Rehabilitation Practices in Patients With Moderate and Severe Traumatic Brain Injury.
Natalie Kreitzer, Kelly Rath, Brad G Kurowski and 4 others
PMID 30829824WHAT IT FOUND
Most ICU clinicians caring for moderate and severe TBI supported starting rehabilitation, but timing varied.
They usually waited for extubation, normal intracranial pressure and hemodynamic stability, and cited staff and resource limits as barriers.
Key findings
0198% of respondents recommended rehabilitative care while patients with TBI were in the ICU.
02Only 11% based initiation on time since injury, while 38% used patient milestones and 52% said it depended on the type of rehabilitation.
03The most frequently cited barrier was limited resources, such as short staffed therapists and high nurse ratios.
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 response rate was relatively low, so the results may not represent all clinicians who care for patients with traumatic brain injury in the intensive care unit. Responses were not linked to the specialty of each respondent, so differences between respondent groups cannot be checked. All respondents were people who already cared for patients with traumatic brain injury in the intensive care unit, so the 98% support for rehabilitation may not reflect wider practice. The survey was not designed to compare perceptions between different clinicians. The authors describe the data as informative of current practice, not definitive, and say research is still needed on timing, safety, and efficacy. It is unknown what proportion of the approximately 2400 neurocritical care members and 2000 rehabilitation medicine members cared for patients with traumatic brain injury in the intensive care unit.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read these findings as proof that early intensive care unit rehabilitation is safe or effective. The paper reports clinician practices and barriers, not patient outcomes, and the authors say the data are informative of current practice, not definitive.