The transition from hospital to home for individuals with acquired brain injury: A literature review and research recommendations

Purpose. To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research. Method. Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review. Results/discussion. A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical. Conclusion. Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.

[1]  J. Fleming,et al.  The Development of Self-Awareness and Relationship to Emotional Functioning During Early Community Reintegration After Traumatic Brain Injury , 2006, Brain Impairment.

[2]  A. Térent,et al.  Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences , 2006, Disability and rehabilitation.

[3]  C. Unsworth,et al.  Factors That Lead to Successful Community Integration Following Severe Traumatic Brain Injury , 2006, The Journal of head trauma rehabilitation.

[4]  Tzu-Ting Huang,et al.  A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling. , 2005, Journal of clinical nursing.

[5]  Linda A Readding Hospital to home: smoothing the journey for the new ostomist. , 2005, British journal of nursing.

[6]  W. Schupp,et al.  Intensification of the transition between inpatient neurological rehabilitation and home care of stroke patients. Controlled clinical trial with follow-up assessment six months after discharge , 2005, Clinical rehabilitation.

[7]  A. Sinclair,et al.  Post-discharge home-based support for older cardiac patients: a randomised controlled trial. , 2005, Age and ageing.

[8]  A. Olofsson,et al.  ‘If only I manage to get home I'll get better’-Interviews with stroke patients after emergency stay in hospital on their experiences and needs , 2005, Clinical rehabilitation.

[9]  J. Powell,et al.  The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial. , 2005, Archives of physical medicine and rehabilitation.

[10]  M. Dijkers,et al.  Community activities and individuals' satisfaction with them: quality of life in the first year after traumatic brain injury. , 2005, Archives of physical medicine and rehabilitation.

[11]  E. Frank,et al.  Factors Predicting Rehabilitative Service Provision in Adults with Traumatic Brain Injury , 2005 .

[12]  Jan Erik Nordrehaug,et al.  A Qualitative Study of the Information Needs of Acute Myocardial Infarction Patients, and Their Preferences for Follow-up Contact After Discharge , 2005, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[13]  J. Powell,et al.  Development of a Telephone Follow‐up Program for Individuals Following Traumatic Brain Injury , 2004, The Journal of head trauma rehabilitation.

[14]  M. Clinton,et al.  Stroke care in the home: the impact of social support on the general health of family caregivers. , 2004, Journal of clinical nursing.

[15]  N. Chumbler,et al.  The sense of coherence, burden, and depressive symptoms in informal caregivers during the first month after stroke , 2004, International journal of geriatric psychiatry.

[16]  E. Rideout Review: comprehensive discharge planning plus post-discharge support reduces total readmissions in older patients with congestive heart failure , 2004, Evidence-based nursing.

[17]  T. Ownsworth,et al.  Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model , 2004, Disability and rehabilitation.

[18]  S. Gauggel,et al.  Awareness of activity limitations, goal setting and rehabilitation outcome in patients with brain injuries , 2004, Brain injury.

[19]  J. Gubrium,et al.  The experience of time in the transition from hospital to home following stroke. , 2004, Journal of rehabilitation research and development.

[20]  G. Simpson,et al.  Post-acute Rehabilitation for People With Traumatic Brain Injury: A Model Description and Evaluation of the Liverpool Hospital Transitional Living Program , 2004, Brain Impairment.

[21]  G. Whiteneck,et al.  Perceived Needs Following Traumatic Brain Injury , 2004, The Journal of head trauma rehabilitation.

[22]  C. Blomstrand,et al.  Psychological well-being of spouses of stroke patients during the first year after stroke , 2004, Clinical rehabilitation.

[23]  C. Cott,et al.  Client-centred rehabilitation: client perspectives , 2004, Disability and rehabilitation.

[24]  L. Re Changes in the quality of life of cerebral stroke patients in the first year after rehabilitation , 2003 .

