Table 6, Summary of relevant qualitative and quantitative evidence - Service coordination: inpatient to outpatient settings for people with complex rehabilitation needs after traumatic injury

Table 6Summary of relevant qualitative and quantitative evidence

Qualitative theme	Quantitative intervention and results	Study IDs
1 Service commissioning
Rehabilitation services should be developed to included the entire patient pathway, ensuring that there is a clear vision of how different areas should coordinate and communicate with each other. (moderate quality)	The multidisciplinary care pathway intervention was designed to span from admission at the emergency room to discharge from nursing home rehabilitation units. Length of hospital stay Multidisciplinary care pathway versus Standard care – Significantly shorter in multidisciplinary care pathway group^* (moderate quality)	Quantitative Flikweerk 2014 Qualitative Christiaens 2015 Jeyaraj 2013 Kornhaber 2019 Lindahl 2013 Stolee 2019
If rehabilitation services are understaffed, healthcare workers can become overworked which affects the coordination of rehabilitatin services. This may cause long waiting lists, cases to be missed and less patient contact time. (high quality)	The MDT post-operative rehabilitation intervention included increasing staffing levels from 1.07 WTE nurses/aides per bed, plus 2 × 1 WTE physiotherapists, 2 × 1 WTE occupational therapists and 0.2 WTE dietician. Changes in ADL MDT post-operative rehabilitation versus Conventional post-operative rehabilitation - Number of participants achieving Independence in P-ADL at each time point at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Independence in P-ADL at each time point at 12 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade A at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade B at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade C at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade D at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade E at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade F at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade G at 12 month post-operative follow-up – Clinically importantly lower in MDT post-operative rehabilitation group (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 12 months post-operative follow-up – Clinically importantly higher in MDT post-operative rehabilitation group (very low quality)	Quantitative Stenvall 2007 Qualitative Kennedy 2012 Stolee 2019 Odumuyiwa 2019
2 Integrating multiple services
Multidisciplinary team approach to medical and social support needs should be integrated and united at transfer from inpatient to outpatient rehabilitation services. (high quality)	The multidisciplinary team care, multidisciplinary care pathway, multidisciplinary outpatient treatment, multidisciplinary post-opertive rehabilitation and support discharge team care involved assessment and care from different professionals such as physiotherapist, psychologist nurses, healthcare assistants etc, depending on the needs of the patients until they were discharged into the community. Return to work or education Multidisciplinary intervention versus Usual care - Number of participants who had returned to work at 6 months post-discharge – No clinically important difference between groups (very low quality) Multidisciplinary outpatient treatment versus Usual care by GP - Number of participants returning to work at 12 months post-injury – No clinically important difference between groups (very low quality) Length of hospital stay Multidisciplinary intervention versus Usual care – No clinically important difference between groups (very low quality) Multidisciplinary care pathway versus Standard care – Significantly shorter in multidisciplinary care pathway group^* (moderate quality) Supported discharge team versus Usual care – Significantly shorter in Supported discharge team group^* (moderate quality) Changes in ADL Multidisciplinary intervention versus Usual care - Number of participants with impairment of ADL at 6 months post-discharge – No clinically important difference between groups (very low quality) - FIM at 6 months post-discharge – No clinically important difference between groups (very low quality) MDT post-operative rehabilitation versus Conventional post-operative rehabilitation - Number of participants achieving Independence in P-ADL at each time point at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Independence in P-ADL at each time point at 12 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade A at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade B at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade C at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade D at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade E at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade F at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade G at 12 month post-operative follow-up – Clinically importantly lower in MDT post-operative rehabilitation group (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 12 months post-operative follow-up –Clinically importantly higher in MDT post-operative rehabilitation group (very low quality) Multidisciplinary outpatient treatment versus Usual care by GP - Glasgow Outcome Scale at 12 months post-injury – No clinically important difference between groups (very low quality)	Quantitative Browne 2013 Filkweert 2014 Parsons 2019 Stenvall 2007 Vikane 2017 Qualitative Isbel 2017 Kornhaber 2019 Odumuyiwa 2019 Sena Martins 2017 Slomic 2017
