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The Transition from Hospital to Home: Protocol for a Longitudinal Study of Australian Aboriginal and Torres Strait Islander Traumatic Brain Injury (TBI)

  • India Bohanna (a1), Michelle S. Fitts (a2), Katrina Bird (a1), Jennifer Fleming (a3), John Gilroy (a4), Adrian Esterman (a5), Paul Maruff (a6) and Alan R. Clough (a7)...


Background: Traumatic brain injury (TBI) is a leading cause of disability in Australia. Evidence shows that multidisciplinary rehabilitation and support in the six months following TBI is important for successful independent living and social re-integration. Despite this, access to services and supports during this period is often limited by environmental, socio-economic, geographic and cultural factors. Australian studies on outcomes after brain injury have reported primarily on non-Indigenous people. This study will investigate key sentinel events during the transition from hospital to home after a TBI in the first longitudinal study with Indigenous Australians.

Method: Indigenous Australians admitted to one of three major trauma hospitals in northern Australia with a TBI, and their care givers, will be recruited. Clinical and brain injury risk factor information, along with measures of cognitive function, transition events, mental health and community re-integration will be collected at three time points prior to hospital discharge, and at three and six months post-discharge. Qualitative interviews will also be conducted. Data will be analysed using regression methods for the quantitative component, and situational analysis for the qualitative component. Annual rates of brain injury will be calculated for patients admitted to tertiary hospital facilities in the study region with a diagnosis of TBI.

Discussion: Understanding the experience and events which shape the transition period is critical to determining the services and supports that may enhance transition outcomes, and ensure that such services are culturally appropriate and endorsed by Indigenous families and communities.


Corresponding author

Address for correspondence: Dr India Bohanna, College of Public Health, Medical & Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia. E-mail:


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Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (2013). Guidelines for research into aboriginal health. Retrieved from
Armstrong, E., Hersh, D., Katzenellenbogen, J., Coffin, J., Thompson, S., Ciccone, N., . . . Woods, D. (2015). Study protocol: Missing voices- communication difficulties after stroke and traumatic brain injury in Aboriginal Australians. Brain Impairment, 16 (2), 145156.
Australian Bureau of Statistics (ABS). (2004). National Aboriginal and Torres Strait Islander Social Survey (NATSISS) 2002, cat. no.4714.0. Canberra, Australia: ABS. Retrieved from:
Australian Institute of Health and Welfare (2012). Hospital separations due to injury and poisoning, Australia 2009–10. Canberra, Australia: AIHW. Retrieved from
Bernabeu, M., Laxe, S., Lopez, R., Stucki, G., Ward, A., Barnes, M., . . . Zasler, N. (2009). Developing core sets for persons with traumatic brain injury based on the international classification of functioning, disability, and health. Neurorehabilitation and Neural Repair, 23 (5), 464467. doi: 10.1177/1545968308328725.
Bohanna, I., Stephens, A., Wargent, R., Catherall, J., Timms, C., Graham, D., & Clough, A. (2013). Assessment of acquired brain injury in aboriginal and torres strait Islander Australians: Guidance for DisabilityCare Australia. James Cook University. Retrieved from
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2), 77101.
Brown, A.D., Mentha, R., Rowley, K.G., Skinner, T., Davy, C., & O'Dea, K. (2013). Depression in Aboriginal men in central Australia: Adaptation of the patient health questionnaire 9. BMC Psychiatry, 13 (1), 1. doi: 10.1186/1471-244X-13-271.
Cairney, S., O'Connor, N., Dingwall, K.M., Maruff, P., Shafiq-Antonacci, R., Currie, J., & Currie, B.J. (2013). A prospective study of neurocognitive changes 15 years after chronic inhalant abuse. Addiction, 108 (6), 11071114. doi: 10.1111/add.12124.
Clarke, A.E. (2005). Situational analysis: Grounded theory after the postmodern turn. Thousand Oaks, CA: Sage.
Clough, A.R., Bailie, R., Burns, C.B., Guyula, T., Wunungmurra, R., & Wanybarrnga, S.R. (2002). Methods: Validity and utility of community health workers' estimation of kava use. Australian and New Zealand Journal of Public Health, 26 (1), 5257. doi: 10.1111/j.1467-842X.2002.tb00271.x.
Clough, A.R., Cairney, S., D'abbs, P., Parker, R., Maruff, P., Gray, D., & O'reilly, B. (2004). Measuring exposure to cannabis use and other substance use in remote aboriginal populations in Northern Australia: Evaluation of a ‘community epidemiology’ approach using proxy respondents. Addiction Research & Theory, 12 (3), 261274. doi: 10.1080/16066350410001667143.
Conneeley, A.L. (2002). Social integration following traumatic brain injury and rehabilitation. The British Journal of Occupational Therapy, 65 (8), 356362. doi: 10.1177/030802260206500802.
Council of Australian Governments (COAG). (2011). National disability strategy 2010–2020. Canberra, Australia: Commonwealth of Australia. Retrieved from
Creswell, J.W., & Plano Clark, V. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage.
Doig, E., Fleming, J., & Tooth, L. (2001). Patterns of community integration 2–5 years post-discharge from brain injury rehabilitation. Brain Injury, 15 (9), 747762. doi: 10.1080/02699050119845.
Draper, K., Ponsford, J., & Schönberger, M. (2007). Psychosocial and emotional outcomes 10 years following traumatic brain injury. The Journal of head trauma rehabilitation, 22 (5), 278287. doi: 10.1097/01.HTR.0000290972.63753.a7.
Fleming, J., Tooth, L., Hassell, M., & Chan, W. (1999). Prediction of community integration and vocational outcome 2–5 years after traumatic brain injury rehabilitation in Australia. Brain Injury, 13 (6), 417431. doi: 10.1080/026990599121476.
Foster, M., Fleming, J., Tilse, C., & Rosenman, L. (2000). Referral to post-acute care following traumatic brain injury (TBI) in the Australian context. Brain Injury, 14 (12), 10351045. doi: 10.1080/02699050050203531.
Gilroy, J. (2012). The participation of aboriginal people with disability in disability services in NSW, Australia. Retrieved from
Gilroy, J., Donelly, M., Colmar, S., & Parmenter, T. (2013). Conceptual framework for policy and research development with Indigenous people with disabilities. Australian Aboriginal Studies, (2), 42. Retrieved from;dn=751842945817584;res=IELIND.
Gowing, C.J., McDermott, K.M., Ward, L.M., & Martin, B.L. (2015). Ten years of trauma in the ‘top end’ of the northern territory, Australia: A retrospective analysis. International Emergency Nursing, 23 (1), 1721.
Graham, I.D., Logan, J., Harrison, M.B., Straus, S.E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26 (1), 1324. doi:10.1002/chp.47.
Harrison, J., Helps, Y., & Henley, G. (2008). Hospital separations due to traumatic brain injury, Australia 2004–05. Injury Research and Statistics Series, 45. Retrieved from
Helps, Y.L., & Harrison, J.E. (2006). Hospitalised injury of Australia's Aboriginal and torres strait Islander people: 2000–02. Australian Institute of Health and Welfare (Media and Publishing Unit). Retrieved from
Hunter, B.H., & Smith, D.E. (2002). Surveying mobile populations: Lessons from recent longitudinal surveys of Indigenous Australians. Australian Economic Review, 35 (3), 261275. Retrieved from
