Traumatic brain injury; needs and treatment options in the chronic phase. A randomized controlled community-based intervention

Traumatic brain injury (TBI) affects the persons central nervous system with a need for extensive and highly specialized initial health care provision followed by comprehensive rehabilitation efforts, as life-long medical, cognitive, emotional and behavioural changes are to be expected. The proposal includes a complex intervention study addressing the long-term treatment needs and the effect of a goal-oriented community-based rehabilitation program for individuals with TBI living at home. An individualized and goal-oriented intervention will be provided in the persons home environment in close collaboration with family members and local health care providers. The person´s most troubling TBI symptoms, such as memory loss, executive dysfunction, emotional and interpersonal problems and sensory problems will be targeted, with the main aim of promoting community re-integration. A pilot study including 6 subjects have been conducted. The randomized controlled study in which one hundred and twenty patients have been enrolled, with half being randomly allocated to the intervention group, and subsequently compared to the second group receiving treatment as usual is finalized. The participants have been followed after 4 and 12 months, with less than 4% drop out. Individual goal attainment seems to be high in the intervention group. Efficacy of the intervention measured along dimensions related to cognition, emotional functioning, health related quality of life and community participation will be reported after peer review of the results. Users have been involved in the development of the intervention and will contribute in the discussion of results and implementation. The findings of this study will bear relevance to other conditions involving chronic neurological deficit, and have innovation potential in establishing new modes of collaboration and knowledge transition between specialized acute and post-acute neurosurgical and rehabilitation facilities, and rehabilitation services in the municipalities.

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Traumatic brain injury (TBI) affects the persons central nervous system with a need for extensive and highly specialized initial health care provision followed by comprehensive rehabilitation efforts, as life-long medical, cognitive, emotional and behavioural changes are to be expected. The proposal includes a complex intervention study addressing the long-term treatment needs and the effect of a goal-oriented community-based rehabilitation program for individuals with TBI living at home. The feasibility of the proposed interventions, and the implementation of procedures, will be explored in an initial pilot study. An individualized and goal-oriented intervention will be provided in the persons home environment in close collaboration with family members and local health care providers. The person´s most troubling TBI symptoms, such as memory loss, executive dysfunction, emotional and interpersonal problems and sensory problems will be targeted, with the main aim of promoting community re-integration. One hundred and twenty patients will be enrolled in the study, with half being randomly allocated to the intervention group, and subsequently compared to the second group receiving treatment as usual. Efficacy of the intervention will be measured along dimensions related to cognition, emotional functioning, family functioning and community participation. Users will be involved in the development of the intervention, discussion of results and implementation. Cost-benefit and process evaluation analysis will be provided along with intervention effect evaluations. The findings of this study will bear relevance to other conditions involving chronic neurological deficit, and have innovation potential in establishing new modes of collaboration and knowledge transition between specialized acute and post-acute neurosurgical and rehabilitation facilities, and rehabilitation services in the municipalities.