Core outcomes in neurorehabilitation: development of a core outcome set for acquired brain injury

Acquired brain injury (ABI) is an umbrella term describing any injury sustained to the brain since birth. The Royal College of Physicians and the British Society for Rehabilitation Medicine (2003) has defined ABI as an inclusive category of injuries that embraces acute (rapid onset) brain injury of any cause including trauma due to head injury (traumatic brain injury, TBI), post-surgical damage (e.g. following tumour removal), vascular accident (stroke or sub-arachnoid haemorrhage), cerebral anoxia, toxic or metabolic insult (e.g. hypoglycaemia), infection (e.g. meningitis, encephalitis) or other inflammation (e.g. vasculitis).

Neurorehabilitation provide persons with neurological conditions or injuries (e.g. ABI) rehabilitation aimed at reducing disability, preventing deterioration and helping people regain and maximise their functional potential (Turner-Stokes, 2008). The principles of rehabilitation, as outlined by Langhorne, Bernhardt, and Kwakkel (2011) include: 1. Goal-setting; 2. High-intensity practice; 3. Multidisciplinary, and ;4. Task-specific training.

Functional outcomes can be subdivided by cognitive and physical function and there are recommended outcome were identified for TBI outcomes (Wilde et al, 2010) and non-TBI outcomes (Ali et al, 2013; Kwakkel et al 201), in line with development of Core Outcome Sets. However, there is no consensus on a core outcome set for varying types of ABIs, despite the fact that rehabilitation services may all fall under this single umbrella term.

This project seek to develop and establish a Core Outcome Set for acquired brain injury for neurorehabilitation. To do this, this project has two key stages: 1. Systematic review of randomised control trials studying neurorehabilitation in ABI (Trepel 2020), and 2. A series of consensus exercises to agree the set of core outcomes that have the greatest utility to service users, healthcare providers and policy-makers.

References
Ali, M., English, C., Bernhardt, J., Sunnerhagen, K. S., & Brady, M. (2013). More outcomes than trials: a call for consistent data collection across stroke rehabilitation trials. International Journal of stroke, 8(1), 18-24. https://doi.org/10.1111/j.1747-4949.2012.00973.x

Kwakkel, G., Lannin, N. A., Borschmann, K., English, C., Ali, M., Churilov, L., ... & Krakauer, J. W. (2017). Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the stroke recovery and rehabilitation roundtable. Neurorehabilitation and Neural Repair, 31(9), 784-792. https://doi.org/10.1177/1545968317732662

Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693-1702. https://doi.org/10.1016/S0140-6736(11)60325-5

Royal College of Physicians and British Society of Rehabilitation Medicine. (2003). Rehabilitation following acquired brain injury: national clinical guidelines. (Turner-Stokes L, ed). London: RCP, BSRM.

Trepel, D, Ahern, E., Philips, N., Mockler, D., McGettrick, G., Fitzpatrick-Naidoo, K. (2020) The effectiveness of community neurorehabilitation for persons with an acquired brain injury. PROSPERO 2020 CRD42020148604.

Turner-Stokes, L. (2008). Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches. Journal of Rehabilitation Medicine, 40 (9), 691-701

Wilde, E. A., Whiteneck, G. G., Bogner, J., Bushnik, T., Cifu, D. X., Dikmen, S., ... & Millis, S. R. (2010). Recommendations for the use of common outcome measures in traumatic brain injury research. Archives of Physical Medicine and Rehabilitation, 91(11), 1650-1660. https://doi.org/10.1016/j.apmr.2010.06.033

Contributors

Dominic Trépel
Eileen Mitchell
Elayne Ahern
Nicola Phillips
Grainne McGettrick

Further Study Information

Current Stage: Ongoing
Date: April 2020 - March 2022
Funding source(s): Irish Research Council


Health Area

Disease Category: Rehabilitation

Disease Name: Acquired brain injury

Target Population

Age Range: 0 - 200

Sex: Either

Nature of Intervention: Rehabilitation

Stakeholders Involved

- Charities
- Clinical experts
- Conference participants
- Consumers (caregivers)
- Consumers (patients)
- Economists
- Governmental agencies
- Methodologists
- Policy makers
- Researchers
- Service commissioners
- Service providers
- Service users

Study Type

- COS for clinical trials or clinical research
- COS for practice

Method(s)

- Consensus meeting
- Focus group(s)
- Systematic review

This project seek to develop and establish a Core Outcome Set for acquired brain injury for neurorehabilitation. To do this, this project has two key stages: 1. Systematic review of randomised control trials studying neurorehabilitation in ABI (Trepel 2020), and 2. A series of consensus exercises to agree the set of core outcomes that have the greatest utility to service users, healthcare providers and policy-makers.

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