal of the International Society for Burn Injuries, 42, 1223–32, 2016 [PubMed: 27237124]

    • Keightley 2011

      Keightley, Michelle, Kendall, Victoria, Jang, Shu-Hyun, Parker, Cindy, Agnihotri, Sabrina, Colantonio, Angela, Minore, Bruce, Katt, Mae, Cameron, Anita, White, Randy, Longboat-White, Claudine, Bellavance, Alice, From health care to home community: an Aboriginal community-based ABI transition strategy, Brain Injury, 25, 142–52, 2011 [PubMed: 21219087]

    • Kersten 2018

      Kersten, Paula, Cummins, Christine, Kayes, Nicola, Babbage, Duncan, Elder, Hinemoa, Foster, Allison, Weatherall, Mark, Siegert, Richard John, Smith, Greta, McPherson, Kathryn, Making sense of recovery after traumatic brain injury through a peer mentoring intervention: a qualitative exploration, BMJ Open, 8, e020672, 2018 [PMC free article: PMC6252636] [PubMed: 30309988]

    • Kimmel 2016

      Kimmel, Lara A., Holland, Anne E., Hart, Melissa J., Edwards, Elton R., Page, Richard S., Hau, Raphael, Bucknill, Andrew, Gabbe, Belinda J., Discharge from the acute hospital: trauma patients’ perceptions of care, Australian health review : a publication of the Australian Hospital Association, 40, 625–632, 2016 [PubMed: 26910554]

    • Lindahl 2013

      Lindahl, Marianne, Hvalsoe, Berit, Poulsen, Jeppe Rosengaard, Langberg, Henning, Quality in rehabilitation after a working age person has sustained a fracture: partnership contributes to continuity, Work (Reading, Mass.), 44, 177–89, 2013 [PubMed: 23324675]

    • McPherson 2018

      McPherson, K., Fadyl, J., Theadom, A., Channon, A., Levack, W., Starkey, N., Wilkinson-Meyers, L., Kayes, N., Feigin, V., Barker-Collo, S., Harwood, M., Mudge, S., Christie, G., Jenkins, S., Living Life after Traumatic Brain Injury: Phase 1 of a Longitudinal Qualitative Study, Journal of Head Trauma Rehabilitation, 33, E44–E52, 2018 [PubMed: 28520671]

    • McRae 2016

      McRae, Philippa, Hallab, Lisa, Simpson, Grahame, Anstey, Braun Brooks Ellingsen Frost Gilworth Gilworth Gracey Harradine Kreutzer Macaden Medin Menon Nightingale Olver Oppermann Petrella Ponsford Rubenson Sabatello Simpson Tate Teasdale van Velzen van Velzen, Navigating employment pathways and supports following brain injury in Australia: Client perspectives, Australian Journal of Rehabilitation Counselling, 22, 76–92, 2016

    • Norrbrink 2016

      Norrbrink, Cecilia, Lofgren, Monika, Needs and requests-patients and physicians voices about improving the management of spinal cord injury neuropathic pain, Disability and Rehabilitation, 38, 151–8, 2016 [PubMed: 25918963]

    • O’Callaghan 2012

      O’Callaghan, Anna, McAllister, Lindy, Wilson, Linda, Insight vs readiness: factors affecting engagement in therapy from the perspectives of adults with TBI and their significant others, Brain Injury, 26, 1599–610, 2012 [PubMed: 22738228]

    • Odumuyiwa 2019

      Odumuyiwa, Tolu, Improving access to social care services following acquired brain injury: a needs analysis, Journal of Long-Term Care, 164–175, 2019

    • Pol 2019

      Pol, M., Peek, S., Van Nes, F., Van Hartingsveldt, M., Buurman, B., Krose, B., Everyday life after a hip fracture: What community-living older adults perceive as most beneficial for their recovery, Age and Ageing, 48, 440–447, 2019 [PMC free article: PMC6503934] [PubMed: 30806451]

