Cecilie Røe

• Sveinall, Håkon; Røe, Cecilie; Engebretsen, Kaia Beck; Skatteboe, Sigrid; Pripp, Are Hugo & Brox, Jens Ivar [Show all 7 contributors for this article] (2026). Patient expectations assessed before randomisation and after the first treatment session, and their associations with pain outcome at 3 months in patients with tennis elbow: a secondary analysis of a randomised controlled feasibility trial in Norwegian secondary care. BMJ Open. 16(9). doi: 10.1136/bmjopen-2026-122686. Full text in Research Archive Show summary

  Objective: To evaluate patients' expectations of pain improvement before randomisation (T1) and after the first treatment (T2), and to examine how expectations at these two time points were associated with pain outcome measured at 3 months (T3). Design: Exploratory secondary analyses of a three-arm, randomised controlled feasibility trial in patients with tennis elbow comparing heavy slow resistance training, shock wave therapy and advice (1:1:1). Setting: Outpatient clinic at Oslo University Hospital. Participants: Adults with lateral epicondylalgia, commonly known as tennis elbow. Main outcome measures: Expected pain was rated on a Numeric Rating Scale (NRS, 0-10) at T1 and T2. Present pain (NRS, 0-10) was reported at 3 months (T3). Changes in expectations from T1 to T2 were summarised descriptively. Univariable linear regressions assessed associations between T3 pain and expectations at T1 and T2, treatment group and baseline factors. Explained variance was quantified by R2. Multivariable models including demographics and baseline pain were evaluated via adjusted R2. Results: Fifty-four participants were included. In the shock wave group, nine (47%) came to expect greater improvement from T1 to T2; by contrast, in the advice group, seven (41%) expected less improvement. Expectations at T1 were not associated with T3 pain, whereas expectations at T2 were positively associated with T3 pain (b=0.61, 95% CI 0.33 to 0.89, p<0.01, R2=0.27), suggesting that higher expected pain at T2 was associated with higher reported pain at T3. Adding education and baseline pain increased explained variance modestly (R2 from 0.27 to 0.32). Conclusion: In this study, expectations measured after randomisation and one treatment session were associated with pain at 3 months for patients with tennis elbow. Larger, prospectively designed studies should investigate how postrandomisation expectations relate to clinical outcomes in non-blinded musculoskeletal trials.

• Kleffelgård, Ingerid; Valaas, Lars-Johan; Søberg, Helene Lundgaard; Hadzic-Andelic, Nada; Røe, Cecilie & Steenstrup, Sophie [Show all 10 contributors for this article] (2026). The impact of persistent post-concussion symptoms and exercise intolerance on patient-specific functioning after mild traumtatic brain injury: a biopsychosocial persepctive. Journal of Rehabilitation Medicine. ISSN 1650-1977. 58. doi: 10.2340/jrm.v58.45811. Full text in Research Archive
• Valaas, Lars-Johan; Søberg, Helene Lundgaard; Rasmussen, Mari Storli; Steenstrup, Sophie; Brunborg, Cathrine & Røe, Cecilie [Show all 7 contributors for this article] (2026). Effects of sub-symptom threshold aerobic exercise on persistent postconcussion symptom burden and exercise intolerance: a randomized controlled trial. Physical Therapy & Rehabilitation Journal (PTJ). ISSN 0031-9023. 106(6). doi: 10.1093/ptj/pzag049. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; DAHL, HILDE MARGRETE; Borgen, Ida Maria Henriksen & Hauger, Solveig L. [Show all 12 contributors for this article] (2026). Effects of an individualized and goal-oriented intervention in the chronic phase of pediatric acquired brain injury: the Child in Context Intervention (CICI)—a randomized controlled trial. BMC Pediatrics. doi: 10.1186/s12887-026-06997-y. Full text in Research Archive
• Vreeburg, Rick J.G.; Singh, Ranjit D.; Yue, John K.; Dijck, Jeroen T.J.M. van; Boogert, Hugo F. den & Posti, Jussi P. [Show all 262 contributors for this article] (2026). The effectiveness of decompressive craniectomy size in traumatic brain injury; an international, observational, comparative effectiveness study. Brain and Spine. 6. doi: 10.1016/j.bas.2026.106019. Full text in Research Archive Show summary

  Introduction Guidelines recommend large decompressive craniectomies (DC) in traumatic brain injury (TBI), yet the optimal size remains debated. Real-world practice often differs from guideline recommendations and generalizability of prior evidence to a broader TBI population is uncertain. Research question What is the comparative effectiveness of DC size on 12-month functional outcome in TBI? Material and methods We selected participants enrolled in the CENTER-TBI diagnosed with TBI who received a hemicraniectomy. Effect of DC size on functional outcome was evaluated with random-effects logistic regression, associating center case-mix adjusted DC sizes to GOSE. Center preference was quantified with the median odds ratio (MOR). Results Among 4509 patients enrolled in CENTER-TBI, 295 underwent a hemicraniectomy. DC size varied from 37 cm2 to 165cm2 (IQR 96 cm2-123cm2, ellipsoid calculation), with a two-times higher probability of receiving a 27 cm2 larger (IQR increase) DC for a similar patient in one center versus another random center (adjusted MOR for DC size 1·7). Only 4 patients received a DC ≥ 12 × 15 cm (cm) or 15 cm in diameter, while 0 patients received a DC ≤ 6 × 8 cm. Larger DC size was not associated with more favorable 12-month GOSE scores (aOR 0.73 for 27 cm2 increase in DC size, 95%CI 0.47-1.1). Discussion and conclusion DC size varied widely across European centers. Recommended DC sizes were rarely reached, as were very small DC sizes. Larger versus smaller DC was associated with similar outcomes, however heterogeneity in DC indication may have attenuated observable treatment effects. Neurosurgeons may continue to prefer larger over smaller decompressions.

• Hadzic-Andelic, Nada; Lu, Juan; Fure, Silje Christine Reistad; Brunborg, Cathrine; Løvstad, Marianne & Røe, Cecilie [Show all 7 contributors for this article] (2026). Effects of cognitive–vocational rehabilitation on post-concussion symptoms and emotional distress: a secondary RCT analysis. Brain Injury. ISSN 0269-9052. doi: 10.1080/02699052.2026.2654829. Full text in Research Archive
• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Show all 7 contributors for this article] (2026). Treatment trajectories among patients with musculoskeletal disorders in Norway–a register-based cohort study over 2 years. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1), p. 1–15. doi: 10.1080/02813432.2026.2633751. Full text in Research Archive Show summary

  Objective Explore treatment trajectories over a two-year follow-up among patients with musculoskeletal disorders (MSDs) in Norway and investigate the associations with education and country of origin. Design Register-based cohort study. Settings Data were obtained from three national registers, the Norwegian Control and Payment of Health Reimbursements Database (KUHR), the Norwegian Patient Registry (NPR) and Statistics Norway (SSB). Subjects Patients diagnosed with MSDs in 2015 in primary healthcare according to the International Classification of Primary Care, second edition (ICPC-2). Main outcome measures Treatment trajectory classes of healthcare use over a 2-years follow-up were generated using group-based multi-trajectory modelling, for all patients registered with MSDs and three common diagnoses: spine pain, osteoarthritis and fibromyalgia. Results From the analysis, four treatment trajectory classes of healthcare use were identified for MSD patients overall; low (75%), stable (10%), descending (9%) and high use (5%). The pattern was almost similar for the three diagnostic groups. High use was primarily caused by consistent high use of physiotherapy. For MSD patients overall, low education increased the probability of being in the low and stable use classes, while high education increased the probability of being in the descending use class. Patients with Norway as country of origin, were less likely to be in the class with low use and more likely to be in the class with descending use. Conclusion Using nationwide register data and group-based multi-trajectory modelling show that about 75% of all patients with MSD, consulting primary healthcare in Norway, were classified as low users of healthcare services and 5% were classified as high users. Overall, both education and country of origin were associated with the treatment trajectory classes. However, high use was not associated with neither education nor country of origin.

• Bjorland, Siri; Bjørneboe, John Andreas; Røe, Cecilie; Taso, Mirad; Engebretsen, Kaia Beck & Skatteboe, Sigrid [Show all 9 contributors for this article] (2026). Cognitive functional therapy for persistent neck pain. Pain Management. p. 1–9. doi: 10.1080/17581869.2026.2625646. Full text in Research Archive Show summary

  Aims: Persistent neck pain is a leading cause of years lived with disability. The aim of the current study is to describe and evaluate cognitive functional therapy for patients with persistent neck pain. Methods: We recruited 74 patients (73% women) aged 22–76 years, with persistent neck pain. The outcomes were neck pain at activity and rest measured by 11-point numeric rating scales (NRS), disability by Neck Disability Index (NDI) (0–100), Fear Avoidance Beliefs Questionnaire (FABQ), Hopkin Symptom Check List (HSCL-10) at baseline and post-treatment. The treatment program included 5 sessions and focused on cognitive strategies and exposure to physical activities. Results: Sixty (81%) patients had follow-ups. Neck pain during activity was reduced by a mean of 3.3 (95% Confidence interval (CI) 2.6 to 3.2) and 2.5 (95% CI 1.9 to 3.1) at rest. NDI was reduced by 16.3 (95% CI 12.0–20.5). Similar large improvements were observed for FABQ and HSCL-10. Ninety-eight percent of the participants reported that they would recommend the program to other patients. Conclusions: Clinically relevant improvements were observed in pain, disability, fear-avoidance beliefs, and emotional distress following CFT in patients with persistent neck pain.

• Graziano, Francesca; Guglielmi, Angelo; Consonni, Michela; Ogliari, Giorgia; Younsi, Alexander & Valla, Margherita [Show all 259 contributors for this article] (2026). Paediatric traumatic brain injury: clinical presentation, treatment approaches, management strategies, and outcomes. Insights from the CENTER-TBI study. Journal of Anesthesia, Analgesia and Critical Care. 6. doi: 10.1186/s44158-025-00312-4. Full text in Research Archive Show summary

  Objective: This observational study aims to describe the characteristics and management of paediatric head-injured patients across different paediatric age groups, compared with adults. Design: Secondary analysis of the CENTER-TBI study. Setting: 65 centers in Europe between December 2014 and December 2017. Patients: Patients with traumatic brain injury (TBI) admitted to the hospital were divided into different age groups: paediatrics (pTBI, age ≤ 17 years), adults (18-65 years), and elderly (> 65 years). Paediatrics were further subdivided into three groups: toddlers (from 0 to 4 years), children (from 5 to 12 years), and adolescents (from 13 to 17 years). Interventions: None. Measurements and main results: 3,661 patients were included in the analysis (2,138 admitted to the intensive care unit (ICU) and 1,523 to the ward). Among these, 227 were paediatric (27 toddlers [0-4 years], 65 children [5-12 years], and 135 adolescents [13-17 years]). Most pTBI patients admitted to the ICU presented with mild injuries (Glasgow Coma Scale [GCS] 13-15; 66%), although severe injuries (GCS ≤ 8) were more common in adolescents (23.8%). Susceptibility to neuroworsening and seizures was low in the paediatric group (6% and 3.5%, respectively). Intracranial pressure monitoring was performed in 52 (39.4%) of 132 paediatric ICU patients. Paediatric patients received less intensive therapy targeted to the intracranial pressure (ICP) control particularly in toddlers. Age below 18 years was associated with a lower risk of poor neurological outcomes at six months, particularly in adolescents and children (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.15-0.58 p < 0.001 and OR = 0.29, 95% CI = 0.09-0.71, p < 0.001, respectively). In toddlers, the association was not statistically significant (OR = 0.48, 95% CI = 0.07-1.94, p = 0.4). Conclusions: Paediatric TBI differs significantly from non-paediatric cases, with predominantly mild injuries, lower neuroworsening rates, and less intensive management, especially in younger children. Outcomes at six months are generally more favorable in paediatric patients, emphasizing the need for age-specific management strategies in TBI care.