[25]  R. E. Lalu Veränderungen der Lebensqualität geriatrischer Schlaganfallpatienten im ersten Jahr nach der Rehabilitation , 2003, Zeitschrift für Gerontologie und Geriatrie.

[26]  L. Turner-Stokes,et al.  An evaluation of aftercare following discharge from a specialist in-patient rehabilitation service , 2003, Disability and rehabilitation.

[27]  A. Conneeley Quality of Life and Traumatic Brain Injury: A One-Year Longitudinal Qualitative Study , 2003 .

[28]  S. Rubenach,et al.  A randomized controlled trial of an education and counselling intervention for families after stroke , 2003, Clinical rehabilitation.

[29]  T. Novack,et al.  The relationship between neuropsychologic function and level of caregiver supervision at 1 year after traumatic brain injury. , 2003, Archives of physical medicine and rehabilitation.

[30]  G. Whiteneck,et al.  Understanding outcomes based on the post-acute hospitalization pathways followed by persons with traumatic brain injury , 2003, Brain injury.

[31]  Patricia Minnes,et al.  Community integration: a useful construct, but what does it really mean? , 2003, Brain injury.

[32]  M. Kendall,et al.  Bridging the gap: Transitional rehabilitation services for people with spinal cord injury , 2003, Disability and rehabilitation.

[33]  M. Weinstein,et al.  Outcomes and costs of acute treatment of traumatic brain injury. , 2002, The Journal of trauma.

[34]  A. Conneeley Social Integration following Traumatic Brain Injury and Rehabilitation , 2002 .

[35]  S. Dikmen,et al.  Significant Other Burden and Factors Related to it in Traumatic Brain Injury , 2002, Journal of clinical and experimental neuropsychology.

[36]  J. Sleigh,et al.  Caregiver Burden During the Year Following Severe Traumatic Brain Injury , 2002, Journal of clinical and experimental neuropsychology.

[37]  B. H. Forchhammer,et al.  Follow-up services for stroke survivors after hospital discharge-a randomized control study , 2002, Clinical rehabilitation.

[38]  R. King,et al.  Adaptation to Stroke: A Longitudinal Study of Depressive Symptoms, Physical Health, and Coping Process , 2002, Topics in stroke rehabilitation.

[39]  J. Kleppel,et al.  Assessing Head-Injury Survivors of Motor Vehicle Crashes at Discharge from Trauma Care , 2002, American journal of physical medicine & rehabilitation.

[40]  J. Desrosiers,et al.  Association between personal and environmental factors and the occurrence of handicap situations following a stroke. , 2001, Disability and rehabilitation.

[41]  E. Roth,et al.  Transition to home care after stroke: depression, physical health, and adaptive processes in support persons. , 2001, Research in nursing & health.

[42]  P. Roderick,et al.  Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care. , 2001, Age and ageing.

[43]  B. Paterson,et al.  'They never told us anything': postdischarge instruction for families of persons with brain injuries. , 2001, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[44]  M. Britton,et al.  How do stroke patients fare when discharged straight to their homes? A controlled study on the significance of hospital follow-up after one month. , 2000, Scandinavian journal of rehabilitation medicine.

[45]  K. Johnson Use of telephone follow-up for post-cardiac surgery patients. , 2000, Intensive & critical care nursing.

[46]  W. Yoels,et al.  Factors associated with patients' participation in rehabilitation services: a comparative injury analysis 12 months post-discharge. , 2000, Disability and rehabilitation.

[47]  B. H. Forchhammer,et al.  Can readmission after stroke be prevented? Results of a randomized clinical study: a postdischarge follow-up service for stroke survivors. , 2000, Stroke.

[48]  S. Tyson,et al.  Discharge and follow-up for people with stroke: what happens and why , 2000, Clinical rehabilitation.

[49]  M. Naylor A decade of transitional care research with vulnerable elders. , 2000, The Journal of cardiovascular nursing.

