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Table 3 Continuity of care

From: Organising health care services for people with an acquired brain injury: an overview of systematic reviews and randomised controlled trials

Study Patient Intervention/Comparator Outcomes Results
Case management     
Ellis 2010 Patients with stroke I: Stroke liason worker Subjective health, function, participation, death, institutionalisation, mood, stroke related knowledge, health service utilisation, patient satisfaction Patients with mild to moderate disability had a significant reduction in dependence (OR 0.62, 95% CI 0.44 to 0.87) and there were reports of higher patient and carer satisfaction however there was no other evidence that the intervention improves outcome.
Design: SR C: Alternative care or no post-discharge care
Size: 16 studies
Setting: Predominantly community
AMSTAR: 8/11     
Chesnut 1999 Patients with TBI I: Long term care coordination General functional status There was a lack of high quality studies and studies included in the review reported conflicting results therefore the authors were unable to make clear recommendations on the evidence for this approach.
Design: SR
Size: 3 studies
Setting:
Community
AMSTAR: 3/11     
Allen 2009 Patients with stroke I: 6 months of follow up contact from an Advanced Practice nurse who worked with the GP to implement a care plan, organised further services and provided education NIHSS, TUG, physical performance test, mortality, institutionalisation, QOL, mgt of post-stroke complications, stroke knowledge and lifestyle modification There was little difference between groups at 6 months. The intervention group had slightly improved lifestyle management and stroke knowledge.
Design: RCT
Size: N = 380
Setting: Acute to community
United States
PEDro: 8/10   C: Usual care plus provision of written stroke related education.   
Bell 2005 Patients with TBI I: Regular phone calls over 9 months upon discharge to follow-up any issues, identify concerns and provide information, mentoring, goal setting, reassurance and referral to community resources. Function, community integration, neurobehavioural functioning inventory, Glasgow outcome scale, QOL, emotional state The intervention group had significantly better scores on functional status and perceived quality of wellbeing than the control group however the magnitude of the effect is unclear as the outcome was a composite measure.
Design: RCT
Size: N = 171
Setting: Rehabilitation to community
United States
PEDro: 8/10   C: Usual care   
Bell 2008 Patients with mild TBI I: Regular phone calls over 3 months post injury after presentation to the ED, a contact phone number and additional information about brain injury and where to get help Head injury symptoms, QOL. PHQ, role performance, community participation Patients in the intervention group reported fewer symptoms 6 months post injury than the control group (6.6 difference in adjusted mean symptom score, 95% CI 2.2 to 5.2)
Design: RCT
Size: N = 366
Setting: ED to community
United States
PEDro: 8/10
   C: Usual care (patient handout and outpatient treatment if prescribed).   
Bell 2011 Patients with TBI I: Regular phone calls for up to 21 months post injury from a case manager. The purpose of the calls was to help participants to identify, prioritise and solve problems as independently as possible Function, level of disability, participation, symptoms, QOL, vocational status No significant differences were found between groups for any of the measures at either 1 or 2 years post injury.
Design: RCT
Size: N = 433
Setting: Rehabilitation to community
United States
PEDro: 6/10 C: Usual care
Trexler 2010 Patients with ABI I: Allocated to ‘resource facilitators’ who contacted participants every 2 weeks (via telephone or home/community visits). A large focus of the facilitator was returning the patient to work (CM) Participation, self reported health Levels of participation improved more in the intervention group (F = 9.11) and more of the intervention group were employed at the time of 6 month follow up (n = 7 vs n = 4).
Design: RCT
Size: N = 22
Setting: Community
United States
PEDro: 4/10   C: Usual care (no ‘resource facilitator’   
Early supported discharge     
Fearon 2012 Patients with acute stroke I: Early supported discharge Death or long term dependency, length of stay, ADL function, subjective health status, mood, carer outcome, patient and carer satisfaction Appropriately resourced Early Supported Discharge models can reduce length of stay (equivalent to approximately 7 days). Patients receiving ESD are more likely to be independent and living at home OR 0.80 (95% CI 0.67 to 0.97)
Design: SR C: Other models of care
Size: 14 studies
Setting: Acute stroke to home
AMSTAR: 9/11     
Short term package     
Andersen 2000 Patients with stroke Ia: Three home visits from a geriatric rehabilitation physician for medication review, referral/liason with other services, information Function, ADLs, mortality, institutionalisation and readmission Significantly less hospital readmissions in both intervention groups compared to the control group at 6 months (26% vs 34% and 44%).
There was no difference in functional outcome between groups at 6 months.
Design: RCT (three arms)
Size: N = 155
Setting: Rehabilitation to community Ib: Home visits (average of 3) from the hospital physiotherapists for instruction and education
Denmark
PEDro: 7/10
   C: Standard aftercare (may have included outpatient rehabilitation and home care)   
Forster 2009 Patients with stroke I: Follow up assessment from a stroke nurse 5–6 months after stroke. Issues identified in the assessment were managed in a standardised manner Function, mood, satisfaction with care, caregiver burden There were no real differences between groups at 12 month follow up however patients reported improved satisfaction with care in some areas.
Design: RCT     
Size: N = 265     
Setting:     
Community     
United Kingdom   C: Letter sent to GP recommending 6 month review   
PEDro: 8/10     
Ghaffar 2006 Patients with mild TBI I: Patients were followed up in a multidisciplinary TBI clinic within 1 week of injury and offered pharmacotherapy, PT, OT and supportive psychotherapy if required Symptoms, General Health questionnaire, cognition In general there were no significant differences between group however a small subgroup (those with a premorbid psychiatric history) appeared to benefit from treatment, reporting lower levels of depression at 6 months (F = 6.8).
Design: RCT
Size: N = 191
Setting: ED to community
Canada
PEDro: 5/10   C: Usual care (no follow up arranged)   
Wade 1997 Patients with head injury I: Routine follow up from an occupational therapist or psychologist 7–10 days post injury with organisation of further follow up as required Symptoms As a whole, there were no significant differences between groups however subgroup analyses revealed that patients in the control group with a more severe head injury were more likely to have continuing problems at 6 months.
Design: RCT
Size: N = 1156
Setting: ED to community
C: Usual care (no routine followup)
United Kingdom
PEDro: 3/10
Wade 1998 Patients with head injury I: Routine follow up from an occupational therapist or psychologist 7–10 days post injury with organisation of further follow up as required Symptoms The intervention group reported fewer or less severe concussion symptoms and less disruption of social activities at 6 months than the control group.
Design: RCT     
Size: N = 314     
Setting: ED, hospital and community     
   C: Usual care (no routine followup)   
United Kingdom     
PEDro: 5/10     
Ytterberg 2000 Patients with stroke I: All day follow up visit one month after discharge Self reported health status There were no significant differences between groups
Design: RCT  
  C: Usual care with no specific follow-up arranged
Size: N = 111  
Setting: Community  
Sweden  
PEDro: 2/10