“Everyone’s brains are different…you can’t just have one therapy plan to suit everyone” – A qualitative investigation of community-based rehabilitation services following traumatic brain injury

To examine the lived experiences of adults who have received community-based rehabilitation (CBR) services in Australia or New Zealand for cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) and their support people. Participants’ recommendations for future models of care were also explored to enhance rehabilitation services for people with TBI. A qualitative descriptive approach grounded in phenomenology was used, whereby semi-structured interviews were conducted with each participant. A total of 28 interviews were completed, four in-person and 24 via video conferencing. Two participant groups were recruited: Adults with TBI; and their support people. Sixteen adults with a self-reported diagnosis of cognitive-communication disorder (CCD) following TBI who had received CBR and 12 support people were included. Interviews were analysed using reflexive thematic analysis. Four themes were identified by the participant groups indicating the core pillars of CBR models of care. They included the importance of: (a) accessible and inclusive CBR services; (b) specialised clinical skills and treatment approaches; the acknowledgment that (c) knowledge is power; and the significance of (d) peer networks and support. This study further advances the evidence base of how services can be optimised to meet the complex needs of adults with CCDs following a TBI. Clinicians, researchers, and service providers should endeavour to incorporate the four core pillars outlined to enhance future CBR models of care for this clinical population.

本研究旨在考察澳大利亚或新西兰境内，因创伤性脑损伤（traumatic brain injury, TBI）罹患认知沟通障碍（cognitive-communication disorders, CCDs）并接受社区康复（community-based rehabilitation, CBR）服务的成年患者及其照料者的真实生活体验，同时探索参与者对未来照护模式的相关建议，以优化针对创伤性脑损伤患者的康复服务。本研究采用基于现象学的定性描述研究范式，对每名参与者开展半结构化访谈，最终共完成28次访谈：其中4次为线下访谈，24次通过视频会议完成。研究共招募两类参与者：创伤性脑损伤成年患者及其照料者，最终纳入16名经自我报告确诊为创伤性脑损伤后认知沟通障碍且接受过社区康复服务的成年患者，以及12名照料者。本研究采用反思性主题分析法对访谈资料进行分析，参与者群体共提炼出四项可作为社区康复照护模式核心支柱的主题，分别为：(a) 可及且包容的社区康复服务；(b) 专业化临床技能与治疗方案；(c) “知识即力量”的认知；以及(d) 同伴网络与支持的重要性。本研究进一步充实了相关证据基础，明确了如何优化服务以满足创伤性脑损伤后认知沟通障碍成年患者的复杂需求。临床医师、研究人员与服务提供者应积极融入上述四项核心支柱，以完善针对该临床人群的未来社区康复照护模式。