Abstract
Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients' conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.
Highlights
Traumatic brain injury (TBI) is a traumatic event that results from an external force to the brain, causing disturbances to normal physical, neurologic and cognitive function, and impacts the patient’s physical, psychological and social well-being.[1]
In the final stage of guideline selection process, the following four guidelines were selected as source guidelines for data extraction, based on the final inclusion criteria: 1. INCOG Guidelines for Cognitive Rehabilitation
The team’s reports and the recommendations have been published in the form of eight articles in the Journal of Head Trauma Rehabilitation in 2014.8,11,15,19-23 In 2016, two Canadian accredited organizations “Institut national d’excellence en santé et en services sociaux” (INESSS) and “Ontario Neurotrauma Foundation” (ONF) released a guideline
Summary
Traumatic brain injury (TBI) is a traumatic event that results from an external force to the brain, causing disturbances to normal physical, neurologic and cognitive function, and impacts the patient’s physical, psychological and social well-being.[1]. Road traffic crashes (RTCs) are the leading cause of TBI in many countries, especially in LMICs.[5] Iran is among the countries with one of the world’s highest rates of RTCs that cause 685 611 nonfatal injuries annually.[6] In a Harvard study on road traffic injuries in 18 countries,[7] Iran had the highest rate of road injury deaths and over one million Iranians sustained nonfatal injuries due to the RTCs in 2005, with the rate of the injuries peaking in the age group of 15-24 years. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran.
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