• For the coordination and delivery of rehabilitation services part of the question: Rehabilitation services for adults (aged 18 years and above) with complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss, and hearing loss, when they transfer from being an inpatient to being an outpatient
• For the coordination and delivery of rehabilitation services and social services part of the question: Rehabilitation services and social services for adults (aged 18 years and above) with social service needs and complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss, and hearing loss, when they transfer from being an inpatient to being an outpatient

• Adults (aged 18 years and above) with complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss, and hearing loss, when they transfer from being an inpatient to being an outpatient. For the social services aspect of this question, the population also have to have social services needs
• Staff working at inpatient and outpatient rehabilitation services and/or social services for adults (aged 18 years and above) who have complex rehabilitation needs after traumatic injury, including those with traumatic brain injury, sight loss and hearing loss.

• For the coordination of rehabilitation services part of the question: Rehabilitation services coordination method A (for example, neuro-navigator, trauma nurse coordinators, rehabilitation consultant, rehabilitation coordinators, case managers, key workers, discharge coordinators, GP, social worker, early supported discharge [homefirst], specialist trauma multidisciplinary team/combined clinics, rehabilitation prescriptions, multi-disciplinary discharge planning meeting/consultation, follow up meeting [phone or face to face], interface teams or intermediate care, occupational therapist)
• For the delivery of rehabilitation services part of the question: Rehabilitation services delivery method A (for example, community, group classes, intensive, multi-disciplinary, cohort clinic, specialist outpatients rehabilitation services, early supported discharge, self-management support, family support, outpatient [at hospital], individual, non-intensive, uni--disciplinary, non-cohort clinic, non-specialist)
• For the coordination of rehabilitation and social services part of the question: Rehabilitation and social services coordination method A (for example, continuing healthcare assessor, housing occupational therapists, housing officers, community healthcare teams [e.g., district nurses], re-enablement specialists, specialist injury/disability voluntary organisations, non-specialist social care/disability/user-led organisations, speech and language therapists, neuro-navigator, trauma nurse coordinators, rehabilitation consultant, rehabilitation coordinators, case managers, key workers, discharge coordinators, GP, social worker, early supported discharge [homefirst], specialist trauma multidisciplinary team/combined clinics, rehabilitation prescriptions, multi-disciplinary discharge planning meeting/consultation, follow up meeting [phone or face to face], interface teams or intermediate care, occupational therapist)
• For the delivery of rehabilitation and social services part of the question: Rehabilitation and social services delivery method A (for example, hospital/discharge-led social care and rehabilitation coordination at discharge, ‘separate/disconnected’ NHS continuing health care and local authority social care assessments for discharge (including assessments for capital costs like aids and adaptations and care costs like costs of a daily carer), rehabilitation and social care services delivered via completely different funding set up between health and social care, liaison at discharge with relevant voluntary organisations, use of personal budgets at discharge, liaison at discharge with reablement services/intermediate care, liaison with housing occupational therapists and other housing liaison at discharge (for example, to establish whether disabled facilities grants may be available if adaptations are needed, community-led social care and rehabilitation coordination at discharge, ‘joined up/connected NHS continuing health care and local authority social care assessments for discharge, rehabilitation and social care services delivered via a pooled/coordinated budget method (health and social care)

• Rehabilitation prescription
• Case managers
• Rehabilitation specialist
• MDT approach
• Social worker

• For the coordination of rehabilitation services part of the question:

  • Rehabilitation services coordination method B (for example, any of the above interventions)
  • No coordination
• For the delivery of rehabilitation services part of the question: Rehabilitation services delivery method B (for example, any of the above interventions)
• For the coordination of rehabilitation and social services part of the question:

  • Rehabilitation and social services coordination method B (for example, any of the above interventions)
  • No coordination
• For the delivery of rehabilitation and social services part of the question: Rehabilitation and social services delivery method B (for example, any of the above interventions)

• Critical

  • Patient satisfaction
  • Length of hospital stay
  • Return to work or education
• Important

  • Overall quality of life (EURO-QoL 5D 3L, SF-36, SF-12, SF-6D, SFMA)
  • Carer impact
  • Unplanned readmission
  • Changes in activity of daily living (Barthel ADL index, COPM, E-ADL-Test, FIMFAM, GAS, Katz, OARS, PAT, PSMS)

Themes will be identified from the literature pertaining to methods to coordinate and deliver rehabilitation services themselves and rehabilitation and social services in combination for adults, when transferring from inpatient to outpatient rehabilitation services, regarded by the population as optimal/not optimal or effective/non-effective.

Themes will be identified from the literature but may include:

• Rehabilitation prescription
• Case managers
• Rehabilitation specialist
• MDT approach
• Social worker

Rehabilitation and social care settings for patients with complex rehabilitation needs after traumatic injury

Exclusion:

• Accident and emergency departments
• Critical care units
• Prisons