Nutrition therapy in patients with moderate to severe traumatic brain injury in the inpatient rehabilitation and subacute setting: A scoping review.

Abstract

Patients with moderate to severe traumatic brain injury (TBI) often face prolonged rehabilitation. These individuals experience elevated nutrition needs and barriers to normal eating behaviours, necessitating effective nutrition therapy to enhance rehabilitation and recovery. Existing nutrition research focuses on intensive and acute care settings, with a notable lack of evidence in the rehabilitation and subacute contexts. This scoping review aims to describe evidence on nutrition therapy and outcomes for adult patients with moderate to severe TBI in inpatient rehabilitation and subacute settings and identify gaps to guide future research. A systematic scoping review was conducted in accordance with PRISMA guidelines, comprising of a literature search of CINAHL and MEDLINE for studies published between January 2010 and August 2024. Articles were included if they were: quantitative studies in adults (≥16 years) with a moderate to severe TBI, admitted to a rehabilitation or subacute facility, that addressed an aspect of nutrition therapy. Data were extracted on study design, patient characteristics, TBI severity, and nutrition-related results. Data were categorised and synthesised according to the study design, nutrition intervention, and outcomes. A total of seventeen studies were identified, comprising between 7 to 1701 participants. Among these, nine studies were prospective observational, seven were retrospective observational, and one was a randomised controlled trial. The investigations covered various aspects of nutrition management: ten focused on the route of nutrition delivery, four assessed nutrition status, three evaluated specific nutrient intakes, and one examined eating behaviours (two studies addressed multiple interventions). Evidence on nutrition management practices for patients with a TBI admitted to a rehabilitation or subacute setting is sparce, with only one interventional study identified, and observational studies predominantly exploring route of nutrition delivery. Further research is essential to delineate optimal nutritional therapies for adults with TBI in rehabilitation and subacute settings to guide clinical care.