Jamieson, L.M., Harrison, J.E., & Berry, J.G. (2008). Hospitalisation for head injury due to assault among Indigenous and non-Indigenous Australians, July 1999–June 2005. Medical Journal of Australia, 188 (10), 576. Retrieved from
Katzenellenbogen, J., Atkins, E., Thompson, S., Hersh, D., Coffin, J., Flicker, L., . . . Armstrong, E. (2016). Missing voices: Profile and extent of acquired communication disorders in aboriginal and non-aboriginal adult stroke survivors in western australia using linked administrative records. International Journal of Stroke, 11 (1), 103116. doi:10.1177/1747493015607521
Kowal, E., Gunthorpe, W., & Bailie, R.S. (2007). Measuring emotional and social wellbeing in aboriginal and torres strait Islander populations: An analysis of a negative life events scale. International Journal for Equity in Health, 6 (18). doi:10.1186/1475-9276-6-18.
Kripalani, S., Jackson, A.T., Schnipper, J.L., & Coleman, E.A. (2007). Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists. Journal of Hospital Medicine, 2 (5), 314323. doi: 10.1002/jhm.228.
Lee, K.K., Conigrave, K.M., Clough, A.R., Dobbins, T.A., Jaragba, M.J., & Patton, G.C. (2009). Five-year longitudinal study of cannabis users in three remote Aboriginal communities in Arnhem Land, Northern Territory, Australia. Drug and Alcohol Review, 28 (6), 623630. doi: 10.1111/j.1465-3362.2009.00067.x.
Maruff, P., Thomas, E., Cysique, L., Brew, B., Collie, A., Snyder, P., & Pietrzak, R.H. (2009). Validity of the CogState brief battery: Relationship to standardized tests and sensitivity to cognitive impairment in mild traumatic brain injury, schizophrenia, and AIDS dementia complex. Archives of Clinical Neuropsychology, 24 (2), 165178. doi:
Nalder, E., Fleming, J., Cornwell, P., & Foster, M. (2012a). Linked lives: The experiences of family caregivers during the transition from hospital to home following traumatic brain injury. Brain Impairment, 13 (1), 108. Retrieved from;dn=830759265286196;res=IELHEA.
Nalder, E., Fleming, J., Cornwell, P., Foster, M., & Haines, T. (2012b). Factors associated with the occurrence of sentinel events during transition from hospital to home for individuals with traumatic brain injury. Journal of Rehabilitation Medicine, 44 (10), 837844. doi:
Nalder, E., Fleming, J., Cornwell, P., Foster, M., Ownsworth, T., Shields, C., & Haines, T. (2012c). Recording sentinel events in the life course of individuals with acquired brain injury: A preliminary study. Brain Injury, 26 (11), 13811396. doi:
Nalder, E., Fleming, J., Cornwell, P., Shields, C., & Foster, M. (2013). Reflections on life: Experiences of individuals with brain injury during the transition from hospital to home. Brain Injury, 27 (11), 12941303. doi:
National Disability Insurance Scheme Act (2013). (Cth) (Austl.). Retrieved from
Pointer, S. (2016). Hospitalised injury in Aboriginal and Torres Strait Islander children and young people 2011–13. In Injury research and statistics series no. 96. Canberra: AIHW. Retrieved from
Productivity Commission. (2011). Disability Care and Support, Report no. 54. Canberra, Australia: Commonwealth of Australia. Retrieved from:
Rabe-Hesketh, S., Skrondal, A., & Pickles, A. (2004). Generalized multilevel structural equation modeling. Psychometrika, 69, 167190. doi:10.1007/BF02295939.
Shores, E.A., Marosszeky, J.E., Sandanam, J., & Batchelor, J. (1986). Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. Medical Journal of Australia, 144 (11), 569572. Retrieved from
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166 (10), 10921097. doi:10.1001/archinte.166.10.1092.
Tate, R.L., Harris, R.D., Cameron, I.D., Myles, B.M., Winstanley, J.B., Hodgkinson, A.E., . . . Harradine, P.G. (2006). Recovery of impairments after severe traumatic brain injury: Findings from a prospective, multicentre study. Brain Impairment, 7 (1), 115. doi:
The National Health and Medical Research Council, the Australian Research Council and the Australian Vice-Chancellors’ Committee (2015). National statement on ethical conduct in human research 2007. Canberra: Commonwealth of Australia. Retrieved from
Turner, B., Fleming, J., Cornwell, P., Haines, T., & Ownsworth, T. (2009a). Profiling early outcomes during the transition from hospital to home after brain injury. Brain Injury, 23 (1), 5160. doi:
Turner, B., Ownsworth, T., Cornwell, P., & Fleming, J. (2009b). Reengagement in meaningful occupations during the transition from hospital to home for people with acquired brain injury and their family caregivers. American Journal of Occupational Therapy, 63 (5), 609620. doi:10.5014/ajot.63.5.609.
Turner-Stokes, L., Disler, P., Nair, A., & Wade, D. (2005). Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database of Systematic Reviews (3). doi: 10.1002/14651858.CD004170.pub2.


The Transition from Hospital to Home: Protocol for a Longitudinal Study of Australian Aboriginal and Torres Strait Islander Traumatic Brain Injury (TBI)

  • India Bohanna (a1), Michelle S. Fitts (a2), Katrina Bird (a1), Jennifer Fleming (a3), John Gilroy (a4), Adrian Esterman (a5), Paul Maruff (a6) and Alan R. Clough (a7)...


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