Effective rehabilitation services in the post-acute phase of moderate and severe traumatic brain injury

Abstract

Background and aims: Rehabilitation services to traumatic brain injury (TBI) have been focused in the acute phase, underpinning the importance of early initiated and well-organized delivery. Less is known about effective rehabilitation service delivery in the post-acute and later phases after TBI. Lack of a framework for depicting differences in service delivery may also contribute to the knowledge gap. Recently, Gutenbrunner et al (J Rehabil Med 2015) proposed a classification for health-related rehabilitation services (International Classification System for Service Organization in Health-related Rehabilitation, ICSO-R) describing provision (i.e., context of delivered services), funding (i.e., sources of income and refunding) and delivery (i.e. mode, structure and intensity) aspects which may be useful for contrasting and comparing rehabilitation services. Aims of this review are: – provide an overview of randomized controlled trials (RCTs) with rehabilitation service relevance provided to moderate and severe TBI in the post-acute phase; – evaluate to which extent providing, funding and delivery dimensions of rehabilitation services are addressed. A systematic literature search was carried out in OVID MEDLINE; EMBASE, CINHAL, PsychINFO and Social SCI, identifying 50 relevant RCTs. The studies emerged from nine different counties across all continents except Africa. Two-third of the studies were conducted in a hospital-based rehabilitation setting. In general, funding of the services was not described. In the delivery dimension, therapeutic strategies targeting body functions (78%) was dominating. Only one study was clearly designed to evaluate service delivery mode aspects, finding no difference between the effects of in-hospital or home-based rehabilitation regarding return to gainful employment. There is a lack of RCTs for evaluation of rehabilitation services in the post-acute phase for moderate and severe TBI. Service aspects may be implicit and possible to evaluate given standardized and better descriptions of the provider, funding and delivery dimensions according to ICSO-R.