Clinician perspectives on challenges and enablers in cognitive rehabilitation following Traumatic Brain Injury: insights from an international survey.

Abstract

To identify clinician perspectives of challenges and enablers in delivery of cognitive rehabilitation to clients with moderate or severe Traumatic Brain Injury (TBI), providing updated international insight following recent practice guidelines. Multidisciplinary healthcare professionals working in adult TBI rehabilitation recruited through professional networks and snowball sampling, responded to an international survey on cognitive rehabilitation practices. Four hundred and forty-seven clinicians provided free text responses describing barriers and facilitators to cognitive rehabilitation practice and outcomes. Data were analysed using deductive-inductive content analysis. At the client level, client motivation and self-awareness, and family and contextual support were key enablers of cognitive rehabilitation. Clinician knowledge, skills, and confidence impacted delivery, with deficiencies in practical skill application impeding cognitive rehabilitation. Therapeutic relationships and a flexible and creative approach facilitated delivery. Systemic factors including poor team cohesion, inadequate funding, time and resource constraints, and setting limitations hindered effective rehabilitation. These findings highlight key barriers and facilitators to cognitive rehabilitation delivery following TBI. Working with family in context, providing practical skills training for clinicians in complex environments and addressing setting and system barriers including staffing, funding, and capacity to access real-world contexts, represent modifiable factors to be addressed in order to enhance cognitive rehabilitation delivery.Implications for rehabilitationClient motivation and self-awareness, family support, and collaborative multidisciplinary teams were identified as important enablers of effective cognitive rehabilitation delivery.Systemic barriers to cognitive rehabilitation reflected structural determinants requiring policy-level change, including improved funding, the formal integration of cognitive rehabilitation within rehabilitation service frameworks, and continuity of care into the community.Clinicians experience challenges applying evidence-based cognitive rehabilitation within real-world settings and may benefit from training and practical guidance that strengthens implementation enablers.