DEVELOPMENT OF EXPERT CONSENSUS TO GUIDE PHYSICAL REHABILITATION IN CHILDREN AND ADOLESCENTS WITH ACQUIRED BRAIN INJURY DURING THE SUBACUTE PHASE

OBJECTIVE: To develop consensus among experts to guide physical rehabilitation in children and adolescents with acquired brain injury during the subacute phase. DESIGN: International Delphi study. METHODS: A 3-round online Delphi study was conducted with 11 international experts in rehabilitation for children and adolescents with acquired brain injury. The first round consisted of open-ended questions; the second and third round consisted of ranking 139 statements on a 5-point Likert scale. RESULTS: The panel reached consensus on 116/139 statements. Consensus was reached on the importance of age, pre-injury developmental stage and the clinical presentation of the child when determining content and focus of physical rehabilitation. In addition, consensus was reached on the importance of participation-focused interventions, and involvement of family members in goal-setting and therapeutic activities. Although dosage was deemed very important, no consensus was reached for determination of dose-response variables to suit and influence the child’s needs. CONCLUSION: This study provides a framework for clinicians to design physical rehabilitation interventions in children with acquired brain injury in the sub-acute recovery phase. The promotion of physical activity in meaningful contexts and involvement of family members are considered as important components to optimize recovery. LAY ABSTRACT Children and adolescents with acquired brain injury are often admitted to rehabilitation services, which have great potential to improve their recovery. However, based on available research, it is unclear how an optimal rehabilitation programme should be created and offered. Therefore 139 statements were developed with an international expert-panel about physical rehabilitation in children with acquired brain injury, of which 116 statements reached consensus. The panel agreed on the importance of an early start of meaningful physical activities and the involvement of family members. Physical activity is seen as an important factor in recovery and the amount (frequency, intensity, time) of practice is suggested to have potential impact on the recovery of children with acquired brain injury. In addition, emphasis is given to the importance of an individualized approach. This research provides a framework for clinicians to design optimal physical rehabilitation interventions in children with acquired brain injury in the sub-acute recovery phase.