Australian Physical Activity Clinical Practice Guideline for people with moderate to severe traumatic brain injury: Technical Report

Abstract

Background In 2020, the World Health Organization (WHO) released updated physical activity and sedentary behaviour guidelines, which for the first-time included a guideline for people living with disability. The disability guideline is based on evidence from the general population and eight common health conditions causing disability, but did not include people with traumatic brain injury (TBI), nor did it consider the rehabilitation phase of recovery from injury. In 2019, the Australian federal government launched the Traumatic Brain Injury Mission. The Mission was tasked with providing $50 million over 10 years under the Medical Research Future Fund (MRFF) to support research. The goal of the Mission is to better predict recovery outcomes after a TBI, identify the most effective care and treatments, and reduce barriers to support people to live their best possible life after TBI. In 2021, our team was funded through the MRFF TBI Mission to develop an Australian Physical Activity Clinical Practice Guideline for people living with moderate to severe TBI (msTBI). The overarching project to guide the development of the guideline was called BRIDGES (BRain Injury: Developing GuidElineS for physical activities). Objective To develop an Australian clinical practice guideline to support the clinical decision-making of health professionals working with people with msTBI and increase uptake of safe and beneficial physical activity by people living with msTBI. Methods The overarching BRIDGES project was guided by the Exploration Preparation Implementation Sustainment (EPIS) framework. We used a Grading of Recommendations Assessment, Development and Evaluation (GRADE) ADOLOPMENT approach to determine whether to ‘adapt’ or ‘adopt’ the WHO guideline or develop de novo recommendations. We established guideline leadership and development groups, conducted a rapid systematic review to identify direct evidence in TBI, and reviewed guidelines in other relevant health conditions (i.e., stroke, cerebral palsy) to identify indirect evidence. To further inform guideline development and implementation considerations, we conducted an audit of brain injury services in Australia and qualitative consultations with key stakeholders, including people with msTBI. Results Direct evidence for the prescription of physical activity for people with msTBI is limited. The clinical practice guideline developed incorporates 10 de novo evidence-based recommendations with additional good practice points and precautionary practice points to guide clinical decision-making. The physical activity recommended is aerobic exercise, strength training, mobility training, sport and physical recreation, and promotion of physical activity. The physical activity is recommended for children, adolescents, adults, and older adults across the continuum of rehabilitation. Conclusion While there remain evidence gaps that require further research, and further work on how the guideline can be implemented into clinical practice is needed, physical activity interventions tailored to the individual’s goals and needs should be standard clinical practice for health professionals working with people with msTBI in Australian rehabilitation, community, home, and school (for children and adolescents) settings