[50]  H. Rodgers,et al.  Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. , 1999, Stroke.

[51]  J. Buckley,et al.  Rehabilitation following myocardial infarction: Evaluation of both ‘fast-track’ and low level exercise on both physical and psychological parameters , 1999 .

[52]  C. Fraser The experience of transition for a daughter caregiver of a stroke survivor. , 1999, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[53]  P. Minnes,et al.  A transitional living environment for persons with brain injuries: staff and client perceptions. , 1998, Brain injury.

[54]  K. Fryday-Field,et al.  Understanding the transition to community living after discharge from an acute care hospital: an exploratory study. , 1997, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[55]  C. Unsworth Clients' perceptions of discharge housing decisions after stroke rehabilitation. , 1996, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[56]  R. Peschel,et al.  Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care , 1994 .

[57]  N. Lincoln,et al.  A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[58]  T. Glass,et al.  The quality and quantity of social support: stroke recovery as psycho-social transition. , 1992, Social science & medicine.

[59]  J. Haselkorn,et al.  Factors predicting satisfactory home care after stroke. , 1991, Archives of physical medicine and rehabilitation.

[60]  N. Michels The transition from hospital to home: an exploratory study. , 1988, Home health care services quarterly.

[61]  B. Munro,et al.  Early discharge and specialist transitional care. , 1988, Image--the journal of nursing scholarship.

[62]  S Shepperd,et al.  Hospital at home versus in-patient hospital care. , 2005, The Cochrane database of systematic reviews.

[63]  Therapy-based rehabilitation services for stroke patients at home. , 2003, The Cochrane database of systematic reviews.

[64]  R. Marquis,et al.  FUNCTIONAL PERFORMANCE, DEPRESSION, ANXIETY, AND STRESS IN PEOPLE WITH SPINAL CORD INJURIES IN THAILAND: A TRANSITION FROM HOSPITAL TO HOME , 2003 .

[65]  R. Lalu [Changes in the quality of life of cerebral stroke patients in the first year after rehabilitation]. , 2003, Zeitschrift fur Gerontologie und Geriatrie.

[66]  S. Chatterji,et al.  The ICF: Applications of the WHO model of functioning, disability and health to brain injury rehabilitation. , 2003, NeuroRehabilitation.

[67]  Lucy Dillon,et al.  Quality in qualitative evaluation: A framework for assessing research evidence. A quality framework. , 2003 .

[68]  J. Connell,et al.  A comparison of adjustment and self-awareness in adults after traumatic brain injury and spinal cord injury: The transition from hospital to community , 2001 .

[69]  P J Donovick,et al.  Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. , 2001, Brain injury.

[70]  S Shepperd,et al.  Discharge planning from hospital to home. , 2000, The Cochrane database of systematic reviews.

[71]  L. Tooth,et al.  Prediction of community integration and vocational outcome 2-5 years after traumatic brain injury rehabilitation in Australia. , 1999, Brain injury.

[72]  S. Burleigh,et al.  Community integration and life satisfaction after traumatic brain injury: long-term findings. , 1998, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[73]  J. Sleigh,et al.  Caregiver burden at 1 year following severe traumatic brain injury. , 1998, Brain injury.

[74]  G. Goldberg,et al.  Stroke Transition after Inpatient Rehabilitation. , 1997, Topics in stroke rehabilitation.

[75]  S. Kaplan,et al.  The Occupational Therapist's Role in a Transitional Living Program for Head Injured Clients. , 1995, Occupational therapy in health care.

[76]  P. Minnes,et al.  Stability of functional outcomes following transitional living programme participation: 3-year follow-up. , 1994, Brain injury.

[77]  J. Levesque Assessing the foreseeable risks in discharge planning: the challenge of discharging the brain-injured patient. , 1988, Social work in health care.

[78]  Nancy K. Schlossberg,et al.  Counseling Adults in Transition: Linking Practice with Theory , 1984 .