Better communication and information sharing between different services reduce the need for adults with rehabilitation to recount or recall their history or symptoms which may be distressing. (moderate quality)	Within the multidisciplinary care pathway and supported discharge team care, patient information was passed to rehabilitation homes and community primary care services respectively, prior to discharge. Length of hospital stay Multidisciplinary care pathway versus Standard care – Significantly shorter in multidisciplinary care pathway group^* (moderate quality) Supported discharge team versus Usual care – Significantly shorter in Supported discharge team group^* (moderate quality)	Quantitative Flikweerk 2014 Parsons 2019 Qualitative Braaf 2018 Christensen 2018 Christiaens 2015 Lindahl 2013 Slomic 2017 Stolee 2019
Having a case manager or coordinator ensures continuity and provides a point of contact for patients’ enquiries. (high quality)	The traumatic clinical care coordination and the extended care practitioner plus telephone calls included a healthcare professional that coordinated care during discharge as well as post-discharge follow-ups and home visits. Patient satisfaction Extended care practitioner + telephone calls versus Standard outpatient care - Patient satisfaction survey at 6 months – No clinically important difference between groups (very low quality) - Patient satisfaction survey at 12 months – No clinically important difference between groups (very low quality) Length of hospital stay Traumatic Clinical Care Coordination versus No Traumatic Clinical Care Coordination – Clinically importantly longer in Traumatic Clinical Care Coordination group (low quality) Overall quality of life Extended care practitioner + telephone calls versus Standard outpatient care - SF-12 physical component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 physical component score at 12 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 12 months – No clinically important difference between groups (very low quality) Change in ADL Extended care practitioner + telephone calls versus Standard outpatient care - GAS at 6 months – No clinically important difference between groups (low quality) - GAS at 12 months – No clinically important difference between groups (very low quality)	Quantitative Hall 2018 Wiechman 2015 Qualitative Braaf 2018 Christiaens 2015 Kennedy 2012
Consistency in the information provided by the different parts of the multidisciplinary team can a build trust between the patients and the team. (moderate quality)	Within the extended care practioner plus telephone calls intervention, the extended care practitioner communication with the multidisciplinary team regulary about progress and concerns. The extended care practitioner then relayed this information to the patient, their families and carers. Patient satisfaction Extended care practitioner + telephone calls versus Standard outpatient care - Patient satisfaction survey at 6 months – No clinically important difference between groups (very low quality) - Patient satisfaction survey at 12 months – No clinically important difference between groups (very low quality) Overall quality of life Extended care practitioner + telephone calls versus Standard outpatient care - SF-12 physical component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 physical component score at 12 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 12 months – No clinically important difference between groups (very low quality) Change in ADL Extended care practitioner + telephone calls versus Standard outpatient care - GAS at 6 months – No clinically important difference between groups (low quality) - GAS at 12 months – No clinically important difference between groups (very low quality)	Quantitative Wiechman 2015 Qualitative Barclay 2019 Braaf 2018 Jeyaraj 2013
3 Delivery
A single point of contact for information, support, and for the coordination of plans is helpful for patients as they transfer from inpatient to outpatient rehabilitation settings. (high quality)	Traumatic Clinical Care Coordination, the discharge planning with a gerontological nurse intervention and extended care practitioner intervention all had a central healthcare professional for patients to contact and help coordinate rehabilitation. Patient satisfaction Extended care practitioner + telephone calls versus Standard outpatient care - Patient satisfaction survey at 6 months – No clinically important difference between groups (very low quality) - Patient satisfaction survey at 12 months – No clinically important difference between groups (very low quality) Length of hospital stay Traumatic Clinical Care Coordination versus No Traumatic Clinical Care Coordination – Clinically importantly longer in Traumatic Clinical Care Coordination group (low quality) Discharge planning versus Routine care at 3 months – Clincally importantly shorter in discharge planning group (low quality) Overall quality of life Discharge planning versus Routine care - SF-36 at discharge – Clinically importantly higher in discharge planning group (low quality) - SF-36 at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - SF-36 at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Extended care