Hope as experienced by people with acquired brain injury in a rehabilitation-or recovery process: a qualitative systematic review and thematic synthesis.
Camilla Højgaard Nejst, Chalotte Glintborg
PMID 38807900WHAT IT FOUND
Hope after brain injury is a double-edged sword: it drives recovery but can cause despair when unfulfilled.
Patients need therapists to make small progress visible, set realistic goals, and balance honesty with support. The therapeutic alliance is crucial for maintaining hope.
Key findings
01Hope is paradoxical, acting as a driving force for some while becoming a source of distress and despair for others when future hopes are unmet.
02The therapeutic alliance is critical; professionals must balance realism with optimism, as negative prognoses or rigid boundaries erode hope, while empathy and visible progress sustain it.
03For people with aphasia, co-constructing personal narratives helps recalibrate hope and identity, allowing them to engage with future possibilities despite communication barriers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review included only ten studies, with small sample sizes (3 to 33 participants per study), which limits the breadth of evidence. Most studies focused on stroke, with only two covering broader ABI populations like traumatic brain injury. The included studies were mostly from high or middle-income countries, limiting transferability to low-resource settings. The broad scope covered many different impairments, stages of recovery, and contexts (inpatient vs. outpatient), making it difficult to apply findings to specific subgroups. The review protocol was not registered (e.g., in PROSPERO), which may raise concerns about selection bias.
Declared interests
The authors declared financial support from the rehabilitation center 'Neurorehabilitation Copenhagen', Municipality of Copenhagen, Denmark, which funds the PhD scholarship of the first author.
The easy way to misread this
Do not interpret 'hope' as a simple positive psychological trait that therapists should always encourage. The review shows hope can be a source of distress and despair. Blindly promoting optimism or setting high goals without considering the patient's reality can undermine trust and increase hopelessness. The goal is not to maximize hope at all costs, but to balance realism with support.