Rehabilitation interventions after traumatic brain injury: a scoping review

Abstract

Purpose

To (1) identify interventional research topics in traumatic brain injury (TBI) rehabilitation, (2) describe potential knowledge gaps, and (3) uncover further needs for interventional TBI rehabilitation research for patients and families.

Method

We searched three databases (2006–2019) and screened 1552 non-duplicate articles. Titles and abstracts were screened for relevance, yielding 754 articles for full-text review. Of these, 425 were included, as relevant to the purpose of the scoping review.

Findings

Among articles on TBI rehabilitation, the majority (71.8%) applied quantitative methodology; of these only 19.7% were randomized controlled trials. Severe TBI was described more often than mild/moderate TBI populations. Hospital vs community/home rehabilitation was 55.1% vs 37.2%; rehabilitation at workplace/school was described in only 4.5% articles, while in 7.2% the setting was undisclosed. Of 83 articles describing work/education, only 14 were in a work/school context. An additional focus in the work/education articles was activities of daily living (n = 28), cognition (n = 33) and emotions (n = 23), few targeted family or network.

Conclusion

The main attention of interventional TBI rehabilitation studies has been on severe TBI and long-term rehabilitation. Gaps identified were rehabilitation of mild/moderate TBI populations, older populations, acute/sub-phase rehabilitation, return to work issues and studies including the family.

Implications for rehabilitation

• A substantial number of interventional studies exist to guide long-term rehabilitation after traumatic brain injury with focus on daily life, physical, emotional and cognitive functioning.

• We recommend a stronger focus in the clinic on the following groups; people with mild/moderate traumatic brain injury, people in the acute and sub-acute phase, and older people with traumatic brain injury.

• Issues that target challenges returning to work should be addressed, while they are of importance to patients and families.

• Emphasis should be put on continuity of care and peer-support.

Keywords:

• Traumatic brain injury
• rehabilitation
• interventions
• scope
• rehabilitation setting

Acknowledgements

This study is part of the research project “Transitions in rehabilitation. Biographical reconstruction, experiential knowledge and professional expertise” and the Danish-Norwegian collaboration the “Phlegethon network.” The Transitions Project is headed by Professor Tone Alm Andreassen, OsloMet - Oslo Metropolitan University. We thank the Transitions Project’s User panel for valuable contributions to the uncovered needs for rehabilitation research and interventions. We also thank Marie Isachsen, at The Univeristy of Oslo Medical Library, Ulleval for helpful assistance with the literature search and search strategy. Last but not least, thanks to the Phlegethon network for fruitful discussions and comments on the manuscript.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The project was supported by funding from the Norwegian Research Council (project number 229082). The project is also part of the Danish-Norwegian collaboration linked to and partly financed by the “Phlegethon network.”