| Themes and subthemes | CERQual Quality | No. of studies | Populations covered | ||
|---|---|---|---|---|---|
| Contribution by injury type (number of studies) | Sub-groups as specified in the protocol (number of studies) | ||||
| 1 Service commissioning | |||||
| 1.1 |
Commission a full service Services need to be funded and available for the entire journey of a service user - along with guidelines and a clear vision for how these services should co-ordinate, communicate and standardise in order to meet the needs of their local population | Moderate | 5 | Brain injury (1), Burns (2), Hip-fracture (1), Fractures (1) | Frail adults aged 65+ (1) |
| 1.2 |
Community services and facilities The availability and accessibility of community and social services (for example, social care and housing services) is just as important for overall rehabilitation as medical services are. These services should be properly funded and promoted. | High | 7 | Brain injury (4), Burns (1), Spinal cord injury (1), Brain injury and multiple trauma (1) | None |
| 1.3 |
Workload and demand Rehabiltation healthcare staff report being overworked and underfunded, leading to long waiting lists and poor healthcare provision. | High | 3 | Brain injury (2), Hip-fracture (1) | Frail adults aged 65+ (1) |
| 1.4 |
Rural services People living in rural areas are often underserved. Additional effort will be needed to ensure that the rehabilitation needs after traumatic injuries of these people are met. | High | 5 | Brain injury (4), Burns (1) | None |
| 2 Integrating multiple services | |||||
| 2.1 |
Integrated multidisciplinary team approach A MDT approach to co-ordinating medical and social support needs is important when transferring from inpatient to outpatient services. | High | 5 | Brain injury (1), Burns (1), Hip-fracture (1), Spinal cord injury (1), Brain injury and multiple trauma (1) | Frail adults aged 65+ (1) |
| 2.2 |
Inter-service awareness and relationships Healthcare staff find it easier for multiple agencies to work together if they know each other’s roles and remits, and have the opportunity to build relationships. | High | 3 | Hip-fracture (1), Fractures (1), Brain injury and multiple trauma (1) | Frail adults aged 65+ (1) |
| 2.3 |
Inter-service communication of information Adults with rehabilitation needs can find it distressing to repeat their injury and medical history to multiple people. Communication between rehabilitation services should be efficient and easy. | Moderate | 6 | Burns (1), Hip-fracture (1), Fractures (1), General trauma (1), Amputations (1), Brain injury and multiple trauma (1) | Frail adults aged 65+ (1) |
| 2.4 |
Case coordinator A case coordinator helps to increase continuity and consistency when transferring between inpatient and outpatient settings. | High | 3 | Brain injury (1), Burns (1), General trauma (1) | None |
| 2.5 |
Interdisciplinary consistency Medical information and instructions from different healthcare professionals should be compatible, complimentary and consistent to prevent confusion. | Moderate | 3 | Brain injury (1), Spinal cord injury (1), General trauma (1) | None |
| 3 Delivery | |||||
| 3.1 |
Continuity of staff Where possible, healthcare professionals and people with rehabilitation needs appreciate continuity of staff, This helps to build trust and rapport while changes in staff can be discouraging, costs time to share history and details, and cause mistakes. | High | 4 | Brain injury (2), Burns (1), Fractures (1) | None |
| 3.2 |
Include family Family play a very significant role in coordination of rehabilitation care when returning to the community. If appropriate, family members should be included in discussions and planning of care, as well as any education needed to provide rehabilitation support. | High | 9 | Brain injury (3), Burns (2), Hip-fracture (3), Spinal cord injury (1) | Frail adults aged 65+ (3) |
| 3.3 |
Point of contact A single, identifiable point of communication for information and support can increase coordination when transferring between inpatient and outpatient rehabilitation services. | High | 5 | Brain injury (3), General trauma (1), Amputations (1) | None |
| 3.4 |
Peer support Peer mentors can encourage people in their ongoing rehabilitation, be a role-model and provide information on their own lived experiences with rehabilitation services in the area. | Very low | 1 | Spinal cord injury (1) | None |