• Bjørneboe, John Andreas; Brox, Jostein Skranes; Myhre, Kjersti; Taso, Mirad; Werner, Erik Lønnmark & Røe, Cecilie [Show all 7 contributors for this article] (2025). Henvisninger til spesialisthelsetjenesten for pasienter med smerter i nakke og rygg. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(9). doi: 10.4045/tidsskr.24.0324. Full text in Research Archive
• Røe, Cecilie; Heide, Marte; Søberg, Helene Lundgaard; Brunborg, Cathrine; Hoksrud, Aasne Fenne & Myhre, Kjersti [Show all 8 contributors for this article] (2025). One-Year Trajectory of Pain, Function, and Health-Related Quality of Life in Patients With Plantar Fasciopathy. Journal of Foot and Ankle Research. 18(3). doi: 10.1002/jfa2.70067. Full text in Research Archive
• Howe, Emilie Isager; Søberg, Helene L.; Røe, Cecilie; Løvstad, Marianne & Andelic, Nada (2025). “What standard should we set?”: A qualitative study of rehabilitation professionals’ perspectives on rehabilitation needs after traumatic injuries. Journal of Rehabilitation Medicine. ISSN 1650-1977. 57. doi: 10.2340/jrm.v57.44087. Full text in Research Archive Show summary

  Objective: To assess rehabilitation professionals’ perspectives on unmet rehabilitation needs in patients with traumatic injuries and how to bridge the gap between met and unmet needs. Design: Semi-structured focus-group interviews analysed using a reflexive thematic approach. Methods: Eighteen strategically sampled health professionals (67% female, aged 27–56 years) from specialist and community-based rehabilitation services in Northern and South-Eastern Norway were interviewed regarding their perspectives on alignment of current rehabilitation services with patient needs, reasons for misalignment, and potential service improvements. Results: Care continuity and multidisciplinary collaboration was identified as essential for high-quality rehabilitation services. Unmet needs were noted in community-based services for cognitive and mental health support, as well as financial assistance for patients. Health professionals faced challenges prioritizing patient needs and expressed frustration with not being able to provide legally mandated services. Contributing factors included insufficient resources, lack of competency standards, and weak organizational structure. Suggested improvements were early rehabilitation assessments and stronger collaboration between specialist and community services. Conclusions: Strengthening community-based rehabilitation for traumatic injuries requires establishing professional competency standards, stronger coordination across care levels, and greater integration of psychosocial support. Advancing these dimensions calls for critical reflection on clinical practice, service organization, and health policy.

• Whitehouse, Daniel P.; Wilson, Lindsay; Czeiter, Endre; Buki, Andras; Wang, Kevin K.W. & Steinbüchel, Nicole von [Show all 260 contributors for this article] (2025). Association of Blood-Based Biomarkers and 6-Month Patient-Reported Outcomes in Patients With Mild TBI. Neurology. ISSN 0028-3878. 104(1). doi: 10.1212/wnl.0000000000210040. Full text in Research Archive Show summary

  Background and objectives: There is seemingly contradictory evidence concerning relationships between day-of-injury biomarkers and outcomes after mild traumatic brain injury (mTBI). To address this issue, we examined the association between a panel of biomarkers and multidimensional TBI outcomes. Methods: Participants with mTBI (Glasgow coma scores [GCSs] 13-15) were selected from Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury, a European observational study recruiting patients with TBI with indication for brain CT and presentation within 24 hours. Exclusion criteria for this secondary analysis were age younger than 16 years, incomplete biomarker panel, death, or no recorded outcomes. Participants were separated into 2 groups, CT-negative and CT-positive. Multivariable binary logistic regression was used to assess the relation between the log biomarker level (glial fibrillary acidic protein [GFAP], neurofilament light [NfL], neuron-specific enolase [NSE], S100 calcium-binding protein B [S100B], tau, ubiquitin C-terminal hydrolase L1 [UCH-L1]) and dichotomized 6-month outcomes (functional outcomes [GOSE score <8], health-related quality of life [HRQoL; Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) score <52, Short-Form 12-Item Survey version 2 Mental Component Summary (SF12v2 MCS) score <40, Short-Form 12-Item Survey version 2 Physical Component Summary (SF12v2 PCS) score <40], persistent postconcussion symptoms [Rivermead Post-Concussion Symptoms Questionnaire score ≥16], anxiety disorder [Generalized Anxiety Disorder-7 (GAD-7) score ≥8], depression [Patient Health Questionnaire-9 (PHQ-9) score ≥10], and post-traumatic stress disorder [PTSD Checklist for DSM-5 (PCL-5) score ≥33]). Results: A total of 1,589 participants (865 CT-negative, 724 CT-positive) were included (77% GCS 15, median age 52 years, 66% male). Higher biomarker levels were associated with a GOSE score <8: CT-negative: S100B (odds ratio [OR] 1.78, 95% CI 1.43-2.23) and UCH-L1 (OR 1.16, 95% CI 1.01-1.33); CT-positive: GFAP (OR 1.22, 95% CI 1.11-1.36), NfL (OR 1.30, 95% CI 1.11-1.52), S100B (OR 1.51, 95% CI 1.23-1.86), tau (OR 1.36, 95% CI 1.17-1.59), and UCH-L1 (OR 1.34, 95% CI 1.17-1.53). In CT-positive participants, positive association was seen between NfL (OR 1.3, 95% CI 1.06-1.60) and UCH-L1 (OR 1.28, 95% CI 1.07-1.54) with QOLIBRI-OS; S100B (OR 1.32, 95% CI 1.02-1.70) with SF12v2 PCS; and NSE (OR 1.52, 95% CI 1.06-2.18) and UCH-L1 (OR 1.21, 95% CI 1.01-1.46) with the GAD-7. However, in CT-negative participants only, negative associations were seen between GFAP and impairment on the QOLIBRI-OS (OR 0.76, 95% CI 0.66-0.88), SF12v2 MCS (OR 0.71, 95% CI 0.61-0.82), SF12v2 PCS (OR 0.79, 95% CI 0.68-0.91), GAD-7 (OR 0.80, 0.68-0.95), PHQ-9 (OR 0.80, 95% CI 0.68-0.93), and PCL-5 (OR 0.80, 95% CI 0.66-0.97). Discussion: Participants with higher biomarker levels had greater odds of impaired functional recovery. However, in CT-negative participants, higher GFAP concentrations were associated with better HRQoL and less impaired mental health. Further exploration is required of the patient phenotypes that may explain the relationships observed in this analysis.

• Mikolić, Ana; Klaveren, David van; Jost, Mathilde; Maas, Andrew IR; Shi, Shuyuan & Silverberg, Noah D [Show all 246 contributors for this article] (2025). Prognostic models for depression and post-traumatic stress disorder symptoms following traumatic brain injury: a CENTER-TBI study. BMJ Mental Health. 28(1). doi: 10.1136/bmjment-2024-301181. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is associated with an increased risk of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). We aimed to identify predictors and develop models for the prediction of depression and PTSD symptoms at 6 months post-TBI. Methods We analysed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. We used linear regression to model the relationship between predictors and depression (Patient Health Questionnaire-9) and PTSD symptoms (PTSD Checklist for Diagnostic and Statistical Manual for Mental Health Disorders Fifth Edition). Predictors were selected based on Akaike’s Information Criterion. Additionally, we fitted logistic models for the endpoints ‘probable MDD’ and ‘probable PTSD’. We also examined the incremental prognostic value of 2–3 weeks of symptoms. Results We included 2163 adults (76% Glasgow Coma Scale=13–15). Depending on the scoring criteria, 7–18% screened positive for probable MDD and about 10% for probable PTSD. For both outcomes, the selected models included psychiatric history, employment status, sex, injury cause, alcohol intoxication and total injury severity; and for depression symptoms also preinjury health and education. The performance of the models was modest (proportion of explained variance=R2 8% and 7% for depression and PTSD, respectively). Symptoms assessed at 2–3 weeks had a large incremental prognostic value (delta R2=0.25, 95% CI 0.24 to 0.26 for depression symptoms; delta R2=0.30, 95% CI 0.29 to 0.31 for PTSD). Conclusion Preinjury characteristics, such as psychiatric history and unemployment, and injury characteristics, such as violent injury cause, can increase the risk of mental health problems after TBI. The identification of patients at risk should be guided by early screening of mental health.

• Nelson, Lindsay D.; Magnus, Brooke E.; Yue, John K.; Balsis, Steve; Patrick, Christopher J. & Temkin, Nancy [Show all 272 contributors for this article] (2025). Beyond mild, moderate, and severe traumatic brain injury: modelling severity from clinical, neuroimaging, and blood-based indicators. EBioMedicine. 121. doi: 10.1016/j.ebiom.2025.106001. Full text in Research Archive Show summary

  Background: The conventional clinical approach to characterising traumatic brain injuries (TBIs) as mild, moderate, or severe using the Glasgow Coma Scale (GCS) total score has well-known limitations, prompting calls for more sophisticated strategies. Methods: We used item response theory (IRT) to develop a new method for quantifying TBI severity using 24 clinical, head computed tomography, and blood-based biomarker variables familiar to clinicians and researchers. IRT uses individuals' response patterns across indicators to estimate relationships between the indicators and a latent continuum of TBI severity. Model parameters were used to assign severity scores in two large cohorts, and associations with traditional GCS categories and 6-month functional outcomes (Glasgow Outcome Scale-Extended [GOSE]) were tested with correlational and logistic regression analyses. Findings: In the prospective Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort (N = 2545), modelling showed the 24 indicators index a common latent continuum of TBI severity. IRT enabled us to identify the relative contribution of these features to estimate an individual's TBI severity. Finally, within both the TRACK-TBI derivation sample and an external validation sample (Collaborative European NeuroTrauma Effectiveness Research in TBI [CENTER-TBI]), TBI severity scores generated using this novel IRT-based method incrementally predicted functional (GOSE) outcome better than classic clinical (mild, moderate, severe) or International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) classification methods. Interpretation: Our findings directly inform ongoing international efforts to refine and deploy new pragmatic, empirically-supported strategies for characterising TBI, while illustrating a strategy that may be useful to improve staging systems for other diseases.

