Guidance for community-based caregivers in assisting people with moderate to severe traumatic brain injury with transfers and manual handling: evidence and key stakeholder perspectives.

Abstract

Adults with moderate to severe traumatic brain injury (TBI) rely on assistance from paid and unpaid caregivers upon return to the community. An inability to move independently makes these adults highly dependent on caregivers for transfers and manual handling tasks. Evidence-based guidelines are therefore important to ensure that caregivers and people in the community are protected and that practices are standard and consistent. This study commenced with a rapid review of evidence-based recommendations between 2000 and 2015 pertaining to transfers and manual handling in people with TBI; and ended with a structured stakeholder dialogue that reflected upon this evidence and gathered perspectives on how to address key issues in community-based manual handling following TBI. Three relevant guidelines were identified, providing nine recommendations encompassing assessment of the person's ability to assist caregivers, manual handling and appropriate equipment use. Due to the low number of recommendations and low level of supporting evidence, these recommendations alone could not provide comprehensive guidance. Three systematic reviews and two primary studies were also identified, and these suggest that comprehensive training programmes in transfers and manual handling tasks are effective. Further to this, a structured stakeholder dialogue was conducted, which revealed six major themes - (i) comprehensive risk assessment, (ii) presence of two caregivers, (iii) provision of training, (iv) home environment modification, (v) equipment, and (vi) policy implementation context. Recommendations for health professionals include providing information packs to caregivers, risk assessment and mitigation for those at high risk, and strategies to prevent and minimise injury in caregivers. Development of comprehensive guidance for caregivers in transfers and manual handling in people with moderate to severe TBI living in the community is a hidden but important priority.