practitioner + telephone calls versus Standard outpatient care - SF-12 physical component score at 6 months - No clinically important difference between groups (very low quality) - SF-12 physical component score at 12 months - No clinically important difference between groups (very low quality) - SF-12 mental component score at 6 months - No clinically important difference between groups (very low quality) - SF-12 mental component score at 12 months - No clinically important difference between groups (very low quality) Changes in ADL Discharge planning versus Routine care - Barthel Index at discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Extended care practitioner + telephone calls versus Standard outpatient care - GAS at 6 months – No clinically important difference between groups (low quality) - GAS at 12 months – No clinically important difference between groups (very low quality)	Quantitative Hall 2018 Huang 2005 Wiechman 2015 Qualitative Braaf 2018 Christensen 2018 Graff 2018 Kennedy 2012 Turner 2011
Peer mentors with lived experience in the delivery of rehabilitation services can support patients, offer encouragement and answer questions. (very low quality)	Patients involved in multidisciplinary outpatient treatment internvention shared their experiences at group sessions. Return to work or education Multidisciplinary outpatient treatment versus Usual care by GP - Number of participants returning to work at 12 months post-injury – No clinically important difference between groups (very low quality) Changes in ADL Multidisciplinary outpatient treatment versus Usual care by GP - Glasgow Outcome Scale at 12 months post-injury – No clinically important difference between groups (very low quality)	Quantitative Vikane 2017 Qualitative Barclay 2019
4 Information
Transitions can be smoothed by increasing information available. Patients need to know about the arrangements that have been made for them and their ongoing treatment plan, or what they will need to arrange themselves. This information is empowering and improves treatment adherence. (high quality)	Both discharge planning interventions, extended care coordinator intervention, and the Traumatic Clinical Care Coordination intervention made sharing information with patients and family a key area to focus on. Patient satisfaction Comprehensive discharge planning versus Routine discharge planning - Patient satisfaction questionnaire – No clinically important difference between groups (very low quality) Extended care practitioner + telephone calls versus Standard outpatient care - Patient satisfaction survey at 6 months – No clinically important difference between groups (very low quality) - Patient satisfaction survey at 12 months – No clinically important difference between groups (very low quality) Length of hospital stay Traumatic Clinical Care Coordination versus No Traumatic Clinical Care Coordination – Clinically importantly longer in Traumatic Clinical Care Coordination group (low quality) Discharge planning versus Routine care at 3 months – Clinically importantly shorter in discharge planning group (low quality) Comprehensive discharge planning versus Routine discharge planning - At 3 months – No clinically important difference between groups (very low quality) Overall quality of life Discharge planning versus Routine care - SF-36 at discharge – Clinically importantly higher in discharge planning group (low quality) - SF-36 at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - SF-36 at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Extended care practitioner + telephone calls versus Standard outpatient care - SF-12 physical component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 physical component score at 12 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 12 months – No clinically important difference between groups (very low quality) Changes in ADL Discharge planning versus Routine care - Barthel Index at discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Comprehensive discharge planning versus Routine discharge planning - Functional Status Subscale before discharge – No clinically important difference between groups (very low quality) - Functional Status Subscale at 2 weeks post-discharge – No clinically important difference between groups (very low quality) - Functional Status Subscale at 3 months post-discharge – No clinically important difference between groups (very low quality) Extended care practitioner + telephone calls versus Standard outpatient care - GAS at 6 months – No clinically important difference between groups (low quality) - GAS at 12 months – No clinically important difference between groups (very low quality)	Quantitative Hall 2018 Huang 2005 Lin 2009 Wiechman 2015 Qualitative Braaf 2018 Christiaens 2015 Graff 2018 Kornhaber 2019 O’Callaghan 2012 Stolee 2019 Turner 2011
Information should be presented in plain, accessible language. Written information can help rehabilitation patients to understand and retain information. (very low quality)	The discharge planning intervention included hard copies of rehabilitation plans, goals and any concerns given to patient and carers prior to discharge. Length of hospital stay Discharge planning versus Routine care at 3 months – Clinically importantly shorter in discharge planning group (low quality) Overall quality of life Discharge planning versus Routine care - SF-36 at discharge – Clinically importantly higher in discharge planning group (low quality) - SF-36 at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - SF-36 at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Changes in ADL Discharge planning versus Routine care - Barthel Index at discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality)	Quantitative Huang 2005 Qualitative Braaf 2018