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Soberg, Helene Lundgaard & Røise, Olav [Show all 15 contributors for this article] (2025). Early Injury-Related Predictors of Disability 6 Months After Moderate to Severe Trauma: A Longitudinal Study. Disabilities. 5(3). doi: 10.3390/disabilities5030073. Full text in Research Archive Show summary

  Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs.

• Bjørneboe, John Andreas; Røe, Cecilie; Brox, Jens Ivar; Sveinall, Håkon; Ignatius, Janica Sofia & Wilhelmsen, Maja [Show all 7 contributors for this article] (2025). Responsiveness and minimal important change of neck disability index and numeric pain rating scale for neck patients in the Norwegian neck and back register. European spine journal. ISSN 0940-6719. 34(6), p. 2219–2226. doi: 10.1007/s00586-025-08836-7. Full text in Research Archive Show summary

  Purpose To evaluate the responsiveness and the minimal important change (MIC) of Neck Disability Index (NDI) and pain during activity by the numeric rating scale (NRSa) in the Norwegian neck and back registry (NNRR). Materials and methods Participants with neck pain responding to baseline, 6 and 12-months follow-up in the NNRR were included. Responsiveness was calculated using the area under the receiver operating characteristic (ROC). The minimal important change (MIC) was calculated with an anchor-based method and distribution-based methods. For the anchor-based method we used the Patient Global Impression of Change (PGIC) as the anchor. The PGIC was on a 7-point Likert scale, and trichotomized into three ordinal categories. Results A total of 551 patients with neck pain were included. Among these patients, 60% were women with an average age of 48, and 63% had experienced neck pain for more than one year. For improved patients NDI and NRSa had adequate responsiveness at both follow-ups. MIC calculations using an anchor-based method were more accurate than those using a distribution-based method, which fell below the measurement error for the instruments. Using anchor-based calculation of MIC, the MIC for NDI was 17 at the 6-months follow-up and 9 at 12-months follow-up. Correspondingly, NRSa had a MIC of 2.5 at both follow-ups. Conclusion NDI and NRSa were responsive at both 6-months and 12-months follow-up and can be used in registries following patients with neck pain over time.

• Bhattacharyay, Shubhayu; Leeuwen, Florian D. van; Beqiri, Erta; Åkerlund, Cecilia A. I.; Wilson, Lindsay & Steyerberg, Ewout W. [Show all 257 contributors for this article] (2025). TILTomorrow today: dynamic factors predicting changes in intracranial pressure treatment intensity after traumatic brain injury. Scientific Reports. 15(1). doi: 10.1038/s41598-024-83862-x. Full text in Research Archive
• Sveinall, Håkon; Brox, Jens Ivar; Engebretsen, Kaia Beck; Hoksrud, Aasne Fenne; Røe, Cecilie & Johnsen, Marianne Bakke (2025). Measurement properties of core outcomes in patients with tennis elbow. Shoulder & Elbow. ISSN 1758-5732. 0(0), p. 1–14. doi: 10.1177/17585732251344264. Full text in Research Archive
• Madsen, Benedikte Årebrot; Fure, Silje Christine Reistad; Røe, Cecilie; Løke, Daniel; Løvstad, Marianne & Andelic, Nada [Show all 7 contributors for this article] (2025). The relationship between personality traits and health-related quality of life after mild-to-moderate traumatic brain injury. BMC Neurology. 25. doi: 10.1186/s12883-025-04153-0. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) causes major societal burden and may negatively influence an individual’s health-related quality of life (HRQoL). Personality factors have been linked to persistent post-concussion symptoms (PPCS), and PPCS have been found to affect HRQoL. However, there is a knowledge gap concerning the association between personality traits and HRQoL after mild-to-moderate TBI. Thus, this study aims to investigate the association between personality traits and HRQoL in patients with mild-to-moderate TBI at 15 months post-injury, while controlling for socio-demographic characteristics, injury-related factors and symptom burden. Methods Data from 86 participants with mild- to-moderate TBI from a previous randomised controlled trial were analysed. Sociodemographic, injury-related and psychological factors were recorded 2–3 months post-injury. Personality traits were measured at 15 months post-injury with The NEO Five-factor Inventory-3. The Quality of Life after Brain Injury– Overall Scale (QOLIBRI-OS) and the EuroQol-visual analogue scale (EQ-VAS) were used to measure HRQoL at 15 months post-injury. Two separate multiple linear regression models were performed for the outcome variables; QOLIBRI-OS (model 1) and EQ-VAS (model 2). Results The factors associated with lower HRQoL were more severe PPCS, higher levels of the personality traits neuroticism and conscientiousness (model 1), female sex and being single/living alone (model 2). Higher levels of the personality trait extraversion were associated with higher HRQoL in both models. Conclusion The results highlight how non-injury factors may be associated with recovery and HRQoL after TBI. Considering personality factors may be helpful when identifying individual risk and protective factors for outcomes after mild-to-moderate TBI.

• Selj, Joanna Nordhagen; Perrin, Paul B.; Hauger, Solveig Lægreid; Røe, Cecilie; Moksnes, Håkon Øgreid & Schäfer, Christoph [Show all 10 contributors for this article] (2025). Health-Related Quality of Life and Unmet Healthcare Needs in the First Year Following Moderate-to-Severe Traumatic Injuries-An Observational Study. Journal of Clinical Medicine. 14(12). doi: 10.3390/jcm14124213. Full text in Research Archive Show summary

  Background: Traumatic injuries often lead to long-lasting impairments and complex rehabilitation needs. Trauma patients report lower health-related quality of life (HRQoL) and increased needs for healthcare and social support. This study aimed to describe HRQoL trajectories in a Norwegian cohort with moderate-to-severe trauma over 12 months and assess the relationship between unmet needs and HRQoL. Methods: A multicenter prospective cohort study with follow-up at six and twelve months post-injury included adults aged 18+ with a New Injury Severity Score (NISS) > 9 and a minimum hospital stay of two days. HRQoL was assessed using the EQ-5D-5L. Needs and unmet needs were evaluated using the Needs and Provision Complexity Scale. Hierarchical linear modeling (HLM) examined predictors of HRQoL trajectories. Results: Of 538 participants, 83% were followed up at six and/or twelve months. Mean age was 52 years, falls were the most common cause of injury (44%), and 76% had a severe injury (NISS > 15). HRQoL remained stable, except for improvements in usual activities and anxiety-depression domains. HLM showed that older age (b = −2.698), longer hospital stay (b = −4.108), and unmet healthcare (b = −1.094) and social support needs (b = −3.132) were associated with worse HRQoL over time. Unmet personal care needs were linked to improved HRQoL (b = 2.654). The only significant predictor*time interaction was between unmet healthcare needs and overall HRQoL. Conclusions: HRQoL largely remained stable, with improvements in some domains. Unmet healthcare needs predicted a decline in HRQoL, highlighting the importance of timely support and targeted interventions from health professionals.

• Andelic, Nada; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Schäfer, Christoph; Hellstrøm, Torgeir & Howe, Emilie Isager [Show all 11 contributors for this article] (2024). Needs for Community-Based Rehabilitation Services and Support 12 Months After Moderate and Severe Physical Traumatic Injuries. American Journal of Physical Medicine & Rehabilitation. ISSN 0894-9115. 103(8), p. 740–744. doi: 10.1097/PHM.0000000000002492. Full text in Research Archive
• Gupta, Deepak; Singh, Ranjit D.; Vreeburg, Rick Jg; Dijck, Jeroen T.J.M. van; Boogert, Hugo den & Sharma, Kaveri [Show all 74 contributors for this article] (2024). Disparities in casemix, acute interventions, discharge destinations and mortality of patients with traumatic brain injury between Europe and India. Journal of Global Health. ISSN 2047-2978. doi: 10.7189/jogh.14.04227. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is a major global health problem that disproportionally affects low- and middle-income countries. The needs for patients with TBI therefore may differ between levels of national development. We aimed to describe differences in epidemiology and acute care provision of TBI between India and Europe. Methods We used data from two prospective observational registry studies – the Collaborative Indian NeuroTrauma Effectiveness Research in TBI (CINTER-TBI) and the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI), which included TBI patients with an indication for brain CT-scan presenting to 65 centres across Europe and Israel and two trauma centres in India. We performed descriptive analyses of demographic, injury, and treatment characteristics and used random-effects logistic regression with covariate adjustment to examine the likelihood of acute neurosurgical interventions and in-hospital mortality. Results We included 22 849 patients from CENTE

• Samanta, Romit J; Chiollaz, Anne-Cécile; Needham, Edward; Yue, John K; Helmy, Adel & Zanier, Elisa R. [Show all 61 contributors for this article] (2024). Parsimonious immune-response endotypes and global outcome in patients with traumatic brain injury. EBioMedicine. 118. doi: 10.1016/j.ebiom.2024.105310. Full text in Research Archive Show summary

  Background: The inflammatory response in patients with traumatic brain injury (TBI) offers opportunities for stratification and intervention. Previous unselected approaches to immunomodulation in patients with TBI have not improved patient outcomes. Methods: Serum and plasma samples from two prospective, multi-centre observational studies of patients with TBI were used to discover (Collaborative European NeuroTrauma Effectiveness Research [CENTER-TBI], Europe) and validate (Transforming Research and Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI] Pilot, USA) individual variations in the immune response using a multiplex panel of 30 inflammatory mediators. Mediators that were associated with unfavourable outcomes (Glasgow outcome score-extended [GOS-E] ≤ 4) were used for hierarchical clustering to identify patients with similar signatures. Findings: Two clusters were identified in both the discovery and validation cohorts, termed early-inflammatory and pauci-inflammatory. The early-inflammatory phen

• Kleffelgård, Ingerid; Forslund, Marit Vindal; Hauger, Solveig Lægreid; Røe, Cecilie; Bragstad, Line Kildal & Søberg, Helene L. [Show all 8 contributors for this article] (2024). Process evaluation of a complex intervention evaluating the effectiveness of home-based rehabilitation in the chronic phase of traumatic brain injury. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2024.2324119. Full text in Research Archive Show summary

  Purpose To perform a process evaluation of a randomized controlled trial (RCT) evaluating a manualized intervention aiming to ameliorate long-term symptoms of traumatic brain injury (TBI) by assessing implementation fidelity, delivery context and acceptability of the intervention. Methods Data from 60 participants were collected during recruitment, intervention delivery and outcome data collection in the RCT. Enrollment records, logs and checklists documented the delivery of the intervention (implementation fidelity) and the collaboration with family members and outside collaborators (delivery context). Attendance-rate, self-reported acceptability and willingness to participate in future studies were used to assess the acceptability of the intervention. Results The main elements and dose of the intervention were delivered as intended with an excellent adherence to the manual items. Family members co-participated in the intervention for 39 (65%) of the participants. Outside collaborators were contacted for 32 (53%) of the participants. Acceptability scores were high for participants, family members and therapists. Conclusions The intervention was successfully delivered with high acceptability. This process evaluation informs researchers, clinicians and stakeholders about important factors influencing the outcomes of the intervention that should be considered in clinical implementation of rehabilitation interventions.

