Background: Effective nursing interventions for caring for patients with moderate to severe traumatic brain injury are still challenging during a transition from hospital to home. Since traumatic brain injury has deep-rooted sequelae, patients and their caregivers require better arrangement and information on the condition to achieve improved outcomes after discharge.
Objective: This study aimed to assess transitional care programs to improve outcomes of patients with traumatic brain injury and their caregivers.
Methods: A systematic review and meta-analysis were performed on studies retrieved from ProQuest, PubMed, Science Direct, CINAHL, and Google Scholar from January 2010 to July 2021. RevMan 5.4.1 software was used for meta-analysis.
Results: Nine studies were systematically selected from 1,137 studies. The standard approaches of interventions used in patients with traumatic brain injury and their caregivers were education, mentored problem-solving, home-and community-based rehabilitation, counseling, skill-building, and psychological support. We observed that there was significant evidence indicating beneficial effects of intervention in increasing the physical functioning of patients with traumatic brain injury (SMD = -0.44, 95% CI -0.60 to -0.28, p <0.001), reducing the psychological symptoms among caregivers (SMD = -0.42, 95% CI -0.59 to -0.24, p <0.001), and increasing the satisfaction (SMD = -0.35, 95% CI -0.60 to -0.11, p = 0.005).
Conclusion: Education, skill-building, and psychological support should be the main components in transitional care nursing programs for patients with traumatic brain injury and their caregivers.
Copyright (c) 2021 Amelia Ganefianty, Praneed Songwathana, Kittikorn Nilmanat
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Article MetricsAbstract views: 904 | PDF views: 720
Alghnam, S., AlSayyari, A., Albabtain, I., Aldebasi, B., & Alkelya, M. (2017). Long-term disabilities after traumatic head injury (THI): A retrospective analysis from a large level-I trauma center in Saudi Arabia. Injury Epidemiology, 4(1), 1-8. https://doi.org/10.1186/s40621-017-0126-7
Altman, I. M., Swick, S., Parrot, D., & Malec, J. F. (2010). Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged. Archives of Physical Medicine and Rehabilitation, 91(11), 1697-1704. https://doi.org/10.1016/j.apmr.2010.08.001
Arango-Lasprilla, J. C., Quijano, M. C., Aponte, M., Cuervo, M. T., Nicholls, E., Rogers, H. L., & Kreutzer, J. (2010). Family needs in caregivers of individuals with traumatic brain injury from Colombia, South America. Brain Injury, 24(7-8), 1017-1026. https://doi.org/10.3109/02699052.2010.490516
Blennow, K., Brody, D. L., Kochanek, P. M., Levin, H., McKee, A., Ribbers, G. M., . . . Zetterberg, H. (2016). Traumatic brain injuries. Nature Reviews Disease Primers, 2(1), 1-19. https://doi.org/10.1038/nrdp.2016.84
Brito, A., Costantini, T. W., Berndtson, A. E., Smith, A., Doucet, J. J., & Godat, L. N. (2019). Readmissions after acute hospitalization for traumatic brain injury. Journal of Surgical Research, 244, 332-337. https://doi.org/10.1016/j.jss.2019.06.071
Bushnik, T., Kreutzer, J. S., Marwitz, J. H., Sima, A. P., & Godwin, E. E. (2015). Efficacy of the brain injury family intervention: Impact on family members. Journal of Head Trauma Rehabilitation, 30(4), 249-260. https://doi.org/10.1097/HTR.0000000000000144
Caplan, B., Bogner, J., Brenner, L., Powell, J. M., Fraser, R., Brockway, J. A., . . . Bell, K. R. (2016). A telehealth approach to caregiver self-management following traumatic brain injury: A randomized controlled trial. Journal of Head Trauma Rehabilitation, 31(3), 180-190. https://doi.org/10.1097/HTR.0000000000000167
Caro, D. (2011). Towards sustainable traumatic brain injury care systems: Healthcare leadership imperatives in Canada. Healthcare Management Forum, 24(1), 25-30. https://doi.org/10.1016/j.hcmf.2010.10.002
Chen, Y., Tan, Y. J., Sun, Y., Chua, C. Z., Yoo, J. K. S., Wong, S. H., . . . Phan, P. (2020). A pragmatic randomized controlled trial of a cardiac hospital-to-home transitional care program in a Singapore academic medical center. Journal of Patient Safety and Risk Management, 25(2), 55-66. https://doi.org/10.1177%2F2516043520914196
