A Systematic Review of Hospital-to-School Reintegration Interventions for Children and Youth with Acquired Brain Injury

ObjectivesWe reviewed the literature on interventions that aimed to improve hospital-to-school reintegration for children and youth with acquired brain injury (ABI). ABI is the leading cause of disability among children and youth. A successful hospital-to-school reintegration process is essential to the rehabilitative process. However, little is known about the effective components of of such interventions.Methods and findingsOur research team conducted a systematic review, completing comprehensive searches of seven databases and selected reference lists for relevant articles published in a peer-reviewed journal between 1989 and June 2014. We selected articles for inclusion that report on studies involving: a clinical population with ABI; sample had an average age of 20 years or younger; an intentional structured intervention affecting hospital-to-school transitions or related components; an experimental design; and a statistically evaluated health outcome. Two independent reviewers applied our inclusion criteria, extracted data, and rated study quality. A meta-analysis was not feasible due to the heterogeneity of the studies reported. Of the 6933 articles identified in our initial search, 17 articles (reporting on 350 preadolescents and adolescents, aged 4–19, (average age 11.5 years, SD: 2.21) met our inclusion criteria. They reported on interventions varying in number of sessions (one to 119) and session length (20 minutes to 4 hours). The majority of interventions involved multiple one-to-one sessions conducted by a trained clinician or educator, homework activities, and parental involvement. The interventions were delivered through different settings and media, including hospitals, schools, and online. Although outcomes varied (with effect sizes ranging from small to large), 14 of the articles reported at least one significant improvement in cognitive, social, psychological, or behavioral functioning or knowledge of ABI.ConclusionsCognitive, behavioral, and problem-solving interventions have the potential to improve school reintegration for youth with ABI. However, more comprehensive interventions are needed to help link rehabilitation clinicians, educators, adolescents, and families.

【研究目的】本研究针对旨在改善获得性脑损伤（acquired brain injury, ABI）患儿及青少年的医院-学校复学衔接效果的干预措施开展文献综述。获得性脑损伤是儿童及青少年群体致残的首要病因，成功的医院-学校复学衔接流程对康复进程至关重要，但目前学界对该类干预措施的有效构成要素仍知之甚少。
【研究方法与结果】本研究团队开展了一项系统综述，对1989年至2014年6月期间发表于同行评议期刊的相关文献，通过全面检索7个数据库及筛选参考文献列表完成文献搜集。纳入标准如下：研究对象为获得性脑损伤临床人群；样本平均年龄不超过20岁；实施了针对医院-学校过渡环节或相关要素的结构化干预；采用实验设计；并对健康结局进行了统计学评估。由两名独立研究者严格执行纳入标准筛选、数据提取及研究质量评级。由于纳入研究存在异质性，无法开展元分析。初始检索共识别出6933篇文献，最终有17篇文献（涉及350名青春期前儿童与青少年，年龄4~19岁，平均年龄11.5岁，标准差(SD)=2.21）符合纳入标准。上述文献所报道的干预措施在干预次数（1~119次）及单次疗程时长（20分钟至4小时）方面均存在差异。大部分干预措施包含由经过培训的临床医师或教育者开展的多次一对一疗程、家庭作业活动及家长参与环节。干预实施的场景与媒介多样，涵盖医院、学校及线上平台。尽管干预结局存在差异（效应量范围从微小到显著），其中14篇文献均报告了至少一项认知、社交、心理或行为功能，或获得性脑损伤相关知识的显著改善。
【研究结论】认知、行为及问题解决类干预措施有望改善获得性脑损伤青少年的学校复学效果。但目前仍需开发更具系统性的综合干预方案，以搭建康复临床医师、教育者、青少年及家庭之间的沟通衔接桥梁。