• Howe, Emilie Isager; Andelic, Nada; Brunborg, Cathrine; Zeldovich, Marina; Helseth, Eirik & Skandsen, Toril [Show all 25 contributors for this article] (2024). Frequency and predictors of headache in the first 12 months after traumatic brain injury: results from CENTER-TBI. The Journal of Headache and Pain. ISSN 1129-2369. 25(1). doi: 10.1186/s10194-024-01751-0. Full text in Research Archive Show summary

  Background: Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury. Methods: A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors. Results: A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury. Conclusions: Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache. Trial registration: ClinicalTrials.gov NCT02210221.

• Kals, Mart; Wilson, Lindsay; Levey, Daniel F.; Parodi, Livia; Steyerberg, Ewout W. & Richardson, Sylvia [Show all 79 contributors for this article] (2024). Genetic vulnerability and adverse mental health outcomes following mild traumatic brain injury: a meta-analysis of CENTER-TBI and TRACK-TBI cohorts. EClinicalMedicine. doi: 10.1016/j.eclinm.2024.102956. Full text in Research Archive Show summary

  Background Post-traumatic stress disorder (PTSD) and depression are common after mild traumatic brain injury (mTBI), but their biological drivers are uncertain. We therefore explored whether polygenic risk scores (PRS) derived for PTSD and major depressive disorder (MDD) are associated with the development of cognate TBI-related phenotypes. Methods Meta-analyses were conducted using data from two multicenter, prospective observational cohort studies of patients with mTBI: the CENTER-TBI study (ClinicalTrials.gov ID NCT02210221) in Europe (December 2014–December 2017) and the TRACK-TBI study in the US (March 2014–July 2018). In both cohorts, the most common causes of injury were road traffic accidents and falls. Primary outcomes, specifically probable PTSD and depression, were defined at 6 months post-injury using scores ≥33 on the PTSD Checklist-5 and ≥15 on the Patient Health Questionnaire-9, respectively. We calculated PTSD-PRS and MDD-PRS for patients aged ≥17 years who had a Glasgow Coma Scale score of 13

• Røe, Cecilie; Borgen, Ida Maria Henriksen; Fure, Silje Christine Reistad; Forslund, Marit Vindal; Kleffelgård, Ingerid & Andelic, Nada [Show all 8 contributors for this article] (2024). The Participation Assessment with Recombined Tools-Objective (PART-O): measurement properties of the Norwegian version after traumatic brain injury. Brain Injury. ISSN 0269-9052. doi: 10.1080/02699052.2024.2304855. Full text in Research Archive Show summary

  Objective To translate and evaluate the validity of the Participation Assessment with Recombined Tools-Objective (PART-O) in a Norwegian context. Methods One hundred and twenty persons with TBI with verified intracranial lesions and persistent symptoms lasting more than 2 years, included in a randomized controlled trial, rated their participation using the PART-O at baseline. The PART-O with its three subscales (Productivity, Out and About, and Social Relations) was translated to Norwegian. Descriptive statistics, Cronbach's alpha, Rasch analysis, and correlation analysis were applied. Results The Rasch analysis indicated a unidimensional construct of PART-O and its subscales (χ2 < 12.69, p > 0.28). The internal consistency was moderate (Cronbach's alpha 0.48–0.52) and there was a need to reduce scaling options for most of the items. The Out and About and Productivity subscales had considerable floor effects. PART-O showed moderate positive correlation to TBI-related quality of life and global functioning. Conclusions PART-O and its subscales reflect unidimensional aspects of participation. In the present Norwegian TBI population the original scaling of PART-O was too detailed for all subscales. The floor effects and suboptimal targeting between items and subjects participation level of the Out and About subscale is a matter of concern.

• Richter, Sophie; Winzeck, Stefan; Correia, Marta M.; Czeiter, Endre; Whitehouse, Daniel & Kornaropoulos, Evgenios N. [Show all 53 contributors for this article] (2024). Predicting recovery in patients with mild traumatic brain injury and a normal CT using serum biomarkers and diffusion tensor imaging (CENTER-TBI): an observational cohort study. EClinicalMedicine. 75. doi: 10.1016/j.eclinm.2024.102751. Full text in Research Archive Show summary

  Background Even patients with normal computed tomography (CT) head imaging may experience persistent symptoms for months to years after mild traumatic brain injury (mTBI). There is currently no good way to predict recovery and triage patients who may benefit from early follow-up and targeted intervention. We aimed to assess if existing prognostic models can be improved by serum biomarkers or diffusion tensor imaging metrics (DTI) from MRI, and if serum biomarkers can identify patients for DTI. Methods We included 1025 patients aged >18 years with a Glasgow Coma Score >12 and normal CT from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study which recruited between December 19,2014 and December 17, 2017 (NCT02210221). Biomarkers (GFAP, NFL, S100B) were obtained at a median of 8.8 h (Q1–Q3 4.2–16.7) and DTI at 13 days (3–19) after injury. DTI metrics were available in 153 patients for 48 white matter tracts (ICBM-DTI-81 atlas). Incomplete recovery at three months was defined as an extended Glasgow Outcome Scale score <8. Existing prognostic models were fitted with and without biomarkers, or with and without DTI, and internally validated using bootstrapping. Findings 385 (38%) patients had incomplete recovery. Adding biomarkers did not improve performance beyond the best existing clinical prognostic model [optimism-corrected AUC 0.69 (95% CI 0.65–0.72) and R2 17% (11–22)]. Adding DTI metrics significantly enhanced all models [best optimism-corrected AUC 0.82 (0.79–0.85) and R2 75% (39–100)]. The top three prognostic tracts were the left posterior thalamic radiation, left superior cerebellar peduncle and right uncinate fasciculus. Serum biomarkers could have avoided 1 in 5 DTI scans, with GFAP <12 h and NFL 12–24 h from injury performing best. Interpretation DTI substantially improved existing prognostic models for functional outcome in patients with mTBI and a normal CT, and biomarkers could help select patients for MRI. If validated, DTI could allow for targeted follow-up and enrichment of clinical trials of early interventions to improve outcome.

• Wilson, Lindsay; Newcombe, Virginia FJ; Whitehouse, Daniel P; Mondello, Stefania; Maas, Andrew I. R. & Menon, David K. [Show all 52 contributors for this article] (2024). Association of early blood-based biomarkers and six-month functional outcomes in conventional severity categories of traumatic brain injury: capturing the continuous spectrum of injury. EBioMedicine. doi: 10.1016/j.ebiom.2024.105298. Full text in Research Archive Show summary

  Background Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity.

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Brunborg, Cathrine & Søberg, Helene L. [Show all 10 contributors for this article] (2024). Return to Work One Year after Moderate to Severe Traumatic Injury in a Working Age Population. Journal of Clinical Medicine. 13(17). doi: 10.3390/jcm13175308. Full text in Research Archive Show summary

  Background/Objectives: Physical trauma may cause long-term disabilities. The importance of place of residence in the return to work after injuries is little researched. The primary aims of this study were to describe return to work or school (RTW) at 6 and 12 months after moderate to severe traumatic injury and to investigate demographic and injury-related predictors for RTW with an initial focus on geographic centrality of residency. The secondary aim was to investigate the association between RTW and functioning. <p><p>Methods: A prospective cohort study conducted at two Norwegian trauma centres. Inclusion criteria: age 18 to 70 years, at least a two-day hospital stay and a New Injury Severity Score > 9. Information about centrality, demographics, injuries, and return to work were collected. Associations between possible predictors and RTW were assessed using binary logistic regression. <p>Results: Of the 223 participants, 68% had returned to work after 6 months and 77% after 12 months. Twelve-month RTW was 89% after thorax/abdomen injuries, 78% after extremity/spine injuries and 73% after head injuries. More central residency was a significant predictor for RTW in univariable but only within the extremity/spine injury subgroup in multivariable analysis. Negative factors were age, having a blue-collar job, number of injuries and rehabilitation complexity. Function 12 months post-injury was associated with RTW in the multivariable model. <p>Conclusions: RTW after one year was high in all major trauma groups. Demographic and injury-related factors were more important predictors of RTW than centrality of residency. Blue-collar workers and patients with multiple injuries and high rehabilitation complexity should be given special attention to support RTW.

• Løvstad, Marianne; Borgen, Ida Maria Henriksen; Hauger, Solveig; Kleffelgård, Ingerid; Brunborg, Cathrine & Røe, Cecilie [Show all 8 contributors for this article] (2024). Family member reported symptom burden, predictors of caregiver burden and treatment effects in a goal-oriented community-based randomized controlled trial in the chronic phase of traumatic brain injury. BMC Neurology. 24(1). doi: 10.1186/s12883-024-03841-7. Full text in Research Archive Show summary

  Background Family members are often affected by the long-term consequences of traumatic brain injury, but are rarely involved in rehabilitation programs in the chronic phase. We thus do not know what family members´ main concerns are in the chronic phase, what factors are associated with perceived caregiver burden, and whether family members´ health and functioning improves due to rehabilitation efforts received by the patients. This study explored family-members` functioning, predictors of caregiver burden and effect for family members of a goal-oriented intervention in the chronic phase of traumatic brain injury. Methods Family members self-reported data measuring their caregiver burden, depression, general health, loneliness, and their evaluation of patient competency in everyday life, patient awareness levels, main problem areas (target outcomes) for the patient related to the brain injury, and demographic data were collected. Regression models were used to explore predictors of caregiver burden, and mixed models analysis was used to explore treatment effects. Results In total, 73 family members were included, 39 in the intervention group and 34 in the control group. Moderate to high caregiver burden was reported by 40% of family members, and 16% experienced clinical levels of depression. Family member loneliness and their evaluation of the patient`s level of functional competency explained 57% of the variability in caregiver burden. There were no treatment-related changes in caregiver burden, family member depression or general health. At T2 there was however a significant reduction in how family members rated severity of target outcomes that the family members had nominated at baseline (-0.38, 95% CI, -0.75 to -0.02, p = 0.04), but not for the target outcomes the patients had nominated. Conclusions A significant proportion of family members to patients in the chronic phase of TBI continue to experience challenging caregiver burden and emotional symptoms. Both family member-related and patient factors contribute to caregiver burden. Interventions targeting patient complaints do not automatically alleviate family members´ burden. It is important to address social support for family members early after injury, and there is a need for more interventions specifically targeting family members´ needs.