    • Roberts 2017 and 2018

      Roberts, Jessica Louise, Din, Nafees Ud, Williams, Michelle, Hawkes, Claire A., Charles, Joanna M., Hoare, Zoe, Morrison, Val, Alexander, Swapna, Lemmey, Andrew, Sackley, Catherine, Logan, Phillipa, Wilkinson, Clare, Rycroft-Malone, Jo, Williams, Nefyn H., Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups, BMJ Open, 7, e014362, 2017 [PMC free article: PMC5652569] [PubMed: 29025824]
      Roberts, J. L., Pritchard, A. W., Williams, M., Totton, N., Morrison, V., D. In N.U, Williams, N. H., Mixed methods process evaluation of an enhanced community-based rehabilitation intervention for elderly patients with hip fracture, BMJ Open, 8 (8) (no pagination), 2018 [PMC free article: PMC6089270] [PubMed: 30093516]

    • Singh 2018

      Singh, Hardeep, Shah, Meeral, Flett, Heather M., Craven, B. Catherine, Verrier, Mary C., Musselman, Kristin E., Perspectives of individuals with sub-acute spinal cord injury after personalized adapted locomotor training, Disability and Rehabilitation, 40, 820–828, 2018 [PubMed: 28084843]

    • Stott-Eveneshen 2017

      Stott-Eveneshen, Sarah, Sims-Gould, Joanie, McAllister, Megan M., Fleig, Lena, Hanson, Heather M., Cook, Wendy L., Ashe, Maureen C., Reflections on Hip Fracture Recovery From Older Adults Enrolled in a Clinical Trial, Gerontology & geriatric medicine, 3, 2333721417697663, 2017 [PMC free article: PMC5433673] [PubMed: 28540341]

    • Turner 2011

      Turner, Benjamin James, Fleming, Jennifer, Ownsworth, Tamara, Cornwell, Petrea, Perceived service and support needs during transition from hospital to home following acquired brain injury, Disability and Rehabilitation, 33, 818–29, 2011 [PubMed: 20812814]
    Evidence for children and young people

    • Arshad 2015

      Arshad, Sira N., Gaskell, Sarah L., Baker, Charlotte, Ellis, Nicola, Potts, Jennie, Coucill, Theresa, Ryan, Lynn, Smith, Jan, Nixon, Anna, Greaves, Kate, Monk, Rebecca, Shelmerdine, Teresa, Leach, Alison, Shah, Mamta, Measuring the impact of a burns school reintegration programme on the time taken to return to school: A multi-disciplinary team intervention for children returning to school after a significant burn injury, Burns : journal of the International Society for Burn Injuries, 41, 727–34, 2015 [PubMed: 25535118]

    • Brown 2012

      Brown, F., Sofronoff, K., Whittingham, K., Boyd, R., McKinlay, L., Parenting a child with a traumatic brain injury: A focus group study, Developmental Medicine and Child Neurology, 54, 24–25, 2012

    • Foster 2019

      Foster, Kim, Mitchell, Rebecca, Young, Alexandra, Van, Connie, Curtis, Kate, Parent experiences and psychosocial support needs 6 months following paediatric critical injury: A qualitative study, Injury, 50, 1082–1088, 2019 [PubMed: 30655002]

    • Wharewera-Mika 2016

      Wharewera-Mika, Julie, Cooper, Erana, Kool, Bridget, Pereira, Susana, Kelly, Patrick, Caregivers’ voices: The experiences of caregivers of children who sustained serious accidental and non-accidental head injury in early childhood, Clinical child psychology and psychiatry, 21, 268–86, 2016 [PubMed: 26088208]

Appendices

Appendix B. Literature search strategies

Literature search strategies for review question

D.4a.

What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

D.4b.

What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

A combined search was conducted for both review questions.

