Abstract：
BACKGROUND: Community integration (CI) is recognised as an overarching goal for the rehabilitation of individuals with acquired brain injury (ABI). However, adults with less severe ABI often experience a lack of support when they return home after discharge from hospital or inpatient rehabilitation, despite having persistent impairments and ongoing needs. Individuals living in rural areas are even less likely to receive adequate support during this period, which is often marked by challenges and uncertainty. This review aims to map and explore the research literature to identify existing models for rehabilitation service provision aimed at promoting the CI of home-dwelling adults with ABI living in rural areas.
METHODS: A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion.
RESULTS: Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level.
CONCLUSIONS: The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowledge on such issues may facilitate a wider reorganisation of care systems to enhance the CI of adults with ABI in rural areas. However, this will require more research with a wider scope than microlevel service delivery.
METHODS: A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion.
RESULTS: Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level.
CONCLUSIONS: The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowledge on such issues may facilitate a wider reorganisation of care systems to enhance the CI of adults with ABI in rural areas. However, this will require more research with a wider scope than microlevel service delivery.
摘要：
背景：社区融合（CI）被认为是获得性脑损伤（ABI）患者康复的首要目标。然而,患有不那么严重的ABI的成年人在出院或住院康复后返回家中时通常会缺乏支持，尽管有持续的损伤和持续的需求。生活在农村地区的个人在此期间获得足够支持的可能性更小，这往往是由挑战和不确定性。这篇综述旨在绘制和探索研究文献，以确定现有的康复服务提供模式，旨在促进农村地区患有ABI的居家成人的CI。
方法：对研究文献进行范围审查。该研究遵循了JoannaBriggs研究所的范围审查指南和PRISMA扩展范围审查。搜索的数据库是MEDLINE,Embase,AMED,CINAHL,WebofScience,科克伦图书馆,PsycInfo,谷歌学者。研究设计没有限制，出版时间,或原产国，但只有英语文学，丹麦语,挪威语,或瑞典语被考虑列入。
结果：共纳入27篇。所有这些都起源于四个西方国家，主要是英语国家：澳大利亚，加拿大,英国,和美国。主题分析确定了六个模型类别，这些类别反映了在农村地区ABI成年人中提供促进CI的康复的不同策略。将模型类别分类为微观(个体，人际关系)，中观(组织，社区),和宏观(政策，社会）层面强调，大多数纳入的文献都集中在个人或人际层面的微观问题上。微观模型类别包括自我管理和教育，使用导航员，并将日常生活活动纳入康复。关于农村地区服务发展或包容性农村社区发展等中观问题的文章少得多，只有一篇文章涉及宏观层面的政策制定。
结论：纳入的文章数量相对较少，研究的地理分布有限，这表明需要更多关于旨在促进农村地区成人ABI患者CI的康复模式的研究。尽管我们确定了在农村地区提供康复服务的几种现有方法，仍需要开发充分考虑ABI后CI的复杂性和长期性质的模型.结果还表明，农村地区的CI不仅依赖于针对ABI个人的专业服务提供，而且可以通过支持重要的其他人来促进。发展包容性社区，改善政策。有关此类问题的更多知识可能有助于更广泛地重组护理系统，以增强农村地区ABI成年人的CI。然而,这将需要比微观层面服务交付更广泛的研究。
方法：对研究文献进行范围审查。该研究遵循了JoannaBriggs研究所的范围审查指南和PRISMA扩展范围审查。搜索的数据库是MEDLINE,Embase,AMED,CINAHL,WebofScience,科克伦图书馆,PsycInfo,谷歌学者。研究设计没有限制，出版时间,或原产国，但只有英语文学，丹麦语,挪威语,或瑞典语被考虑列入。
结果：共纳入27篇。所有这些都起源于四个西方国家，主要是英语国家：澳大利亚，加拿大,英国,和美国。主题分析确定了六个模型类别，这些类别反映了在农村地区ABI成年人中提供促进CI的康复的不同策略。将模型类别分类为微观(个体，人际关系)，中观(组织，社区),和宏观(政策，社会）层面强调，大多数纳入的文献都集中在个人或人际层面的微观问题上。微观模型类别包括自我管理和教育，使用导航员，并将日常生活活动纳入康复。关于农村地区服务发展或包容性农村社区发展等中观问题的文章少得多，只有一篇文章涉及宏观层面的政策制定。
结论：纳入的文章数量相对较少，研究的地理分布有限，这表明需要更多关于旨在促进农村地区成人ABI患者CI的康复模式的研究。尽管我们确定了在农村地区提供康复服务的几种现有方法，仍需要开发充分考虑ABI后CI的复杂性和长期性质的模型.结果还表明，农村地区的CI不仅依赖于针对ABI个人的专业服务提供，而且可以通过支持重要的其他人来促进。发展包容性社区，改善政策。有关此类问题的更多知识可能有助于更广泛地重组护理系统，以增强农村地区ABI成年人的CI。然而,这将需要比微观层面服务交付更广泛的研究。