• Sveinall, Håkon; Brox, Jens Ivar; Engebretsen, Kaia Beck; Hoksrud, Aasne Fenne; Røe, Cecilie & Johnsen, Marianne Bakke (2024). Heavy slow resistance training, radial extracorporeal shock wave therapy or advice for patients with tennis elbow in the Norwegian secondary care: a randomised controlled feasibility trial. BMJ Open. 14(12). doi: 10.1136/bmjopen-2024-085916. Full text in Research Archive Show summary

  Objectives To evaluate the feasibility of recruitment, appointment adherence, intervention compliance, acceptance and comprehensibility, in addition to retention rate and data completeness. An ancillary aim was to describe within-group changes in the secondary outcome measures (patient-reported and performance-based). Design A single-centre, three-armed, randomised controlled feasibility trial with a parallel design, with follow-up after 3 and 6 months. Setting Participants were recruited from the outpatient clinic at Oslo University Hospital. Participants Patients with lateral epicondylalgia, commonly known as tennis elbow. Interventions Participants were randomised in a 1:1:1 ratio to heavy slow resistance training, radial extracorporeal shock wave therapy or information and advice. Main outcome measures Feasibility was assessed according to a priori criteria for success. Results In total, 89 patients were screened for eligibility, and 69 (78%) patients were eligible for randomisation. 60 (92%) participants were randomised which gave a recruitment rate of 3.4 per month (against an a priori success cut-off of 3.75). The participants rated all the interventions as acceptable and comprehensive. Only 6 of 19 (32%) did comply with heavy slow resistance training. Retention rate and completeness of data were successful at 3 months. At 6 months, the retention rate was below the criteria for success. Patient-reported and performance-based outcomes improved in all groups. Conclusion The current study shows that the process of recruitment and the retention rate at follow-up can be feasible with minor amendments. Participants had low compliance with heavy slow resistance training mainly due to pain aggravation, which suggests that this intervention was not suitable for patients with tennis elbow. Shock wave therapy and information and advice should be investigated further in a full-scale randomised controlled trial including sham shock wave therapy.

• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Show all 7 contributors for this article] (2024). Musculoskeletal disorders in Norway: trends in health care utilization and patient pathways: a nationwide register study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), p. 582–592. doi: 10.1080/02813432.2024.2368848. Full text in Research Archive Show summary

  Objective Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. Design Register-based cohort study. Settings Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). Subjects Patients with MSD according to ICPC-2 and ICD-10 during 2014–2017. Main outcome measures Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). Result About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). Conclusion One third of the Norwegian population consulted health care services due to MSD annually between 2014–2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP.

• Heide, Marte; Røe, Cecilie; Mørk, Marianne; Myhre, Kjersti; Brunborg, Cathrine & Brox, Jens Ivar [Show all 7 contributors for this article] (2024). Is radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses more effective than advice plus customised foot orthoses alone in the treatment of plantar fasciopathy? A double-blind, randomised, sham-controlled trial. British Journal of Sports Medicine. ISSN 0306-3674. 58(16), p. 910–918. doi: 10.1136/bjsports-2024-108139. Full text in Research Archive Show summary

  Objectives To assess whether radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses is more effective than advice plus customised foot orthoses alone in alleviating heel pain in patients with plantar fasciopathy. Methods 200 patients with plantar fasciopathy were included in a four-arm, parallel-group, sham-controlled, observer-blinded, partly patient-blinded trial. At baseline, before randomisation, all patients received advice plus customised foot orthoses. Patients were randomised to rESWT (n=50), sham-rESWT (n=50), exercise (n=50) or advice plus customised foot orthoses alone (n=50). Patients in the rESWT and sham-rESWT groups received three treatments. The exercise programme comprised two exercises performed three times a week for 12 weeks, including eight supervised sessions with a physiotherapist. Patients allocated to advice plus customised foot orthoses did not receive additional treatment. The primary outcome was change in heel pain during activity in the previous week per Numeric Rating Scale (0–10) from baseline to 6-month follow-up. The outcome was collected at baseline, and 3, 6 and 12 months. Results The primary analysis showed no statistically significant between-group differences in mean change in heel pain during activity for rESWT versus advice plus customised foot orthoses (−0.02, 95% CI −1.01 to 0.96), sham-rESWT versus advice plus customised foot orthoses (0.52, 95% CI −0.49 to 1.53) and exercise versus advice plus customised foot orthoses (−0.11, 95% CI −1.11 to 0.89) at 6 months. Conclusion In patients with plantar fasciopathy, there was no additional benefit of rESWT, sham-rESWT or a standardised exercise programme over advice plus customised foot orthoses in alleviating heel pain.

• Vyvere, Thijs Vande; Pisicǎ, Dana; Wilms, Guido; Claes, Lene; Dyck, Pieter Van & Snoeckx, Annemiek [Show all 261 contributors for this article] (2024). Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. Journal of Neurotrauma. ISSN 0897-7151. 41(19-20), p. 2248–2297. doi: 10.1089/neu.2023.0553. Full text in Research Archive Show summary

  In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.

• Robba, Chiara; Graziano, Francesca; Picetti, Edoardo; Åkerlund, Cecilia; Addis, Alberto & Pastore, Giuseppe [Show all 72 contributors for this article] (2024). Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data. Intensive Care Medicine. ISSN 0342-4642. doi: 10.1007/s00134-024-07324-8. Full text in Research Archive Show summary

  Purpose: We analysed the impact of early systemic insults (hypoxemia and hypotension, SIs) on brain injury biomarker profiles, acute care requirements during intensive care unit (ICU) stay, and 6-month outcomes in patients with traumatic brain injury (TBI). Methods: From patients recruited to the Collaborative European neurotrauma effectiveness research in TBI (CENTER-TBI) study, we documented the prevalence and risk factors for SIs and analysed their effect on the levels of brain injury biomarkers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and protein Tau], critical care needs, and 6-month outcomes [Glasgow Outcome Scale Extended (GOSE)]. Results: Among 1695 TBI patients, 24.5% had SIs: 16.1% had hypoxemia, 15.2% had hypotension, and 6.8% had both. Biomarkers differed by SI category, with higher S100B, Tau, UCH-L1, NSE and NfL values in patients with hypotension or both SIs. The ratio of neural to glial injury (quantified as UCH-L1/GFAP and Tau/GFAP ratios) was higher in patients with hypotension than in those with no SIs or hypoxia alone. At 6 months, 380 patients died (22%), and 759 (45%) had GOSE ≤ 4. Patients who experienced at least one SI had higher mortality than those who did not (31.8% vs. 19%, p < 0.001). Conclusion: Though less frequent than previously described, SIs in TBI patients are associated with higher release of neuronal than glial injury biomarkers and with increased requirements for ICU therapies aimed at reducing intracranial hypertension. Hypotension or combined SIs are significantly associated with adverse 6-month outcomes. Current criteria for hypotension may lead to higher biomarker levels and more negative outcomes than those for hypoxemia suggesting a need to revisit pressure targets in the prehospital settings.

• Zheng, Jiang; Ouyang, Yufang; Zhang, Ke; Wang, Zhixing; Younsi, Alexander & Alhalabi, Obada [Show all 54 contributors for this article] (2024). Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury. JAMA Network Open. doi: 10.1001/jamanetworkopen.2024.1556. Full text in Research Archive Show summary

  Importance: The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial. Objective: To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI. Design, setting, and participants: This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023. Main outcomes and measures: The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale-Extended [GOSE] score ≤4). Results: A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90). Conclusions and relevance: The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.

• Ntikas, Michail; Stewart, William; Ietswaart, Magdalena; Hunter, Angus M.; Maas, Andrew I R & Menon, David K [Show all 57 contributors for this article] (2024). Contrasting Characteristics and Outcomes of Sports-Related and Non-Sports-Related Traumatic Brain Injury. JAMA Network Open. 7. doi: 10.1001/jamanetworkopen.2023.53318. Full text in Research Archive Show summary

  Importance: Exposure to traumatic brain injury (TBI) has raised widespread concern over participation in sports, particularly over possible long-term consequences. However, little is known about the outcomes of individuals presenting to hospitals with sports-related TBI. Objective: To compare the characteristics and outcomes of individuals presenting to hospitals with sports-related and non-sports-related TBI. Design, setting, and participants: The CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) observational cohort study was conducted at hospitals in 18 countries. The study enrolled 4509 patients who had TBI and had an indication for computed tomography (CT), of whom 4360 were 16 years or older. Outcomes were assessed at 3 and 6 months, and groups were compared using regression analyses adjusting for clinical and demographic differences. Data were collected between December 9, 2014, and December 17, 2017, and analyzed from August 2022 to March 2023. Exposure: Sports-related and non-sports-related TBI with subgroups selected by severity of injury. Main outcomes and measures: The main outcome was the Glasgow Outcome Scale-Extended (GOSE) at 6 months, with secondary outcomes covering postconcussion symptoms, health-related quality of life, and mental health. Results: A total of 4360 patients were studied, including 256 (6%) with sports-related TBI (mean [SD] age, 38.9 [18.1] years; 161 [63%] male) and 4104 with non-sports-related TBI (mean [SD] age, 51.0 [20.2] years; 2773 [68%] male). Compared with patients with non-sports-related TBI, patients with sports-related TBI were younger, more likely to have tertiary education, more likely to be previously healthy, and less likely to have a major extracranial injury. After adjustment, the groups did not differ in incomplete recovery (GOSE scores <8) at 6 months (odds ratio [OR], 1.27; 95% CI, 0.90-1.78; P = .22 for all patients; OR, 1.20; 95% CI, 0.83-1.73; P = .34 for those with mild TBI; and OR, 1.19; 95% CI, 0.74-1.92; P = .65 for those with mild TBI and negative CT findings). At 6 months, there was incomplete recovery in 103 of 223 patients (46%) with outcomes in the sports-related TBI group, 65 of 168 (39%) in those with mild sports-related TBI, and 30 of 98 (31%) in those with mild sports-related TBI and negative CT findings. In contrast, at 6 months, the sports-related TBI group had lower prevalence of anxiety, depression, posttraumatic stress disorder, and postconcussion symptoms than the non-sports-related group. Conclusions and relevance: In this cohort study of 4360 patients with TBI, functional limitations 6 months after injury were common after sports-related TBI, even mild sports-related TBI. Persisting impairment was evident in the sports-related TBI group despite better recovery compared with non-sports-related TBI on measures of mental health and postconcussion symptoms. These findings caution against taking an overoptimistic view of outcomes after sports-related TBI, even if the initial injury appears mild.

