Author Affiliations: Parkwood Institute Research, Lawson Research Institute, London, Ontario, Canada (Drs Mehta and Teasell); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (Drs Mehta, Teasell, and MacKenize); Parkwood Institute, St. Joseph's Health Care London, London, Canada (Drs Mehta, Teasell, and MacKenize); Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (Mss Lauren Devito and Julia Devito); Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada (Ms Patsakos and Dr Bayley); KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada (Ms Patsakos); Acquired Brain Injury Program, Hamilton Health Sciences, Hamilton, Ontario, Canada (Dr Velikonja); Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Velikonja); Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Bayley); and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Dr Bayley).
J Head Trauma Rehabil. 2024;39(5):359-368. doi: 10.1097/HTR.0000000000000961. Epub 2024 Sep 10.
Objective: After sustaining a moderate to severe traumatic brain injury (MSTBI), individuals often experience comorbid mental health conditions that can impair the rehabilitation and recovery process. The objective of this initiative was to update recommendations on the assessment and management of mental health conditions for the Canadian Clinical Practice Guideline for the Rehabilitation of Adults with MSTBI (CAN-TBI 2023).
Design: A systematic search was conducted by the Evidence-Based Review of Moderate to Severe Acquired Brain Injury to identify new and relevant articles. Expert Panel reviewed and discussed the new and existing evidence, evaluated its quality, and added, removed, or modified recommendations and tools as needed. A consensus process was followed to achieve agreement on recommendations.
Results: CAN-TBI 2023 includes 20 recommendations regarding best practices for the assessment and management of mental health conditions post-MSTBI. About 17 recommendations were updated, 1 new recommendation was formed, and 2 recommendations remained unchanged. The Guideline emphasizes the importance of screening and assessment of mental health conditions throughout the rehabilitation continuum. The Expert Panel recommended incorporating multimodal treatments that include pharmacological and nonpharmacological approaches to manage mental health concerns.
Conclusion: The CAN-TBI 2023 recommendations for the assessment and management of mental health conditions should be used to inform clinical practice. Additional high-quality research in this area is needed, as 13 recommendations are based on level C evidence, 4 on level B evidence, and 3 on level A evidence.
目的：在遭受中度至重度创伤性脑损伤（MSTBI）后，个体通常会出现合并的心理健康状况，这会影响康复和恢复过程。本倡议的目的是更新关于评估和管理 MSTBI 成人心理健康状况的建议，这是加拿大临床实践指南康复成人 MSTBI（CAN-TBI 2023）的一部分。
设计：通过对中度至重度获得性脑损伤的循证审查，进行了系统搜索，以确定新的和相关的文章。专家小组审查并讨论了新的和现有的证据，评估了其质量，并根据需要添加、删除或修改建议和工具。采用共识过程就建议达成一致。
结果：CAN-TBI 2023 包括 20 条关于 MSTBI 后评估和管理心理健康状况的最佳实践建议。大约 17 条建议得到了更新，1 条新建议形成，2 条建议保持不变。该指南强调了在康复过程中筛查和评估心理健康状况的重要性。专家组建议采用包括药物和非药物方法的多模式治疗来管理心理健康问题。
结论：CAN-TBI 2023 关于评估和管理心理健康状况的建议应用于指导临床实践。该领域需要更多高质量的研究，因为 13 条建议基于 C 级证据，4 条基于 B 级证据，3 条基于 A 级证据。