Coffey, A., Mulcahy, H., Savage, E., Fitzgerald, S., Bradley, C., Benefield, L., & Leahy‐Warren, P. (2017). Transitional care interventions: Relevance for nursing in the community. Public Health Nursing, 34(5), 454-460. https://doi.org/10.1111/phn.12324
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159. https://doi.org/10.1037/0033-2909.112.1.155
Dewan, M. C., Rattani, A., Gupta, S., Baticulon, R. E., Hung, Y.-C., Punchak, M., . . . Rubiano, A. M. (2019). Estimating the global incidence of traumatic brain injury. Journal of Neurosurgery, 130(4), 1080-1097. https://doi.org/10.3171/2017.10.JNS17352
Fann, J. R., Bombardier, C. H., Temkin, N., Esselman, P., Warms, C., Barber, J., & Dikmen, S. (2017). Sertraline for major depression during the year following traumatic brain injury: A randomized controlled trial. The Journal of Head Trauma Rehabilitation, 32(5), 332. https://dx.doi.org/10.1097%2FHTR.0000000000000322
Gaines-Dillard, N. (2015). Nurse led telephone follow-up improves satisfaction in motorcycle trauma patients. Journal of Trauma Nursing, 22(2), 71-77. https://doi.org/10.1097/JTN.0000000000000110
Gupta, S., Khajanchi, M., Kumar, V., Raykar, N. P., Alkire, B. C., Roy, N., & Park, K. B. (2020). Third delay in traumatic brain injury: Time to management as a predictor of mortality. Journal of Neurosurgery, 132(1), 289-295. https://doi.org/10.3171/2018.8.JNS182182
Hart, T., Benn, E. K. T., Bagiella, E., Arenth, P., Dikmen, S., Hesdorffer, D. C., . . . Zafonte, R. (2014). Early trajectory of psychiatric symptoms after traumatic brain injury: Relationship to patient and injury characteristics. Journal of Neurotrauma, 31(7), 610-617. https://doi.org/10.1089/neu.2013.3041
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557-560. https://doi.org/10.1136/bmj.327.7414.557
Iaccarino, C., Carretta, A., Nicolosi, F., & Morselli, C. (2018). Epidemiology of severe traumatic brain injury. Journal of Neurosurgical Sciences, 62(5), 535-541.
Imanigoghary, Z., Peyrovi, H., Nouhi, E., & Kazemi, M. (2017). The role of nurses in coping process of family caregivers of vegetative patients: A qualitative study. International Journal of Community based Nursing and Midwifery, 5(1), 70-81.
Iverson, G. L. (2010). Clinical and methodological challenges with assessing mild traumatic brain injury in the military. The Journal of Head Trauma Rehabilitation, 25(5), 313-319. https://doi.org/10.1097/HTR.0b013e3181d6f9bd
Joanna Briggs Institute (JBI). (2020). Critical appraisal tools: Checklist for randomized controlled trials. Retrieved from https://jbi.global/critical-appraisal-tools
Kelly, A., Ponsford, J., & Couchman, G. (2013). Impact of a family-focused intervention on self-concept after acquired brain injury. Neuropsychological Rehabilitation, 23(4), 563-579. https://doi.org/10.1080/09602011.2013.795903
Kreutzer, J. S., Marwitz, J. H., Sima, A. P., Mills, A., Hsu, N. H., & Lukow, H. R. (2018). Efficacy of the resilience and adjustment intervention after traumatic brain injury: A randomized controlled trial. Brain Injury, 32(8), 963-971. https://doi.org/10.1080/02699052.2018.1468577
Lefebvre, H., & Levert, M.-J. (2012). The close relatives of people who have had a traumatic brain injury and their special needs. Brain Injury, 26(9), 1084-1097. https://doi.org/10.3109/02699052.2012.666364
Manskow, U. S., Friborg, O., Røe, C., Braine, M., Damsgard, E., & Anke, A. (2017). Patterns of change and stability in caregiver burden and life satisfaction from 1 to 2 years after severe traumatic brain injury: A Norwegian longitudinal study. NeuroRehabilitation, 40(2), 211-222. https://doi.org/10.3233/NRE-161406
McAllister, S., Ganefianty, A., Faried, A., Sutiono, A. B., Sarjono, K., Melia, R., . . . Derrett, S. (2018). The Bandung neurosurgery patient outcomes project, Indonesia (Part I): Methods, participant characteristics, and pre‐discharge outcomes. The International Journal of Health Planning and Management, 33(1), e57-e66. https://doi.org/10.1002/hpm.2408
Meleis, A. I. (2010). Transitions theory: Middle range and situation specific theories in nursing research and practice. New York: Springer Publishing Company.