• Hovset, Camilla Guren; Røe, Cecilie; Søberg, Helene L.; Brunborg, Cathrine; Helseth, Eirik & Andelic, Nada [Show all 7 contributors for this article] (2024). Patient satisfaction with rehabilitation services following traumatic brain injury: a quality registry study. Journal of Rehabilitation Medicine. ISSN 1650-1977. 56. doi: 10.2340/jrm.v56.35115. Full text in Research Archive Show summary

  Objective: To examine factors associated with patient satisfaction with rehabilitation services received after traumatic brain injury. Design: Cross-sectional study. Subjects/Patients: Persons with mild to severe traumatic brain injury (n = 1,375) registered in the “Oslo TBI Registry – Rehabilitation” quality register at Oslo University Hospital from 1 January 2018–31 July 2022. Methods: Sociodemographics, injury-related variables, patient-reported outcome measures, global func­ tioning, and rehabilitation-related variables were recorded at hospital outpatient visits. The patients reported satisfaction with services receiv­ed at the outpatient clinic and in primary healthcare at the final follow-up. Multivariable logistic regression models were applied to examine factors associated with patient satisfaction. Results: Of 316 patients, 83% reported satisfaction with services received at the hospital outpatient clinic. Belief in recovery (odds ratio [OR] = 2.73), shorter time to follow-up (OR = 0.39), and lower symptom burden (OR = 0.96) significantly increased satisfaction. Among 283 patients, 62% reported satisfaction with services in primary healthcare, where belief in recovery (OR = 2.90), shorter time to follow-up (OR = 0.50), higher age (OR = 1.04), and higher number of rehabilitation services received in primary healthcare (OR = 1.32) significantly increased satisfaction. Conclusion: Across service levels, the strongest associated factors for satisfaction were belief in recovery and shorter time to follow-up, suggesting that timely delivery of traumatic brain injury-related specialized services could increase overall satisfaction.

• Skatteboe, Sigrid; Røe, Cecilie; Heide, Marte; Brox, Jens Ivar; Ignatius, Janica Sofia & Bratsberg, Andrea Mathisen [Show all 8 contributors for this article] (2024). Responsiveness and minimal important change of specific and generic patient-reported outcome measures for back patients: the Norwegian Neck and Back Register. European spine journal. ISSN 0940-6719. 33(8), p. 2960–2968. doi: 10.1007/s00586-024-08394-4. Full text in Research Archive Show summary

  Purpose To evaluate responsiveness and minimal important change (MIC) of Oswestry Disability Index (ODI), pain during activity on a numeric rating scale (NRSa) and health related quality of life (EQ-5D) based on data from the Norwegian neck and back registry (NNRR). Methods A total of 1617 patients who responded to NNRR follow-up after both 6 and 12 months were included in this study. Responsiveness was calculated using standardized response mean and area under the receiver operating characteristic (ROC) curve. We calculated MIC with both an anchor-based and distribution-based method. Results The condition specific ODI had best responsiveness, the more generic NRSa and EQ-5D had lower responsiveness. We found that the MIC for ODI varied from 3.0 to 9.5, from 0.4 to 2.5 for NRSa while the EQ5D varied from 0.05 to 0.12 depending on the method for calculation. Conclusion In a register based back pain population, the condition specific ODI was more responsive to change than the more generic tools NRSa and EQ5D. The variations in responsiveness and MIC estimates also indicate that they should be regarded as indicative, rather than fixed estimates.

• Deynse, Helena Van; Cools, Wilfried; Deken, Viktor-Jan De; Depreitere, Bart; Hubloue, Ives & Tisseghem, Ellen [Show all 257 contributors for this article] (2024). One-year employment outcome prediction after traumatic brain injury: A CENTER-TBI study. Disability and Health Journal. ISSN 1936-6574. doi: 10.1016/j.dhjo.2024.101716. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) can come with long term consequences for functional outcome that can complicate return to work. Objectives This study aims to make accurate patient-specific predictions on one-year return to work after TBI using machine learning algorithms. Within this process, specific research questions were defined: 1 How can we make accurate predictions on employment outcome, and does this require follow-up data beyond hospitalization? 2 Which predictors are required to make accurate predictions? 3 Are predictions accurate enough for use in clinical practice? Methods This study used the core CENTER-TBI observational cohort dataset, collected across 18 European countries between 2014 and 2017. Hospitalized patients with sufficient follow-up data were selected for the current analysis (N = 586). Data regarding hospital stay and follow-up until three months post-injury were used to predict return to work after one year. Three distinct algorithms were used to predict employment outcomes: elastic net logistic regression, random forest and gradient boosting. Finally, a reduced model and corresponding ROC-curve was created. Results Full models without follow-up achieved an area under the curve (AUC) of about 81 %, which increased up to 88 % with follow-up data. A reduced model with five predictors achieved similar results with an AUC of 90 %.

• Vreeburg, Rick J G; Singh, Ranjit D.; Erp, Inge A M van; Korhonen, Tommi K; Yue, John K & Mee, Harry [Show all 81 contributors for this article] (2024). Early versus delayed cranioplasty after decompressive craniectomy in traumatic brain injury: a multicenter observational study within CENTER-TBI and Net-QuRe. Journal of Neurosurgery. ISSN 0022-3085. 141(4), p. 895–907. doi: 10.3171/2024.1.JNS232172. Full text in Research Archive Show summary

  OBJECTIVE The aim of this study was to compare the outcomes of early (≤ 90 days) and delayed (> 90 days) cranioplasty following decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). METHODS The authors analyzed participants enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and the Neurotraumatology Quality Registry (Net-QuRe) studies who were diagnosed with TBI and underwent DC and subsequent cranioplasty. These prospective, multicenter, observational cohort studies included 5091 patients enrolled from 2014 to 2020. The effect of cranioplasty timing on functional outcome was evaluated with multivariable ordinal regression and with propensity score matching (PSM) in a sensitivity analysis of functional outcome (Glasgow Outcome Scale–Extended [GOSE] score) and quality of life (Quality of Life After Brain Injury [QOLIBRI] instrument) at 12 months following DC. RESULTS Among 173 eligible patients, 73 (42%) underwent early cra

• Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina Marit; Svendsen, Edel Jannecke; Røe, Cecilie; Borgen, Ida Maria Henriksen & Hauger, Solveig [Show all 10 contributors for this article] (2024). SMART-goal domains and goal attainment in an individualized, goal-oriented intervention for children with acquired brain injury and their families. Neuropsychological Rehabilitation. ISSN 0960-2011. 35(6), p. 1229–1253. doi: 10.1080/09602011.2024.2402095. Full text in Research Archive Show summary

  Pediatric acquired brain injury (pABI) may lead to long-lasting challenges in need of rehabilitation-efforts years after the insult. The Child in Context Intervention (CICI) is an individualized, goal-oriented intervention targeting children with pABI, their families and schools in the chronic phase. This paper describes the goals that patients and families in the CICI intervention group identified to work on. The 29 participating families worked on 90 goals that were predominantly coded to the domains of Body functioning (46.6%) and Activities and participation (40.5%), according to the International Classification of functioning, Disability and Health (ICF). The most frequently used codes focused on fatigue and emotional symptoms, in addition to codes in the AP domain describing the need for increased independence in everyday life at school, at home, and socially. Goal attainment in the intervention group was high, with positive progress on 94.4% of the goals and positive goal achievement for all included families. The high level of goal attainment provides promising evidence of the CICI programme’s efficacy, and highlights the need to further develop evidence-based rehabilitation programs for children with pABI in the chronic stage of recovery.

• Pisică, Dana; Volovici, Victor; Yue, John K; Essen, Thomas A. Van; Boogert, Hugo F den & Vyvere, Thijs Vande [Show all 73 contributors for this article] (2024). Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study. Neurosurgery. ISSN 0148-396X. doi: 10.1227/neu.0000000000002982. Full text in Research Archive Show summary

  BACKGROUND AND OBJECTIVES: Guideline recommendations for surgical management of traumatic epidural hematomas (EDHs) do not directly address EDHs that co-occur with other intracranial hematomas; the relative rates of isolated vs nonisolated EDHs and guideline adherence are unknown. We describe characteristics of a contemporary cohort of patients with EDHs and identify factors influencing acute surgery. METHODS: This research was conducted within the longitudinal, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury cohort study which prospectively enrolled patients with traumatic brain injury from 65 hospitals in 18 European countries from 2014 to 2017. All patients with EDH on the first scan were included. We describe clinical, imaging, management, and outcome characteristics and assess associations between site and baseline characteristics and acute EDH surgery, using regression modeling. RESULTS: In 461 patients with EDH, median age was 41 years (IQR 24-56),

• Moksnes, Håkon Øgreid; Andelic, Nada; Schäfer, Christoph; Anke, Audny Gabriele Wagner; Søberg, Helene L. & Røe, Cecilie [Show all 17 contributors for this article] (2024). Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries. Journal of Rehabilitation Medicine. ISSN 1650-1977. 56, p. 1–10. doi: 10.2340/jrm.v56.40078. Full text in Research Archive Show summary

  Objective: To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs.<p> <p>Design: Multicentre prospective cohort study. <p>Subjects: Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. <p>Methods: Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended–Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. <p>Results: In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. <p>Conclusion: Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

• Søberg, Helene L.; Solvang, Per Koren; Andelic, Nada; Røe, Cecilie & Kirkevold, Marit (2024). Users' Perspectives on the Organization of Rehabilitation Services – A Focus Group Study of User Organization Representatives in Norway. Health Expectations. ISSN 1369-6513. 27(6). doi: 10.1111/hex.70139. Full text in Research Archive Show summary

  Background: User organizations for people with disabilities in Norway work for social equality and participation, and quality of health services for people with disabilities, chronic illnesses and reduced functional capacity. Consideration of the experiences from user representatives is necessary when determining the quality and appropriateness of the rehabilitation services. Rehabilitation services constitute the provision and delivery of intangible products to maintain or improve functioning in individual patients or patient groups. Rehabilitation services can be characterized at the policy (macro), organizational (meso) and individual (micro) levels. Objectives: To explore user representatives' perspectives on rehabilitation service provision and organization and how they experience the influence they exert. Methods: Focus group interviews with 14 representatives nominated from 11 user organizations in Norway conducted in 2021. Two online focus groups using a semi‐structured interview guide were conducted. Data analysis was performed according to Braun and Clarke's thematic data analysis. Results: Six core themes were developed when analyzing the participants' experiences and opinions regarding rehabilitation services. The themes were inter‐connected and addressed perspectives on Access to services, Integration of care, Rehabilitation team, Person centeredness, System and governance and Modes of user representation and contribution. Conclusion: The user representatives revealed tension and complexity influencing the provision and organization of rehabilitation services from individual access to health policy and regulation. Empowering user representatives through training was important to fight tokenism. Filling the role of a user representative at the meso level requires the integration of personal and peer experiences at the micro level, and knowledge of health policy regulations at the macro level. Patient or Public Contribution: The Norwegian Federation of Organisations of Persons with Disabilities recruited user representatives in this study. The user representatives participated in the assessment and discussion of the results of the study. The results were presented for discussion to the User panel at the Research Centre for Habilitation and Rehabilitation Models & Services (CHARM) at the University of Oslo.

