The identification by physiotherapists of the physical problems resulting from a mild traumatic brain injury

Abstract

In New Zealand, over 9000 people are diagnosed with a traumatic brain injury (TBI) each year, with at least 80% being classified as mild. The cognitive deficits resulting from mild traumatic brain injury (MTBI) have been well documented, but this is not the case for the physical problems. As a result, the physical problems are not well understood and few people with a MTBI are referred for physiotherapy. The aim of this research was to use a modified Delphi Technique to gain consensus amongst physiotherapists working with TBI clients with regard to: (1) The common motor performance problems associated with MTBI; (2) The importance of assessing these motor performance problem; and (3) Whether these motor performance problems should be used in a formal assessment (FA) or included as a screening measure (SM). Following a pilot study to establish face validity and clarity of instructions, a national sample of 52 physiotherapists with a minimum of 1 year's experience working with TBI clients was recruited. In Round 1, 42 physiotherapists listed 424 physical problems which, in their clinical experience, may occur in people with a recent MTBI. A planning committee developed these listed problems into 33 items. In Round 2, these items were then rated by the physiotherapists as to their importance of being included in an assessment. Using 75% consensus criteria, 31 items were deemed as being at least 'important' for inclusion. In Round 3, the physiotherapists were asked whether these items should be used in a FA or used as a SM. Of the 31 items which were retained, seven reached consensus for FA (balance with unstable, reduced or changing base of support; dynamic standing balance; high level balance activities; quality of movement; ballistic activities; gait; proprioception). Five items reached consensus for being used as a SM (attention; behaviour; sport and leisure activities; vocational activities; quality of movement). Consensus of classification was not reached for the remaining 19 items which had previously been identified in Round 2 as being at least 'important' to be assessed. These results form the foundation for the development of an assessment/management protocol for physiotherapists working with adults with MTBI.