Shelley-Tremblay John F, Lawton Teri
Department of Psychology, University of South Alabama, Mobile, AL 36688, USA.
Perception Dynamics Institute, PO Box 231305, Encinitas, CA 92023-1305, USA.
Med Sci (Basel). 2025 Jun 23;13(3):82. doi: 10.3390/medsci13030082.
BACKGROUND/OBJECTIVES: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation.
Structured interviews were conducted with 94 clinicians-including neurologists, neuropsychologists, optometrists, occupational and physical therapists, speech-language pathologists, neurosurgeons, and case managers-across academic, private, and community settings in the United States. Interviews followed a semi-structured format adapted for the NIH I-Corps program and were analyzed thematically alongside existing rehabilitation literature.
Clinicians expressed strong consensus on the value of function-oriented, patient-centered care. Key themes included the prevalence of persistent cognitive and visual symptoms, emphasis on real-world goal setting, and barriers such as fragmented communication, reimbursement restrictions, and referral delays. Disciplinary differences were noted in perceptions of symptom persistence and professional roles. Rehabilitation technologies were inconsistently adopted due to financial, training, and interoperability barriers. Equity issues included geographic and insurance-based disparities. A four-domain conceptual framework emerged: discipline-specific expertise, coordinated training, technological integration, and care infrastructure, all shaped by systemic limitations.
Despite widespread clinician endorsement of interprofessional mTBI care, structural barriers hinder consistent implementation. Targeted reforms-such as embedding interdisciplinary models in clinical education, expanding access to integrated technology, and improving reimbursement mechanisms-may enhance care delivery. The resulting framework provides a foundation for scalable, patient-centered rehabilitation models in diverse settings.
背景/目的:轻度创伤性脑损伤(mTBI)会出现持续且多样的症状,需要多方面的护理。尽管越来越推荐进行跨学科康复治疗,但实施情况仍不一致。本研究旨在综合现有文献和临床医生的观点,构建一个基于实践的跨专业mTBI康复概念框架。
对美国学术、私立和社区环境中的94名临床医生进行了结构化访谈,这些医生包括神经科医生、神经心理学家、验光师、职业和物理治疗师、言语语言病理学家、神经外科医生和病例管理人员。访谈采用了适用于美国国立卫生研究院(NIH)I-Corps项目的半结构化形式,并与现有的康复文献一起进行了主题分析。
临床医生对以功能为导向、以患者为中心的护理价值表达了强烈的共识。关键主题包括持续认知和视觉症状的普遍性、对现实世界目标设定的强调以及沟通不畅、报销限制和转诊延迟等障碍。在症状持续性的认知和专业角色方面存在学科差异。由于财务、培训和互操作性障碍,康复技术的采用并不一致。公平问题包括地理和基于保险的差异。出现了一个四领域概念框架:特定学科专业知识、协调培训、技术整合和护理基础设施,所有这些都受到系统限制的影响。
尽管临床医生普遍认可跨专业mTBI护理,但结构性障碍阻碍了其一致实施。有针对性的改革——如将跨学科模式纳入临床教育、扩大对集成技术的获取以及改善报销机制——可能会提高护理质量。由此产生的框架为在不同环境中可扩展的、以患者为中心的康复模式提供了基础。