The effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury: a systematic review.

BACKGROUND: Trauma is the most frequent cause of significant functional impairment that leads to the deterioration in health and often delayed functional and psychosocial recovery. Fundamentally, rehabilitation of those with traumatic injuries surpasses the acute management extending into the reintegration of patients to home life and the wider community. Consequently, rehabilitation from a traumatic injury is a multidisciplinary process that incorporates the continuum of care across different settings and organizations. Planning and maintaining effective rehabilitation across organizations and sectors is a significant challenge. Unmet rehabilitation needs can prolong discharge, limit the patient's activities, restrict participation, decrease quality of life and increase dependence on significant others.

OBJECTIVES: The objective of this systematic review was to identify and synthesize the best available evidence on the effectiveness of collaborative care models in relation to traumatic injury rehabilitation.

REVIEW QUESTION: What is the effectiveness of collaborative care models that facilitate rehabilitation from a traumatic injury?

TYPES OF PARTICIPANTS: This review considered all studies that included adult patients above 18 years of age and of either gender with a traumatic physical injury requiring rehabilitation across different settings/organizations.

TYPES OF INTERVENTIONS: Interventions of interest were models of collaborative care that facilitate those rehabilitating from a traumatic physical injury across different care types and settings. The comparator was usual care. TYPES OF STUDIES: This review aimed to identify randomized controlled trials; however, with the absence of any randomized controlled trials, other research designs were considered.

TYPES OF OUTCOME MEASURES: This review considered studies that reported on participation, functionality, quality of life, pain, psychosocial outcomes and goals.

SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies without language or publication date restrictions. A three-step search strategy was utilized in this review.

METHODOLOGICAL QUALITY: The studies were independently assessed by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute.

DATA EXTRACTION: No studies progressed to data extraction.

DATA SYNTHESIS: Data synthesis was not undertaken as no study was identified of sufficient quality.

RESULTS: This systematic review identified only one paper that met the inclusion criteria. It described the United States Veterans Affair's system of Veteran-centred, post-combat care rehabilitation programs that fundamentally relies on the collaborative care of social workers and nurses to support service members, veterans and their families proceed through the initial recovery, rehabilitation and re-integration into post-combat society and their home communities. Unfortunately, there was no formal evaluation provided that addressed the review's outcomes of interest and therefore the study was excluded.

CONCLUSIONS: This review has highlighted the lack of research concerning collaborative models of care that facilitate rehabilitation from a traumatic injury. It found insufficient data to enable any conclusions to be made about the effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury. IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH: Further research investigating viable collaborative models of care that facilitate the rehabilitation journey across different healthcare sectors is required.