Measures of Rehabilitation Service Use Following Acquired Brain Injury: A Systematic Review

Objective(s): To review existing patient- and/or caregiver-report measures of rehabilitation utilization following acquired brain injury (ABI).

Data Sources: Medline, APA PsycInfo, Embase, and CINAHL were searched in 9/2021. Additional search methods (e.g. internet search; contacting corresponding author) were employed if measures referenced were not included in the manuscript/appendices.

Study Selection: Included articles were empirical research or a research protocol, available in English, and described patient- and/or caregiver-report of rehabilitation utilization post-ABI via quantitative or qualitative methods. Studies using an unstructured qualitative approach were excluded. Two reviewers independently screened 4,703 records using DistillerSR software. Discrepancies were resolved by team adjudication, resulting in 128 included articles.

Data Extraction: Data extraction was piloted by all members of the study team with high levels of agreement (k=.94). Data were extracted by a single member and recurrent team meetings were held to review progress and seek guidance as needed. Data included: characteristics of the measures (e.g. patient- vs. caregiver report, recall period), domains of rehabilitation utilization, and psychometric properties. Data were extracted from articles describing the use of the measures and from the measures directly when they were able to be accessed.

Data Synthesis: One-hundred and thirty-six unique measures were identified from 65 quantitative, 60 qualitative, and 3 psychometric studies. Psychometric properties were reported for only three measures, all of which focused on overall satisfaction. Most studies used unvalidated measures. The most frequent domains included: types of therapies used (e.g. functional, behavioral health, community and academic reintegration) and qualitative aspects (e.g. satisfaction, adequacy). Recall periods ranged from 1 month to “since the ABI event” or focused on current utilization only. Of measures that could be accessed (n=57), many included a limited checklist of types of services for patients/caregivers to complete. Very few measures assessed setting, frequency, intensity, or duration.

Conclusions: Existing measures are unvalidated and limited in scope. Development and validation of a comprehensive instrument measuring rehabilitation utilization is a necessary next step to advance rehabilitation research following ABI.

Author(s) Disclosures: Authors report no disclosures.