Røe Cecilie, Tverdal Cathrine, Howe Emilie Isager, Tenovuo Olli, Azouvi Philippe, Andelic Nada
Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ulleval, Oslo, Norway.
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Front Neurol. 2019 Jun 6;10:557. doi: 10.3389/fneur.2019.00557. eCollection 2019.
There is a gap in knowledge regarding effective rehabilitation service delivery in the post-acute phase after traumatic brain injury (TBI). Recently, Gutenbrunner et al. proposed a classification system for health-related rehabilitation services (International Classification System for Service Organization in Health-related Rehabilitation, ICSO-R) that could be useful for contrasting and comparing rehabilitation services. The ICSO-R describes the dimensions of Provision (i.e., context of delivered services), Funding (i.e., sources of income and refunding), and Delivery (i.e., mode, structure and intensity) at the meso-level of services. We aim to: -Provide an overview of randomized, controlled trials (RCTs) with rehabilitation service relevance provided to patients with moderate and severe TBI in the post-acute phase using the ICSO-R as a framework; and -Evaluate the extent to which the provision, funding and delivery dimensions of rehabilitation services were addressed and differed between the intervention arms in these studies. A systematic literature search was performed in OVID MEDLINE, EMBASE, CINHAL, PsychINFO, and CENTRAL, including multidisciplinary rehabilitation interventions with RCT designs and service relevance targeting moderate and severe TBI in the post-acute phase. 23 studies with 4,644 TBI patients were included. More than two-thirds of the studies were conducted in a hospital-based rehabilitation setting. The contrast in Context between the intervention arms often co-varied with Resources. The funding of the services was explicitly described in only one study. Aspects of the Delivery dimension were described in all of the studies, and the Mode of Production, Intensity, Aspects of Time and Peer Support were contrasted in the intervention arms in several of the studies. A wide variety of outcome measures were applied often covering Body function, as well as the Activities and Participation domains of the International Classification of Functioning, Disability, and Health (ICF). Aspects of service organization and resources as well as delivery may clearly influence outcome of rehabilitation. Presently, lack of uniformity of data and collection methods, the heterogeneity of structures and processes of rehabilitation services, and a lack of common outcome measurements make comparisons between the studies difficult. Standardized descriptions of services by ICSO-R, offer the possibility to improve comparability in the future and thus enhance the relevance of rehabilitation studies.
关于创伤性脑损伤（TBI）后急性期有效康复服务提供方面的知识存在空白。最近，古滕布鲁纳等人提出了一种健康相关康复服务分类系统（国际健康相关康复服务组织分类系统，ICSO-R），该系统可能有助于对比和比较康复服务。ICSO-R在服务的中观层面描述了提供（即所提供服务的背景）、资金（即收入来源和退款）和提供方式（即模式、结构和强度）等维度。我们旨在：- 以ICSO-R为框架，概述为中重度TBI患者在急性期后提供的与康复服务相关的随机对照试验（RCT）；- 评估这些研究中干预组在康复服务的提供、资金和提供方式维度上的涉及程度和差异。在OVID MEDLINE、EMBASE、CINHAL、PsychINFO和CENTRAL中进行了系统的文献检索，包括针对中重度TBI急性期后具有RCT设计和服务相关性的多学科康复干预。纳入了23项研究，共4644名TBI患者。超过三分之二的研究是在基于医院的康复环境中进行的。干预组之间背景的对比往往与资源共同变化。只有一项研究明确描述了服务的资金情况。所有研究都描述了提供方式维度的各个方面，并且在一些研究中干预组对生产模式、强度、时间方面和同伴支持进行了对比。应用了各种各样的结局指标，通常涵盖身体功能以及《国际功能、残疾和健康分类》（ICF）的活动和参与领域。服务组织和资源以及提供方式的各个方面可能明显影响康复结局。目前，数据和收集方法缺乏一致性、康复服务结构和流程的异质性以及缺乏共同的结局测量使得研究之间的比较困难。ICSO-R对服务的标准化描述为未来提高可比性提供了可能性，从而增强康复研究的相关性。
