Design of a web-based intervention for the rehabilitation of balance following traumatic brain injury in military personnel

Abstract

Traumatic Brain Injury (TBI) is the most common neurological injury treated at the Defence Medical Rehabilitation Centre accounting for approximately 80% of referrals to the Neurological Rehabilitation Team (Dharm-Datta et al. 2015). TBI is associated with a range of deficits including physical, cognitive, behavioural and those effecting executive function (Jaeger et al. 2014). Balance problems have been shown to be present long-term in 43% of persons with TBI, and dizziness symptoms are present in up to 80% of TBI patients in the first 24 hours (Jourdan et al. 2016, Maskell et al. 2007). ‘Balance Retraining’, is a web-supported programme, that assists older people to overcome balance problems and dizziness symptoms (Essery et al. 2015), but it has not been designed for use by people with TBI, taking into consideration their potential range of deficits. Gaining an understanding of the target population is vital to create an intervention that is accessible to people with TBI. This study aimed to design an online balance rehabilitation programme for military personnel with TBI. The objective was to conduct FGs with HCPs that have experience of working military personnel who have sustained a TBI. The FGs aimed to discover their experiences of working with this population and gain their opinions on the existing ‘Balance Retraining’ programme to discover if changes were necessary so that it could be used by people in the military with TBI. This was an Interpretative Phenomenological Analysis study. A combination of previously described IPA methods were used to analyse the FG data. These findings were then used to inform design changes for a prototype website. Findings from the FGs discovered that TBI is a complex and multi-faceted disorder and each TBI patient is unique. To meet these individual needs HCPs described the importance of a specialist MDT and the need to consider each patients’ complexities when conducting balance rehabilitation. Being in the military is described as resulting in different challenges and demands from their rehabilitation. These complexities all effect the design of a web-based programme for this population and these factors were described in five categories, visual presentation, military concepts, programme features, communicating information and getting patient buy in. Subsequent research should focus on creating a prototype website using the findings from this study. Think-aloud studies with TBI patients in the military followed by a series of case studies and a feasibility study should be considered to develop and create the prototype website programme.

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Identifiers

ORCID for Jane Burridge: orcid.org/0000-0003-3497-6725

ORCID for Ann-Marie Hughes: orcid.org/0000-0002-3958-8206

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