title: Service utilisation in a public post-acute rehabilitation unit following traumatic brain injury.
abstract: Traumatic brain injury (TBI) causes disability in a proportion of survivors across the spectrum of injury severity. Previous research suggests physical changes are the primary focus of rehabilitation, although cognitive, emotional and behavioural difficulties cause greater concern in the long-term. There is little information about services accessed by those with mild injuries, who often have no physical disabilities. This study investigated factors determining service utilisation in a population-based sample which included 52% mild injuries (PTA ≤ 24 hours). Chi-squares and t-tests were used to examine the impact of demographic, clinical, psychological and physical variables on referral of 175 TBI patients to clinical disciplines in a public, community-based rehabilitation facility in Hobart, Tasmania. Increased service intensity (total disciplines referred to), was associated with greater injury severity (p = .006) and previous TBI (p = .041). Less traditional rehabilitation services (nursing, psychology) received more referrals than traditional disciplines (physiotherapy, occupational therapy, social work). Referral to physiotherapy and occupational therapy was associated with greater injury severity, functional dependence, hospitalisation and older age. Referral to nursing, psychology and social work was associated with more post-concussion symptoms, younger age, anxiety, depression and assault-related injury. The large number of referrals to psychology strengthens the case for including it as a core rehabilitation discipline.
authors.affiliation: a School of Psychology , University of Tasmania , Hobart , Australia.
authors.forename: Gillian
authors.initials: G
authors.lastname: Ta'eed
authors.forename: Clive
authors.initials: C
authors.lastname: Skilbeck
authors.forename: Mark
authors.initials: M
authors.lastname: Slatyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000534:rehabilitation*; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D066086:Health Services for Persons with Disabilities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009788:Occupational Therapy / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Clinical disciplines; Community; Rehabilitation; Service utilisation; TBI