Su Yi Lee1,2,3,4, Bhasker Amatya1,2,3,4, Rodney Judson5, Melinda Truesdale6, Jan D Reinhardt3,7,8,9, Taslim Uddin4,9, Xiang-Hu Xiong3,10, Fary Khan1,2,3,4. 1. a Department of Rehabilitation, Royal Melbourne Hospital , Parkville , Victoria , Australia. 2. b Department of Medicine, The University of Melbourne , Parkville , Victoria , Australia. 3. c Disaster Rehabilitation Committee, International Society for Physical and Rehabilitation Medicine , Geneva , Switzerland , Australia. 4. d Australian Rehabilitation Research Centre, Royal Melbourne Hospital , Parkville , Australia. 5. e Trauma Services, Royal Melbourne Hospital , Parkville , Victoria , Australia. 6. f Emergency Services, Royal Melbourne Hospital , Parkville , Victoria , Australia. 7. g Department of Disaster Health Sciences, Institute of Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University , Chengdu , Sichuan , China. 8. h Swiss Paraplegic Research, Nottwil, Switzerland, Department of Health Sciences, University of Lucerne , Lucerne , Switzerland. 9. i Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) , Dhaka , Bangladesh. 10. j Brain Injury Rehab Laura Fergusson Trust , Christchurch , New Zealand.
Abstract
Objective: To evaluate published traumatic brain injury (TBI) clinical practice guidelines (CPGs) and assess rehabilitation intervention recommendations for applicability in disaster settings. Methods: Recommendations for rehabilitation interventions were synthesized from currently published TBI CPGs, developed by the Department of Labor and Employment (DLE); Scottish Intercollegiate Guidelines Network (SIGN); Department of Veterans Affairs/Department of Defence (DVA/DOD); and American Occupational Therapy Association (AOTA). Three authors independently extracted, compared, and categorized evidence-based rehabilitation intervention recommendations from these CPGs for applicability in disaster settings. Results: The key recommendations from a rehabilitation perspective for TBI survivors in disaster settings included patient/carer education, general physical therapy, practice in daily living activities and safe equipment use, direct cognitive/behavioral feedback, basic compensatory memory/visual strategies, basic swallowing/communication, and psychological input. More advanced interventions are generally not applicable following disasters due to limited access to services, trained staff/resources, equipment, funding, and operational issues. Conclusions: Many recommendations for TBI care are challenging to implement in disaster settings due to complexities related to the environment, resources, service provision, workforce, and other reasons. Further research is needed to identify and address barriers for implementation.
Objective: To evaluate published traumatic brain injury (TBI) clinical practice guidelines (CPGs) and assess rehabilitation intervention recommendations for applicability in disaster settings. Methods: Recommendations for rehabilitation interventions were synthesized from currently published TBI CPGs, developed by the Department of Labor and Employment (DLE); Scottish Intercollegiate Guidelines Network (SIGN); Department of Veterans Affairs/Department of Defence (DVA/DOD); and American Occupational Therapy Association (AOTA). Three authors independently extracted, compared, and categorized evidence-based rehabilitation intervention recommendations from these CPGs for applicability in disaster settings. Results: The key recommendations from a rehabilitation perspective for TBI survivors in disaster settings included patient/carer education, general physical therapy, practice in daily living activities and safe equipment use, direct cognitive/behavioral feedback, basic compensatory memory/visual strategies, basic swallowing/communication, and psychological input. More advanced interventions are generally not applicable following disasters due to limited access to services, trained staff/resources, equipment, funding, and operational issues. Conclusions: Many recommendations for TBI care are challenging to implement in disaster settings due to complexities related to the environment, resources, service provision, workforce, and other reasons. Further research is needed to identify and address barriers for implementation.
Entities:
Keywords:
Traumatic brain injury; clinical practice guidelines; natural disaster; rehabilitation