Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study

Abstract

This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the CENTER-TBI study with severe-to-moderate disability. Impairments in five outcome domains (daily life activities, physical, cognition, speech/language, and psychological) and the use of respective rehabilitation services (occupational therapy, physiotherapy, cognitive and speech therapies, and psychological counselling) were recorded. Sociodemographic and injury-related factors were used to investigate the probability of receiving rehabilitation. Physiotherapy was the most frequently provided rehabilitation service, followed by speech and occupational therapy. Psychological counselling was the least frequently accessed service. The probability of receiving a rehabilitative intervention increased for individuals with greater brain injury severity (odds ratio (OR) 1.75, CI 95%: 1.27–2.42), physical (OR 1.92, CI 95%: 1.21–3.05) and cognitive problems (OR 4.00, CI 95%: 2.34–6.83) but decreased for individuals reporting psychological problems (OR 0.57, CI 95%: 1.21–3.05). The study results emphasize the need for more extensive prescription of rehabilitation services for individuals with disability. Moreover, targeted rehabilitation programs, which aim to improve outcomes, should specifically involve psychological services to meet the needs of individuals recovering from TBI.

In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation

“…The results from the CENTER-TBI study demonstrated different and complex care pathways in the first six months after injury, particularly for patients with severe TBI [7]. Furthermore, rehabilitation needs were reported in 90% of patients with moderate-severe TBI in the first six months after injury [31]. Our data are limited to acute treatment at a Level 1 trauma hospital, and it is likely that several patients were referred to specialized rehabilitation at a later point.…”

“…Reduced functional levels at six months are reported for patients with TBI admitted to the hospital [28]. The study identifying unmet rehabilitation needs emphasized the necessity of a more extensive and standardized assessment of functional impairments and corresponding rehabilitation needs [31]. Currently, there is no systematic assessment of rehabilitation needs at discharge from acute care units at OUH.…”

Patient-Reported Problem Areas in Chronic Traumatic Brain Injury

“…Previous studies have documented limited access to services to address emotional difficulties post-TBI. 44,45 Living with adjustment-related emotional symptoms after TBI may be long term and may at worst increase over time and lead to deterioration of mental health if these individuals do not meet the criteria for psychiatric treatment and if the rehabilitation services fail to acknowledge and address these problems. It is noteworthy that the ICF classification does not cover these issues that are important not only after TBI but also in the chronic phase of many injuries or diseases of varying causes.…”

Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury

“…Evidence suggests that rehabilitation can be effective in reducing symptom burden and in improving participation and quality of life, and also for those who experience persisting symptoms [25][26][27][28]. However, evidence suggests that one-third of patients with chronic TBI have unmet needs related to cognitive, emotional, and vocational functioning [29], and that certain symptoms, such as neuropsychiatric sequelae, might often be overlooked in rehabilitation [30].…”