Article

The purpose of this study was to elaborate practice guidelines for the
prevention of behavioral and affective disorders in adult outpatients after
traumatic brain injury (TBI) ;
but also to identify the support systems available
for family, caregivers of patients with TBI within the community. METHODS: The elaboration of these guidelines followed the procedure validated by the French
health authority for good practice recommendations, close to the Prisma
statement. This involved a systematic and critical review of the literature
looking for studies that investigated the impact of programs in community
settings directed to behavioral and affective disorders post-TBI. Recommendations
were than elaborated by a group of professionals and family representatives.
RESULTS: Only six articles were found comprising 4 studies with a control group.
Two studies showed a beneficial effect of personalized behavior management
program delivered within natural community settings for persons with brain injury
and their caregivers. Two other studies showed the relevance of scheduled
telephone interventions to improve depressive symptoms and one study emphasized
the usefulness of physical training. One study investigated the relevance of an
outreach program; this study showed an improvement of the patients' independence
but did not yield any conclusions regarding anxiety and depression. DISCUSSION
AND RECOMMENDATIONS: In addition to the application of care pathways already
established by the SOFMER, prevention of behavioral and affective disorders for
brain-injured outpatients should involve pain management, as well as development
of therapeutic partnerships. It is recommended to inform patients, their family
and caregivers regarding the local organization and facilities involved in the
management of traumatic brain injury. The relevance of therapeutic education for
implementing coping strategies, educating caregivers on behavioral disorder
management, follow-up telephone interventions, and holistic therapy seems
established. The level of evidence is low and preliminary studies should be
confirmed with larger controlled trials.
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Langue : ANGLAIS