This search was also done in combination with the search for qualitative studies for the adult and the children and young people versions of questions D.1 “What are the best methods to coordinate rehabilitation services for adults/children and young people with complex rehabilitation needs after traumatic injury whilst they are an inpatient, including when transferring between inpatient settings?”, D.2 “What are the best methods to deliver and coordinate rehabilitation services and social services for adults/children and young people with complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient rehabilitation services”, and D.3 “What are the barriers and facilitators to accessing rehabilitation services, including follow-up, following discharge to the community for adults/children and young people with complex rehabilitation needs after traumatic injury?”.

Please note that health economics searches were not run for this question as it focused on qualitative evidence.

Review question search strategies

Databases: Medline; Medline EPub Ahead of Print; and Medline In-Process & Other Non-Indexed Citations

Date of last search: 17/01/2020 (PDF, 218K)

Databases: Embase; and Embase Classic

Date of last search: 17/01/2020 (PDF, 239K)

Database: PsycInfo

Date of last search: 17/01/2020 (PDF, 254K)

Database: Social Policy and Practice

Date of last search: 17/01/2020 (PDF, 201K)

Databases: Cochrane Central Register of Controlled Trials (CCTR); and Cochrane Database of Systematic Reviews (CDSR)

Date of last search: 17/01/2020 (PDF, 260K)

Database: Social Care Online

Date of last search: 17/01/2020 (PDF, 113K)

Appendix C. Clinical evidence study selection

Clinical study selection for (PDF, 158K)

Appendix E. Forest plots

Forest plots for review question: D.4a What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

Not applicable as this was a qualitative question.

Forest plots for review question: D.4b What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

Not applicable as this was a qualitative question.

Appendix G. Economic evidence study selection

Economic study selection for

D.4a.

What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

D.4b.

What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No economic searches were undertaken for this qualitative review.

Appendix H. Economic evidence tables

Economic evidence tables for review question: D.4a What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No economic searches were undertaken for this qualitative review.

Economic evidence tables for review question: D.4b What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No economic searches were undertaken for this qualitative review.

Appendix I. Economic evidence profiles

Economic evidence profiles for review question: D.4a What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No economic searches were undertaken for this qualitative review.

Economic evidence profiles for review question: D.4b What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No economic searches were undertaken for this qualitative review.

Appendix J. Economic analysis

Economic evidence tables for review question: D.4a What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No economic analysis was undertaken for this review question.

Economic evidence tables for review question: D.4b What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No economic analysis was undertaken for this review question.

Appendix K. Excluded studies

Excluded clinical and economic studies for review question: D.4a What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

Economic studies

No economic searches were undertaken for this qualitative review.

Excluded clinical and economic studies for review question: D.4b What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

Economic studies

No economic searches were undertaken for this qualitative review.

Appendix L. Research recommendations

Research recommendations for review question: D.4a What are the support needs and preferences of adults who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No research recommendations were made for this review question.

Research recommendations for review question: D.4b What are the support needs and preferences of children and young people who have complex rehabilitation needs after traumatic injury when they transfer from inpatient to outpatient or community rehabilitation services?

No research recommendations were made for this review question.

FINAL

Evidence reviews underpinning recommendations 1.1.3, 1.2.10, 1.3.1 to 1.3.3, 1.4.2, 1.5.8, 1.6.4, 1.6.7, 1.7.9, 1.7.10, 1.8.10 to 1.8.14, 1.8.18, 1.8.20, 1.8.21 and 1.10.14

These evidence reviews were developed by the National Guideline Alliance, which is a part of the Royal College of Obstetricians and Gynaecologists

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.

Copyright © NICE 2022.
Bookshelf ID: NBK579696PMID: 35471785

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (1.9M)

In this Page

Other titles in this collection

Related NICE guidance and evidence

Supplemental NICE documents

Related information

  • PMC
    PubMed Central citations
  • PubMed
    Links to PubMed

Similar articles in PubMed

See reviews...See all...

Recent Activity

ClearTurn OffTurn On

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...