Mitchell, S. E., Laurens, V., Weigel, G. M., Hirschman, K. B., Scott, A. M., Nguyen, H. Q., . . . Davis, T. C. (2018). Care transitions from patient and caregiver perspectives. The Annals of Family Medicine, 16(3), 225-231. https://doi.org/10.1370/afm.2222
Moriarty, H., Winter, L., Robinson, K., Piersol, C. V., Vause-Earland, T., Iacovone, D. B., . . . Hodgson, N. (2016). A randomized controlled trial to evaluate the veterans' in-home program for military veterans with traumatic brain injury and their families: Report on impact for family members. PM&R, 8(6), 495-509. https://doi.org/10.1016/j.pmrj.2015.10.008
Naylor, M. D., Aiken, L. H., Kurtzman, E. T., Olds, D. M., & Hirschman, K. B. (2011). The importance of transitional care in achieving health reform. Health Affairs, 30(4), 746-754. https://doi.org/10.1377/hlthaff.2011.0041
Oyesanya, T. O., Arulselvam, K., Thompson, N., Norelli, J., & Seel, R. T. (2021). Health, wellness, and safety concerns of persons with moderate-to-severe traumatic brain injury and their family caregivers: A qualitative content analysis. Disability and Rehabilitation, 43(5), 685-695. https://doi.org/10.1080/09638288.2019.1638456
Oyesanya, T. O., Brown, R. L., & Turkstra, L. S. (2017). Caring for Patients with traumatic brain injury: A survey of nurses' perceptions. Journal of Clinical Nursing, 26(11-12), 1562-1574. https://doi.org/10.1111/jocn.13457
Pavlovic, D., Pekic, S., Stojanovic, M., & Popovic, V. (2019). Traumatic brain injury: Neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary, 22(3), 270-282. https://doi.org/10.1007/s11102-019-00957-9
Roozenbeek, B., Maas, A. I. R., & Menon, D. K. (2013). Changing patterns in the epidemiology of traumatic brain injury. Nature Reviews Neurology, 9(4), 231-236. https://doi.org/10.1038/nrneurol.2013.22
Schmidt, F. L., Oh, I. S., & Hayes, T. L. (2009). Fixed- versus random-effects models in meta-analysis: Model properties and an empirical comparison of differences in results. The British Journal of Mathematical and Statistical Psychology, 62(Pt 1), 97-128. https://doi.org/10.1348/000711007x255327
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., . . . Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 349, g7647. https://doi.org/10.1136/bmj.g7647
Sutiono, A. B., Faried, A., McAllister, S., Ganefianty, A., Sarjono, K., Arifin, M. Z., & Derrett, S. (2018). The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow‐up. The International Journal of Health Planning and Management, 33(1), e49-e56. https://doi.org/10.1002/hpm.2406
Trexler, L. E., Trexler, L. C., Malec, J. F., Klyce, D., & Parrott, D. (2010). Prospective randomized controlled trial of resource facilitation on community participation and vocational outcome following brain injury. The Journal of Head Trauma Rehabilitation, 25(6), 440-446. https://doi.org/10.1097/HTR.0b013e3181d41139
Turner, B., Fleming, J., Parry, J., Vromans, M., Cornwell, P., Gordon, C., & Ownsworth, T. (2010). Caregivers of adults with traumatic brain injury: The emotional impact of transition from hospital to home. Brain Impairment, 11(3), 281-292. https://doi.org/10.1375/brim.11.3.281
Turner, B. J., Fleming, J. M., Ownsworth, T. L., & Cornwell, P. L. (2008). The transition from hospital to home for individuals with acquired brain injury: A literature review and research recommendations. Disability and Rehabilitation, 30(16), 1153-1176. https://doi.org/10.1080/09638280701532854
Winter, L., Moriarty, H. J., Robinson, K., Piersol, C. V., Vause-Earland, T., Newhart, B., . . . Gitlin, L. N. (2016). Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial. Brain Injury, 30(4), 373-387. https://doi.org/10.3109/02699052.2016.1144080