Effects of a transitional care program for individuals with limbs disabilities living in a rural community: A randomized controlled trial.

Background: Transitional care (TC) has been proven to be effective in addressing fragmented care and preventing adverse outcomes for chronically ill patients transitioning from hospital to home, but the definitive description of TC that was used successfully for individuals with limbs disability has not been formed in the context of health care reform in China.

Objective: The aim of this study was to evaluate the effect of a TC program on health outcomes in individuals with limbs disability based on an original community for healthcare.

Method: It was a randomized controlled trial. Individuals in the intervention group received ongoing rehabilitation both at the specialized care center and at home through multidisciplinary team, while individuals in the control group received routine follow-up visits by primary healthcare physicians. Outcomes were measured by Short-Form Health Survey-36 (SF-36), Modified Barthel Index (MBI) and Caregiver Strain Index (CSI) at 3 and 6 months respectively.

Results: A total of 84 participants were randomly assigned (intervention n = 42, control n = 42). Mean values of Physical Components Summary, an integral component of SF-36, was significantly better in the intervention group at 3 and 6 months (42.0 ± 2.3 and 44.3 ± 1.5 respectively). The same trend was observed in MBI (72.2 ± 6.8 and 78.6 ± 9.3 at 3 and 6 months respectively). But the significant improvement in CSI was only observed at 6 months. There were significant differences between groups in these scores except Mental Components Summary.

Conclusion: The TC program has been proven to be feasible and improve health-related outcomes.