5 Individual factors
Rehabilitation should be delivered in a way that is adaptable to the circumstances and needs of individuals. Rehabilitation should take into account needs related to age, working patterns, and symptoms or comorbidities such as chronic pain, or disabilities which may limit mobility. (low quality)	The multidisciplinary care pathway, tramatic clinical care coordination, discharge planning with a gerontological nurse, comprehensive discharge planning, supported discharge team care, multidisciplinary post-operative rehabilitation and multidisciplinary outpatient treatment interventions stressed the important of personalising the rehabilitation pathway for patients, rather than a standard ‘one-size-fits-all’ approach. Patient satisfaction Comprehensive discharge planning versus Routine discharge planning - Patient satisfaction questionnaire – No clinically important difference between groups (very low quality) Length of hospital stay Multidisciplinary care pathway versus Standard care – Significantly shorter in multidisciplinary care pathway group^* (moderate quality) Traumatic Clinical Care Coordination versus No Traumatic Clinical Care Coordination – Clinically importantly longer in Traumatic Clinical Care Coordination group (low quality) Discharge planning versus Routine care - At 3 months – Clinically importantly shorter in discharge planning group (low quality) Comprehensive discharge planning versus Routine discharge planning - At 3 months – No clinically important difference between groups (very low quality) Supported discharge team versus Usual care – Significantly shorter in Supported discharge team group^* (moderate quality) Return to work or education Multidisciplinary outpatient treatment versus Usual care by GP - Number of participants returning to work at 12 months post-injury – No clinically important difference between groups (very low quality) Overall quality of life Discharge planning versus Routine care - SF-36 at discharge – Clinically importantly higher in discharge planning group (low quality) - SF-36 at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - SF-36 at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Changes in ADL Discharge planning versus Routine care - Barthel Index at discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Comprehensive discharge planning versus Routine discharge planning - Functional Status Subscale before discharge – No clinically important difference between groups (very low quality) - Functional Status Subscale at 2 weeks post-discharge – No clinically important difference between groups (very low quality) - Functional Status Subscale at 3 months post-discharge – No clinically important difference between groups (very low quality) MDT post-operative rehabilitation versus Conventional post-operative rehabilitation - Number of participants achieving Independence in P-ADL at each time point at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Independence in P-ADL at each time point at 12 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade A at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade B at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade C at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade D at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade E at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade F at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade G at 12 month post-operative follow-up – Clinically importantly lower in MDT post-operative rehabilitation group (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 12 months post-operative follow-up – Clinically importantly higher in MDT post-operative rehabilitation group (very low quality) Multidisciplinary outpatient treatment versus Usual care by GP - Glasgow Outcome Scale at 12 months post-injury – No clinically important difference between groups (very low quality)	Quantitative Flikweerk 2014 Hall 2018 Huang 2005 Lin 2009 Parsons 2019 Stenvall 2007 Vikane 2017 Qualitative Graff 2018 Jeyaraj 2013 Kornhaber 2019 Lindahl 2013 Sena Martins 2017 Stolee 2019
Some adults with rehabilitation needs require physical aids and small adjustments in their home to aid discharge process and rehabilitation progress. (low quality)	The discharge planning intervention and MDT post-operative rehabilitation both involved home visits, where minor home adjustments could be made. Length of hospital stay Discharge planning versus Routine care at 3 months – Clinically importantly shorter in discharge planning group (low quality) Overall quality of life Discharge planning versus Routine care - SF-36 at discharge – Clinically importantly higher in discharge planning group (low quality) - SF-36 at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - SF-36 at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Changes in ADL Discharge planning versus Routine care - Barthel Index at discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) MDT post-operative rehabilitation versus Conventional post-operative rehabilitation - Number