Management of traumatic brain injury: practical development of a recent proposal

Wade, Derick; Nayar, Meenakshi; Haider, Javvad

doi:10.7861/clinmed.2021-0719

Cited by 3 publications

(1 citation statement)

References 21 publications

(30 reference statements)

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“…First, it is not possible to have different ‘specialist’ services for each condition, such as stroke, traumatic brain injury, rheumatoid arthritis, spinal cord injury, etc. 23, 24 Second, services must be patient-centred, not restricting access to a selected subset of patients but accepting any patient when their service is the best available option.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation potential: A critical review of its meaning and validity

Wade

2022

Clin Rehabil

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Background The concept of rehabilitation potential emerged in 1950 as a way to select people for rehabilitation; it is also used to limit access to services. Objective To elucidate the meaning(s) of rehabilitation potential and whether it is valid in selecting patients for rehabilitation, whether as an inpatient, outpatient, or in the community. Method A non-systematic review of how it has been used, a structured discussion of its potential meanings, an exploration of the evidence in support of selecting people who might benefit from rehabilitation, and a discussion of the concept of rehabilitation potential. Findings It has been used in several ways with two primary meanings: predicting a person's function at some later time; predicting who will gain additional improvement in outcome from being seen by a rehabilitation service. The concept is flawed because rehabilitation is a process, not a specific action; the effects anticipated after rehabilitation are not restricted to functional improvement; patient characteristics do not determine many essential outcomes. There is no evidence to guide the selection of patients for an assessment and formulation by a rehabilitation team. Conclusion Rehabilitation potential, defined as data that gives the likelihood of additional benefit from receiving input from an expert rehabilitation service, is an illusion lacking any coherent definition, description, or evidence. Its use to limit access to rehabilitation is invalid. The solution is to offer all people not recently seen by an expert multi-professional rehabilitation team a full rehabilitation assessment and formulation, which will reveal what rehabilitation might achieve.

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Section: Introductionmentioning

confidence: 99%

Rehabilitation potential: A critical review of its meaning and validity

Wade

2022

Clin Rehabil

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Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers

Wade

2024

Clin Rehabil

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Background Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. The problem How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. An analogy How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. The solution A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. Capabilities. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. Conclusion. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.

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Response to: Management of traumatic brain injury: practical development of a recent proposal

Dilley

Carson³

et al. 2022

Clinical Medicine

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We thank our rehabilitation medicine colleagues for their comments on our article, which illustrate how strongly all healthcare professionals involved in the care of patients with traumatic brain injury (TBI) feel about the urgent need to improve clinical services. 1,2 TBI patients desperately require a pathway that delivers effective, personalised acute and chronic care, and we would like to emphasise that our pathway does not propose replacing rehabilitation physicians and facilities. Rather, we view

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Management of traumatic brain injury: practical development of a recent proposal

Cited by 3 publications

References 21 publications

Rehabilitation potential: A critical review of its meaning and validity

Rehabilitation potential: A critical review of its meaning and validity

Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers

Response to: Management of traumatic brain injury: practical development of a recent proposal

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