A Systematic Review of the Effects of Community Transition Programs on Quality of Life and Hospital Readmissions for Adults With Traumatic Spinal Cord Injury

Abstract

Objective: To investigate the effects of community transition programs for adults with traumatic spinal cord injury (tSCI) on hospital readmissions and quality of life (QOL).

Data sources: Seven databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, the Joanna Briggs Institute database, OTseeker, and PEDro) and reference lists of relevant articles were searched from inception through March 2020.

Study selection: Original research studies were included that (1) evaluated interventions designed to support individuals aged 18-65 years with newly acquired tSCI in navigating the transition from subacute care to the community and (2) reported data for QOL or hospital readmission outcomes. Searches identified 4694 studies, and 26 of these met the selection criteria.

Data extraction: Two reviewers independently screened and assessed all studies, extracting information about study type, methodological strengths and weaknesses, participant and intervention characteristics, comparator, and significant results. Any discrepancies were resolved by a third reviewer.

Data synthesis: Studies were grouped according to primary intervention: peer mentoring (n=8), telehealth (n=5), education (n=5), independent living (n=3), occupational therapy (n=1), counseling (n=1), and patient navigation (n=4). Reviewers used the Let Evidence Guide Every Decision appraisal tool rubric to grade the body of evidence for each intervention type. Moderate level evidence supports the positive effects of peer mentoring, and low level evidence indicates positive effects of telehealth, education, independent living, and occupational therapy interventions. Peer mentoring, telehealth, and patient navigation were the only intervention types that included hospital readmission outcomes. Of these, peer mentoring had the most evidence, with 3 of the 4 studies that included hospital readmission outcomes demonstrating statistically significant improvements.

Conclusions: In general, there is a paucity of high-quality evidence with sufficiently similar characteristics to demonstrate and compare benefits from program participation. When high quality studies have been conducted, they have obtained mixed results. Of the different intervention types, peer mentorship has the strongest supporting evidence. Further research is needed to identify specific intervention components that are most effective in improving QOL and reducing hospital readmission for specific subgroups of individuals recovering from tSCI.

Keywords: Patient readmission; Quality of life; Rehabilitation; Spinal cord injuries; Systematic review; Transitional care.