Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal

ABSTRACT

This review aim to provide an overview of recommendations and quality of existing clinical practice guidelines (CPGs) for the management of traumatic brain injury (TBI) from the rehabilitation perspective. Comprehensive literature search, including health databases, CPG clearinghouse/developer websites, and grey literature using Internet search engines up to September 2017. All TBI CPGs published in the last decade were selected if their scope included management of TBI, systematic methods for evidence search, clear defined recommendations, and supporting evidence for rehabilitation interventions. Three authors independently critically appraised the quality of included CPGs using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) Instrument. Four of 13 potential CPGs met the inclusion criteria. Despite variation in scope, target population, size, and guideline development processes, all four CPGs assessed were good quality (AGREE score of 5–7/7). Key rehabilitation recommendations included education, physical rehabilitation, integrated computer-based management, repetitive task-specific practice in daily living activities, safe equipment usage, cognitive/behavioral feedback, compensatory memory/visual strategies, swallowing/communication, and psychological input for TBI survivors. In conclusion, although rehabilitation is an integral component in TBI management, many published CPGs do not include rehabilitation. These CPGs, however, recommend comprehensive, flexible coordinated multidisciplinary care and appropriate follow-up, education, and support for patients with TBI (and carers).

KEYWORDS:

• Traumatic brain injury
• rehabilitation
• clinical practice guidelines
• critical appraisal

Acknowledgments

We thank the Disaster Rehabilitation Committee (DRC) of the International Society of Physical and Rehabilitation Medicine (ISPRM) and Disaster Rehabilitation-Special Interest Group of the Rehabilitation Medicine Society of Australia and New Zealand (RMANZ) for their support. The views expressed in this article are not of the abovementioned committees.

Conflict of Interest

The authors declare no competing or conflicts of interest.

Financial Disclosure

This review was supported by internal resources of the Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia, and no external funding was available. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.