CONTEXT: Transition from the pediatric to the adult health care system is a complex process that should include medical, psychosocial, educational, recreational, and vocational considerations. OBJECTIVE: In this systematic review, we aim to synthesize the evidence on transitional care interventions (TCIs) to improve the quality of life (QoL) for adolescents and young adults with childhood-onset disabilities, including neurodevelopmental disorders. DATA SOURCES: Four electronic databases (Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature) were searched. STUDY SELECTION: In the included studies, researchers examined TCIs for adolescents and young adults (12-24 years of age) with childhood-onset disabilities. Studies were experimental, quasi-experimental, and observational studies published in the last 26 years. DATA EXTRACTION: Two reviewers independently completed study screening, data extraction, and risk-of-bias assessment. RESULTS: Fifty-two studies were included. Five studies reported on QoL, but statistically significant improvements were noted in only 1 of these studies. Significant improvements were also found in secondary outcomes including disability-related knowledge and transitional readiness. TCIs targeted patients, families and/or caregivers, and health care providers and exhibited great heterogeneity in their characteristics and components. LIMITATIONS: Inconsistent reporting on interventions between studies hindered synthesis of the relationships between specific intervention characteristics and outcomes. CONCLUSIONS: Although there is limited evidence on the impact of TCIs on the QoL for youth with childhood-onset disabilities, there is indication that they can be effective in improving patient and provider outcomes. The initiation of transition-focused care at an early age may contribute to improved long-term health outcomes in this population.
BACKGROUND: People with childhood-onset disabilities face unique physical and social challenges in adulthood. Exercise interventions may improve physical performance in children, but there is a lack of research on adults. OBJECTIVE: To describe studies that investigate exercise interventions and to evaluate the quality of physical performance outcome measures for adults with childhood-onset disabilities. METHODS: Eligible studies reported on exercise interventions for adults (ages 16+) with cerebral palsy, spina bifida, or acquired brain injuries. Only randomized controlled trials published in English from 2008 to 2019 were included. MEDLINE, CINAHL, PEDro, EMBASE, and Cochrane Central Register of Controlled Trials were searched. Two reviewers independently screened studies and abstracted data. RESULTS: This scoping review included 4 trials reporting on cerebral palsy only. Three strength training programs found significant improvements in gait, and one mixed training program found significant improvements in strength and fitness. Only two outcome measures used are valid/reliable for adults (6 Minute Walk Test and Borg-20 Grades). CONCLUSION: Certain interventions may improve physical performance, but there is a lack of research on appropriate exercise interventions and physical performance outcome measures for adults with childhood-onset disabilities. Different exercise interventions should be investigated using larger sample sizes and outcome measures should be standardized.
Purpose: Traumatic brain injury (TBI) is a disabling neurological condition that can cause substantial cognitive, behavioural, and physical health problems for the individual. Currently, it is a leading cause of death for Canadians. Rehabilitation (particularly specialized rehabilitation) has been shown to promote recovery in those with moderate-to-severe TBI, but not all eligible candidates receive it. We aim to 1) investigate demographic and clinical characteristics of individuals with moderate-to-severe TBI discharged to rehabilitation within 1-year post-injury over a 7-year period, and 2) identify predictors of discharge to specialized rehabilitation for these individuals. Materials and Methods: Patient characteristics were examined by linking their unique health insurance number through databases. Predictors of specialized rehabilitation were determined using logistic regression models. Results: Of 25,095 individuals with moderate-to-severe TBI, 4,748 individuals were admitted to rehabilitation within 365 days of injury between years 2010/2011 and 2017/2018. Most individuals who were admitted to rehabilitation were 64 years old or older (60%). Majority were male (65.6%). The most common cause of injury was related to a fall (61.7%). 13.9% of individuals had a mental health condition at the time of TBI hospitalization. 72.1% were discharged directly to rehabilitation following acute discharge. Mean wait time to rehabilitation was 37.3 (±52.5) days. 7.2% were rehospitalized immediately following rehabilitation discharge. Younger age, male sex, and higher rurality were some significant predictors of receiving specialized rehabilitation. Repatriated patients were less likely to receive specialized rehabilitation. Conclusion: This study identifies key healthcare utilization characteristics of individuals with moderate-to-severe TBI, as well as significant predictors of discharge to specialized rehabilitation for this population. We also highlight potential future research areas relating to these trends. This knowledge will be useful for policy planners and administrators who wish to improve patient access to care, appropriateness of care, and outcomes following moderate-to-severe TBI.
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