• Mørk, Marianne; Søberg, Helene L.; Heide, Marte; Hoksrud, Aasne Fenne; Groven, Karen Synne & Brunborg, Cathrine [Show all 7 contributors for this article] (2024). Predictors for pain and functioning in patients with plantar fasciopathy one year after inclusion in a treatment trial in specialist care. BMC Musculoskeletal Disorders. 25(1). doi: 10.1186/s12891-024-08187-2. Full text in Research Archive Show summary

  Background Plantar fasciopathy is common, is characterized by heel pain and is associated with decreased functioning and health-related quality of life. While many recover from this condition, a considerable number of people experience persistent heel pain. This study seeks to evaluate predictors for pain and function twelve months after inclusion in a treatment trial in specialist care. Methods Secondary analysis was conducted on 200 patients with plantar fasciopathy included in a randomized controlled trial and followed for twelve months. Baseline demographics and clinical characteristics were included as possible predictors. Univariate and multivariable linear regression models were applied to identify predictors for foot pain (Numeric rating scale) and function (Foot Function Index revised short form) at 12-month follow-up. Results Unilateral heel pain, lower physical activity level and higher number of repetitions in the clinical heel-rise test were identified as statistically significant predictors for reduced pain. Unilateral heel pain, shorter duration of heel pain and being married/cohabitating were predictors for better functioning. Conclusions Unilateral heel pain as opposed to bilateral heel pain, was the most consistent positive predictor for the outcomes pain and function in plantar fasciopathy at 12-month follow-up. Hence, patients with bilateral PF may need extended assessment and treatment. Other predictors varied among outcomes. These findings may be used to improve clinical management of patients with persistent PF.

• Kleffelgård, Ingerid; Borgen, Ida Maria Henriksen; Forslund, Marit Vindal; Søberg, Helene Lundgaard; Røe, Cecilie & Løvstad, Marianne [Show all 7 contributors for this article] (2024). Målorientert og individualisert rehabilitering for hjemmeboende personer i senfase etter traumatisk hodeskade. Fysioterapeuten. ISSN 0016-3384. Full text in Research Archive
• Rohrer-Baumgartner, Nina Marit; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; DAHL, HILDE MARGRETE; Borgen, Ida Maria Henriksen & Hauger, Solveig [Show all 10 contributors for this article] (2024). Children and families with chronic pediatric acquired brain injury in need of rehabilitation: characteristics and main challenges in daily life. Disability and Rehabilitation. ISSN 0963-8288. p. 1–10. doi: 10.1080/09638288.2024.2376936. Full text in Research Archive Show summary

  Purpose: to increase our understanding of child and parent characteristics, family functioning and main challenges in daily life in children and families in need of rehabilitation in the chronic phase of pediatric acquired brain injury (paBi). Methods: Fifty-eight children (aged 6–16, 48% girls) were included at least one year post aBi. Demographics and questionnaire data regarding children’s symptom burden, parents’ emotional symptoms and family functioning were collected. children and parents named their main paBi-related challenges in daily life, and these were categorized in accordance with the international classification of Functioning, Disability and health (icF). Descriptive statistical analyses were performed. Results: Parents’ emotional symptom loads were high; 22.3% had moderate, moderate-severe or severe depression symptoms while the equivalent number for anxiety symptoms was 17.9%. Problematic family functioning was reported by 32.1% of parents. When asked about their main paBi-related challenges in daily life, 69% of children named school. the most frequent icF chapters for children and parents were school education, energy and drive functions (mainly fatigue), and emotional functions. codes spanned across all icF-domains. Conclusions: Rehabilitation for paBi should have a broad, interdisciplinary, and family-centered approach, with school, fatigue, and emotional functioning of parents and children as potential core elements.

• Ignatius, Janica Sofia; Røe, Cecilie; Perrin, Paul B.; Skatteboe, Sigrid; Brox, Jens Ivar & Kielland, Maja Garnaas [Show all 7 contributors for this article] (2024). Influence of nationality on the trajectories of pain, disability and health related quality of life in neck and back patients – The Norwegian Neck and Back Registry. Musculoskeletal Science and Practice. ISSN 2468-8630. 74. doi: 10.1016/j.msksp.2024.103193. Full text in Research Archive Show summary

  Purpose The aim of the current study was to examine differences in trajectories of pain, disability, and health related quality of life (HRQOL) between non-Norwegian and Norwegian patients with neck and back pain over 12 months. Methods The study is based on data from the Norwegian Neck and Back Registry (NNRR). The data include demographics and patient-reported outcome measures such as pain rating, the Oswestry Disability Index and HRQOL. Data were collected at baseline, 6 and 12 months after consultation for neck and back pain in specialist health care. Results A total of 5012 patients were included. We found a significant main effect of nationality. Non-Norwegian patients showed higher levels of pain and disability and lower HRQOL than Norwegian patients. Both patient groups exhibited an improvement in all three outcomes at 6- and 12-month follow-ups. The improvement was similar for pain with the greatest improvement taking place during the first 6 months and then slightly flattening out. For disability and HRQOL, we observed a differential effect over time as a function of nationality. Both groups reported an improvement the first 6 months, however, while the Norwegian patients continued their improvement to 12 months, non-Norwegian patients had increasing disability and lower HRQOL at 12 months. Conclusion Both patient groups improved over the 12-month period. Non-Norwegian patients showed an overall higher level of pain, disability and lower HRQOL compared to Norwegian patients, with a differential effect over time as a function of nationality for disability and HRQOL. Suggesting that future studies should focus on potential systemic barriers that may affect the recovery of neck and back patients based on nationality.

• Bjørneboe, John Andreas; Bratsberg, Andrea Mathisen; Brox, Jens Ivar; Skatteboe, Sigrid; Wilhelmsen, Maja & Samuelsen, Kjetil Magne [Show all 10 contributors for this article] (2024). Symptom burden and follow-up of patients with neck and back complaints in specialized outpatient care: a national register study. Scientific Reports. 14(1). doi: 10.1038/s41598-024-53879-3. Full text in Research Archive Show summary

  Back and neck pain are common in the population, especially among immigrants. In Norway’s specialist care system, treating these patients typically involves a multidisciplinary approach based on the biopsychosocial model. However, language and cultural differences may create barriers to participation. Immigrants are often underrepresented in clinical studies, but a register‑based approach can enhance their participation in research. This study aimed to compare both the symptom burden, and treatment, among Norwegians, non‑Norwegians, and patients requiring translator service for back and neck pain within the Norwegian specialist care system. The Norwegian neck and back registry is a National Quality Register, established in 2012 and fully digitized in late 2020. The baseline data includes demographics and patient recorded outcome measures including Oswestry Disability Index, Fear‑Avoidance Beliefs, pain rating on a numeric rating scale, Hopkins Symptom Checklist and EuroQol five‑dimensional questionnaire on health related quality of life. During the two‑year study period, a total of 14,124 patients were invited, and 10,060 (71%) participated. Norwegian patients reported less pain, better function assessed by Oswestry Disability Index, lower fear avoidance beliefs, less emotional distress, and higher health related quality of life compared to non‑Norwegians. We found that patients with female gender, who were younger, more educated and exhibited fear‑ avoidance behavior were significantly more likely to receive multidisciplinary treatment. We found no difference in the proportion of Norwegian and non‑Norwegian patients receiving multidisciplinary treatment [odds ratio (OR) 1.02 (95% confidence interval (CI) 0.90–1.16)]. However, patients needing a translator were less likely to receive multidisciplinary treatment compared to those who didn’t require translation [OR 0.41 (95% CI (0.25–0.66)]. We found that non‑Norwegian patients experience a higher symptom burden compared to Norwegian. We found that both non‑Norwegians and patient in need of translator were to a greater extent recommended treatment in primary health care. The proportion of non‑Norwegians patients receiving multidisciplinary treatment was similar to Norwegians, but those needing a translator were less likely to receive such treatment.

• Røe, Cecilie; Gutenbrunner, Christoph; Bökel, Andrea; Kirkevold, Marit; Nugraha, Boya & Andelic, Nada [Show all 15 contributors for this article] (2024). Proposed categories for reporting of service organization in rehabilitation in clinical trials: a discussion paper. European Journal of Physical and Rehabilitation Medicine. ISSN 1973-9087. 60(6), p. 1070–1077. doi: 10.23736/S1973-9087.24.08494-6. Full text in Research Archive Show summary

  BACKGROUND: The lack of standardized reporting for crucial organizational factors in rehabilitation poses a significant barrier to understanding their impact on patient outcomes in clinical trials and meta-analyses. AIM: Based on the categories in the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0), we aimed to develop reporting standards specifically for organizational factors in clinical trial METHODS: A comprehensive two-step process was conducted. In Step 1, important categories were identified. The identification was based on previous results from a delphi survey with international stakeholder participation, two systematic literature reviews and results from focus groups with users in Germany, indonesia and Norway. step 2 involved the necessary reduction of categories and the proposal of reporting specifications, achieved through two voting rounds among key researchers, stakeholders and users. RESULTS: the suggested minimum reporting set comprises context and setting as well as Quality assurance and management. the context and setting is proposed to include whether the intervention is delivered by hospital, community or other service providers. the Mode of delivery is proposed to be specified as Inpatient, Outpatient, In-home, or Tele-rehabilitation. Furthermore, the Level of specialization (Primary/Secondary) and the phase of service delivery acute, subacute or long-term rehabilitation services should be reported. the Quality assurance and management should be reported as yes or No, with the option yes requiring description of the quality assurance applied in the methods section. CONCLUSIONS: this study proposed a compulsory and standardized reporting of organizational factors in clinical trials to facilitate the generation of scientific evidence regarding effective service provision and delivery in rehabilitation medicine. Authors are encouraged to consider the proposed reporting set to testing, criticism, and modification to enhance its applicability and robustness.

• Frontera, Walter R.; Cordani, Claudio; Décary, Simon; Groote, Wouter De; Delfuria, Matteo J. & Feys, Peter [Show all 13 contributors for this article] (2024). Relevance and use of health policy, health systems and health services research for strengthening rehabilitation in real-life settings: methodological considerations. European Journal of Physical and Rehabilitation Medicine. ISSN 1973-9087. 60(1), p. 154–163. doi: 10.23736/S1973-9087.24.08386-2. Full text in Research Archive Show summary

  Research on health policy, systems, and services (HPSSR) has seen significant growth in recent decades and received increasing attention in the field of rehabilitation. This growth is driven by the imperative to effectively address real-life challenges in complex healthcare settings. A recent resolution on ‘Strengthening rehabilitation in health systems’ adopted by the World Health Assembly emphasizes the need to support societal health goals related to rehabilitation, particularly to promote high-quality rehabilitation research, including HPSSR. This conceptual paper, discussed with the participants in the 5th Cochrane Rehabilitation Methodological Meeting held in Milan on September 2023, outlines study designs at diverse levels at which HPSSR studies can be conducted: the macro, meso, and micro levels. It categorizes research questions into four types: those framed from the perspective of policies, healthcare delivery organizations or systems, defined patient or provider populations, and important data sources or research methods. Illustrative examples of appropriate methodologies are provided for each type of research question, demonstrating the potential of HPSSR in shaping policies, improving healthcare delivery, and addressing patient and provider perspectives. The paper concludes by discussing the applicability, usefulness, and implementation of HPSSR findings, and the importance of knowledge translation strategies, drawing insights from implementation science. The goal is to facilitate the integration of research findings into everyday clinical practice to bridge the gap between research and practice in rehabilitation.