of participants achieving Independence in P-ADL at each time point at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Independence in P-ADL at each time point at 12 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade A at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade B at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade C at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade D at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade E at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade F at 12 month post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants achieving Katz ADL Grade G at 12 month post-operative follow-up – Clinically importantly lower in MDT post-operative rehabilitation group (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 4 months post-operative follow-up – No clinically important difference between groups (very low quality) - Number of participants returning to at least same Katz ADL level as before trauma at 12 months post-operative follow-up – Clinically importantly higher in MDT post-operative rehabilitation group (very low quality)	Quantitative Huang 2005 Stenvall 2007 Qualitative Lindahl 2013
Some patients (and their families) may not be able to advocate for themselves as strongly as others. Healthcare workers should ensure that these vulnerable service users are properly advocated for in rehabilitation and social service situations. (high quality)	The traumatic clinical care coordination and extended care practitioner interventions involved a central healthcare professional that help to coordinate medical rehabilitation services and social care services. Patient satisfaction Extended care practitioner + telephone calls versus Standard outpatient care - Patient satisfaction survey at 6 months – No clinically important difference between groups (very low quality) - Patient satisfaction survey at 12 months – No clinically important difference between groups (very low quality) Length of hospital stay Traumatic Clinical Care Coordination versus No Traumatic Clinical Care Coordination – Clinically importantly longer in Traumatic Clinical Care Coordination group (low quality) Overall quality of life Extended care practitioner + telephone calls versus Standard outpatient care - SF-12 physical component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 physical component score at 12 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 6 months – No clinically important difference between groups (very low quality) - SF-12 mental component score at 12 months – No clinically important difference between groups (very low quality) Change in ADL Extended care practitioner + telephone calls versus Standard outpatient care - GAS at 6 months – No clinically important difference between groups (low quality) - GAS at 12 months – No clinically important difference between groups (very low quality)	Quantitative Hall 2018 Weichman 2015 Qualitative Christensen 2018 Glenny 2013 Graff 2018
6 Timing
Conversations about rehabilitation and discharge planning should start early on, allowing needs and preferences to be integrated smoothly into recovery plans. Last-minute conversations and preparations can be distressing for patients. (low quality)	The multidisciplinary care pathway and discharge planning interventions ensured that conversations surrounding discharge were initiated early on. Length of hospital stay Multidisciplinary care pathway versus Standard care – Significantly shorter in multidisciplinary care pathway group^* (moderate quality) Discharge planning versus Routine care at 3 months – Clinically importantly shorter in discharge planning group (low quality) Overall quality of life Discharge planning versus Routine care - SF-36 at discharge – Clinically importantly higher in discharge planning group (low quality) - SF-36 at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - SF-36 at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality) Changes in ADL Discharge planning versus Routine care - Barthel Index at discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 2 weeks post-discharge – Clinically importantly higher in discharge planning group (moderate quality) - Barthel Index at 3 months post-discharge – Clinically importantly higher in discharge planning group (moderate quality)	Quantitative Flikweerk 2014 Huang 2005 Qualitative Barclay 2019 Braaf 2018 Kennedy 2012 Kornhaber 2019 O’Callaghan 2012

: ADL: Activities of daily living; EQ-5D; Euroqol 5-Domain; EQ-VAS; Euroqol Visual Analogue Scale; GP: General practitioner; P-ADL: Phyiscal actitivies of daily living; SF-12; 12 item short form survey; SF-36: 36 item short-form survey
*: This outcome measure was reported as statistically significant according to the analysis performed by the authors. As only the median and interquartile ranges/no standard deviations were reported by the study authors, and no published minimally important difference were found, we were unable to determine clinical importance.

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Service coordination: inpatient to outpatient settings for people with complex rehabilitation needs after traumatic injury: Rehabilitation after traumatic injury: Evidence review D.2.

NICE Guideline, No. 211.

National Guideline Alliance (UK).

London: National Institute for Health and Care Excellence (NICE); 2022 Jan.

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