| 3.5 |
Delivery at home Healthcare staff report that delivery of rehabilitation at home is becoming more feasible, meaning people do not have to have such prolonged hospital stays. | Low | 2 | Brain injury (1), Burns (1) | None |
| 3.6 |
Technology Videoconferencing and telemedicine can be useful to reach people who cannot attend in-person consultations for a variety of reasons. Apps can also be useful for alerts or reminders | Low | 3 | Burns (1), Spinal cord injury (2) | None |
| 4 Information | |||||
| 4.1 |
Inform about services and plans Adults with rehabilitation needs report co-ordination being increased when they receive more information on what to expect after discharge, what arrangements are in place and probable timelines. | High | 7 | Brain injury (3), Burns (2), Hip-fracture (1), General trauma (1) | Frail adults aged 65+ (1) |
| 4.2 |
Prognosis Adults with rehabilitation needs want information about the likely long-term prognosis of their injuries and how this will affect their lives going forward. | High | 3 | Brain injury (1), Burns (1), General trauma (1) | None |
| 4.3 |
Format Information should be given information in plain, accessible language. Written information may be helpful for retaining this information. | Very low | 1 | General trauma (1) | None |
| 5 Individual factors | |||||
| 5.1 |
Personalisation Rehabilitation should be delivered in an adaptable fashion, taking into account related to age, and symptoms or comorbidities which may limit mobility. Additional planning may be needed to provide flexible rehabilitation sessions, as well as social vulnerabilities (for example, such as housing and financial situation). | Low | 6 | Brain injury (2), Burns (1), Hip-fracture (1), Spinal cord injury (1), Fractures (1) | Frail adults aged 65+ (1) |
| 5.2 |
Admission criteria Inflexible admission criteria may mean that rehabilitative support is not offered to certain adults (for example, if their difficulties are perceived as less severe). Financial factors or postcode may also limit rehabilitation access. | Low | 3 | Brain injury (2), Hip-fracture (1) | Frail adults aged 65+ (1) |
| 5.3 |
Specialists Upon discharge from inpatient settings, adults with rehabilitation needs report that services become more generic and staff do not have knowledge about their particular conditions or disabilities. It is important for the delivery of an individual’s rehabilitation ongoing care team to include some staff with specialist knowledge. | High | 5 | Brain injury (3), Burns (2) | None |
| 5.4 |
Home adjustments Some adults with rehabilitation needs require physical aids and small adjustments in their home. These adjustments may be vital to the discharge process and progression with rehabilitation. | Low | 1 | Fractures (1) | None |
| 5.5 |
Advocacy Some adults with rehabilitation needs may need support with researching options and initiating conversations. Some might need their family to take the lead healthcare staff about rehabilitation, or in some cases the adult may do it for themselves. | High | 3 | Brain injury (1), Hip-fracture (1), Amputations (1) | Frail adults aged 65+ (1) |
| 6 Timing | |||||
| 6.1 |
Gradual Return to the community should be a gradual and incremental process (for example, using pre-discharge home visits). Abrupt endings or loss of support can be distressing. | High | 8 | Brain injury (2), Burns (2), Hip-fracture (1), Spinal cord injury (1), Fractures (1), Brain injury and multiple trauma (1) | Frail adults aged 65+ (1) |
| 6.2 |
Start early Conversations about discharge planning and any adjustments should start early on to avoid abruptness. Last-minute conversations about needs and rehabilitation close to the time discharge are distressing. | Low | 5 | Brain injury (2), Burns (1), Spinal cord injury (1), General trauma (1) | None |
| 6.3 |
Gap in service Some adults with rehabilitation needs report experiencing gaps in service and long waiting times before starting community rehabilitation, which was confusing and distressing. Some of this distress can be lessened if people were given probably timelines. | Low | 6 | Brain injury (3), Hip-fracture (1), Fractures (1), General trauma (1) | Frail adults aged 65+ (1) |
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.