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Identifying Factors Associated With Perceived Success in the Transition From Hospital to Home After Brain Injury

Nalder, Emily BOccThy (Hons); Fleming, Jennifer PhD; Foster, Michele PhD; Cornwell, Petrea PhD; Shields, Cassandra BPsych (Hons); Khan, Asad PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2012 - Volume 27 - Issue 2 - p 143–153
doi: 10.1097/HTR.0b013e3182168fb1
Focus on Clinical Research and Practice, Part 1

Objective: To identify the factors associated with perceived success of the transition from hospital to home after traumatic brain injury (TBI).

Design: Prospective longitudinal cohort design with data collection at discharge and 1, 3, and 6 months postdischarge.

Participants: A total of 127 individuals with TBI discharged to the community and 83 significant others.

Main Measures: An analog scale (0–100) of perceived success of the transition from hospital to home rated by individuals and significant others; Sentinel Events Questionnaire; EuroQol Group Quality-of-Life measure visual analog scale; Sydney Psychosocial Reintegration Scale; Mayo-Portland Adaptability Inventory-4; short form of the Depression, Anxiety, Stress Scales; Craig Hospital Inventory of Environmental Factors; and Caregiver Strain Index.

Results: Greater perceived success of transition for individuals with a TBI was associated with higher levels of health-related quality of life, level of community integration, and more severe injury. Among survivors, sentinel events such as returning to work and independent community access and changing living situation were associated with greater perceived success; financial strain and difficulty accessing therapy services were associated with less success. Among significant others, lower ratings of transition success were associated with higher significant other stress levels as well as lower levels of community integration and changes in the living situation of the individual with TBI.

Conclusion: A combination of sentinel events and personal and environmental factors influences the perceptions of individuals and their families regarding the success of the transition from hospital to home.

School of Health and Rehabilitation Sciences (Mss Nalder and Shields, and Drs Fleming and Khan) and School of Social Work and Human Services (Dr Foster), the University of Queensland, Brisbane, Australia; Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia (Ms Nalder and Dr Fleming); Centre for Functioning and Health Research, Metro South Health Service District, Brisbane, Australia (Dr Fleming); Metro North Health Service District, Queensland Health, Brisbane, Australia (Dr Cornwell); and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia (Dr Cornwell).

Corresponding Author: Emily Nalder, BOccThy (Hons), School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia 4072 (

This project was supported by an Australian Research Council Linkage Grant and partner organizations, Department of Communities (Disability Services), and Acquired Brain Injury Outreach Service. In addition, the authors thank Dr Terrence Haines, Dr Tamara Ownsworth, Professor Linda Worrall, and Dr Melissa Kendall for their contribution.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.