• Lu, Juan; Rasmussen, Mari Storli; Sigurdardottir, Solrun; Forslund, Marit Vindal; Howe, Emilie & Fure, Silje Christine Reistad [Show all 10 contributors for this article] (2023). Community Integration and Associated Factors 10 Years after Moderate-to-Severe Traumatic Brain Injury. Journal of Clinical Medicine. 12(2), p. 1–10. doi: 10.3390/jcm12020405. Full text in Research Archive Show summary

  This study evaluated the impact of baseline injury characteristics and one-year functional level on the 10-year community integration outcomes for working-age patients with moderate-to- severe traumatic brain injury (TBI). Patients aged 16–55 and diagnosed with moderate-to-severe TBI within 24 h of injury were eligible for the study. Multivariable hierarchical linear regression was utilized to assess the impact of baseline characteristics and one-year functional measures on the mean Community Integration Questionnaire (CIQ) scores 10 years after injury. Of 133 original study participants, 97 survived 10 years, and 75 were available for this study. The mean total CIQ score changed positively from one to 10 years post-injury, from 18.7 (±5.5) to 19.8 (±4.8) (p = 0.04 ). The results suggested that age (β = −0.260, p = 0.013), FIM-Cognitive subscale (β = 0.608, p = 0.002), and the bodily pain subscale (BP) (β = 0.277, p = 0.017) of the SF-36 were significantly associated with the mean CIQ scores. In conclusion, this study demonstrated improved community integration from one to 10 years in a sample of working-age patients with moderate-to-severe TBI. The findings also showed that age, cognitive function, and bodily pain were significant predictors of long-term community integration, suggesting post-acute rehabilitation should focus on factors related to long- term risk and protective factors to improve long-term outcomes.

• Heide, Marte; Mørk, Marianne; Hoksrud, Aasne Fenne; Brox, Jens Ivar & Røe, Cecilie (2023). Responsiveness of specific and generic patient-reported outcome measures in patients with plantar fasciopathy. Disability and Rehabilitation. ISSN 0963-8288. doi: 10.1080/09638288.2023.2267438. Full text in Research Archive Show summary

  Purpose To evaluate and compare responsiveness characteristics for the Foot Function Index revised short form (FFI-RS), RAND-12 Health Status Inventory (RAND-12), and Numeric Rating Scale (NRS), in patients with plantar fasciopathy receiving non-surgical treatment. Materials and methods This study was conducted on a sub-group of patients from an ongoing randomised controlled trial. One-hundred fifteen patients were included. The patient-reported outcome measures (PROMs) were applied at baseline and after 6 months. Responsiveness was calculated using standardised response mean and area under the receiver operating characteristic (ROC) curve. ROC curves were used to compute the minimal important change (MIC) for the outcome measures. Results The region specific FFI-RS had best responsiveness and the NRS at rest had lowest responsiveness. Conclusion FFI-RS were marginally more responsive than the other PROMs. Responsiveness and MIC estimates should be regarded as indicative rather than fixed estimates. Implications for Rehabilitation - The region-specific Foot Function Index Revised Short Form could, based on responsiveness perspectives, be recommended as an outcome measurement for patients with plantar fasciopathy. - Responsiveness and minimal important change estimates are indicative and should be interpreted with caution.

• Mikolić, Ana; Steyerberg, Ewout W.; Polinder, Suzanne; Wilson, Lindsay; Zeldovich, Marina & Steinbueche, Nicole von [Show all 258 contributors for this article] (2023). Prognostic Models for Global Functional Outcome and Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. Journal of Neurotrauma. ISSN 0897-7151. 40(15-16), p. 1651–1670. doi: 10.1089/neu.2022.0320. Full text in Research Archive Show summary

  After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at present

• Zeldovich, Marina; Bockhop, Fabian; Covic, Amra; Mueller, Isabelle; Polinder, Suzanne & Mikolic, Ana [Show all 58 contributors for this article] (2023). Factorial validity and comparability of the six translations of the Rivermead Post-Concussion Symptoms Questionnaire translations: results from the CENTER-TBI study. Journal of Patient-Reported Outcomes. 7(90). doi: 10.1186/s41687-023-00632-5. Full text in Research Archive Show summary

  Background Comparison of patient-reported outcomes in multilingual studies requires evidence of the equivalence of translated versions of the questionnaires. The present study examines the factorial validity and comparability of six language versions of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) administered to individuals following traumatic brain injury (TBI) in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) study. Methods Six competing RPQ models were estimated using data from Dutch (n = 597), English (n = 223), Finnish (n = 213), Italian (n = 268), Norwegian (n = 263), and Spanish (n = 254) language samples recruited six months after injury. To determine whether the same latent construct was measured by the best-fitting model across languages and TBI severity groups (mild/moderate vs. severe), measurement invariance (MI) was tested using a confirmatory factor analysis framework. Results The results did not indicate a violation of the MI assumption. The six RPQ

• Essen, Thomas Van; Erp, Inge A. M. van; Lingsma, Hester F; Pisica, Dana; Yue, John K & Singh, Ranjit D. [Show all 55 contributors for this article] (2023). Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study. EClinicalMedicine. 9(63). doi: 10.1016/j.eclinm.2023.102161. Full text in Research Archive Show summary

  Background Limited evidence existed on the comparative effectiveness of decompressive craniectomy (DC) versus craniotomy for evacuation of traumatic acute subdural hematoma (ASDH) until the recently published randomised clinical trial RESCUE-ASDH. In this study, that ran concurrently, we aimed to determine current practice patterns and compare outcomes of primary DC versus craniotomy. Methods We conducted an analysis of centre treatment preference within the prospective, multicentre, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (known as CENTER-TBI) and NeuroTraumatology Quality Registry (known as Net-QuRe) studies, which enrolled patients throughout Europe and Israel (2014–2020). We included patients with an ASDH who underwent acute neurosurgical evacuation. Patients with severe pre-existing neurological disorders were excluded. In an instrumental variable analysis, we compared outcomes between centres according to treatment preference, measured by the ca

• Madsen, Benedikte Årebrot; Fure, Silje Christine Reistad; Andelic, Nada; Løke, Daniel; Løvstad, Marianne & Røe, Cecilie [Show all 7 contributors for this article] (2023). Exploring the Association between Personality Traits, Symptom Burden, and Return to Work after Mild-to-Moderate Traumatic Brain Injury. Journal of Clinical Medicine. 12(14). doi: 10.3390/jcm12144654. Full text in Research Archive
• Riemann, Lennart; Mikolic, Ana; Maas, Andrew; Unterberg, Andreas; Younsi, Alexander & Åkerlund, Cecilia [Show all 67 contributors for this article] (2023). Computed Tomography Lesions and Their Association With Global Outcome in Young People With Mild Traumatic Brain Injury. Journal of Neurotrauma. ISSN 0897-7151. 40(11-12), p. 1243–1254. doi: 10.1089/neu.2022.0055. Full text in Research Archive Show summary

  Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13–15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a “positive CT” (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17–22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24–0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25–0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care.

• Woodrow, Rebecca E; Winzeck, Stefan; Luppi, Andrea I; Kelleher-Unger, Isaac R; Spindler, Lennart R B & Wilson, J T Lindsay [Show all 86 contributors for this article] (2023). Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury. Brain. ISSN 0006-8950. 146(8), p. 3484–3499. doi: 10.1093/brain/awad056. Full text in Research Archive Show summary

  Chronic post-concussive symptoms are common after mild traumatic brain injury (mTBI) and are difficult to predict or treat. Thalamic functional integrity is particularly vulnerable in mTBI and may be related to long-term outcomes but requires further investigation. We compared structural MRI and resting state functional MRI in 108 patients with a Glasgow Coma Scale (GCS) of 13–15 and normal CT, and 76 controls. We examined whether acute changes in thalamic functional connectivity were early markers for persistent symptoms and explored neurochemical associations of our findings using PET data. Of the mTBI cohort, 47% showed incomplete recovery 6 months post-injury. Despite the absence of structural changes, we found acute thalamic hyperconnectivity in mTBI, with specific vulnerabilities of individual thalamic nuclei. Acute fMRI markers differentiated those with chronic post-concussive symptoms, with time- and outcome-dependent relationships in a sub-cohort followed longitudinally. Moreover, emotional and cog

• Åkerlund, Cecilia A. I.; Holst, Anders; Bhattacharyay, Shubhayu; Stocchetti, Nino; Steyerberg, Ewout & Smielewski, Peter [Show all 111 contributors for this article] (2023). Clinical descriptors of disease trajectories in patients with traumatic brain injury in the intensive care unit (CENTER-TBI): a multicentre observational cohort study. Lancet Neurology. ISSN 1474-4422. 1, p. 71–80. doi: 10.1016/S1474-4422(23)00358-7. Full text in Research Archive Show summary

  Background Patients with traumatic brain injury are a heterogeneous population, and the most severely injured individuals are often treated in an intensive care unit (ICU). The primary injury at impact, and the harmful secondary events that can occur during the first week of the ICU stay, will affect outcome in this vulnerable group of patients. We aimed to identify clinical variables that might distinguish disease trajectories among patients with traumatic brain injury admitted to the ICU. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. We included patients aged 18 years or older with traumatic brain injury who were admitted to the ICU at one of the 65 CENTER-TBI participating centres, which range from large academic hospitals to small rural hospitals. For every patient, we obtained pre-injury data and injury features, clinical characteristics on admission, demographics, physiological param

• Borgen, Ida Maria Henriksen; Løvstad, Marianne; Hauger, Solveig Lægreid; Forslund, Marit Vindal; Kleffelgård, Ingerid & Andelic, Nada [Show all 13 contributors for this article] (2023). Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury: A Randomized Clinical Trial. JAMA Network Open. 6(5), p. 1–14. doi: 10.1001/jamanetworkopen.2023.10821. Full text in Research Archive Show summary

  Importance Traumatic brain injury (TBI) can cause long-lasting and heterogeneous difficulties that require an individually tailored approach to rehabilitation. However, high-quality studies of treatment options in the chronic phase of TBI are lacking. Objective To evaluate the effect of a home-based, individualized, and goal-oriented rehabilitation intervention in the chronic phase of TBI. Design, Setting, and Participants This study was an intention-to-treat parallel-group assessor-blinded randomized clinical trial with 1:1 randomization to an intervention or control group. Participants included adults in southeastern Norway who had sustained a TBI more than 2 years earlier, lived at home, and had ongoing TBI-related difficulties. A population-based sample of 555 individuals were invited, and 120 were included. Participants were assessed at baseline, 4 months, and 12 months after inclusion. Specialized rehabilitation therapists provided the intervention in patients’ homes or via video conference and telephone. Data collection was conducted between June 5, 2018, and December 14, 2021. Interventions The intervention group received an 8-session individually tailored and goal-oriented rehabilitation program over 4 months. The control group received usual care in their municipality. Main Outcomes and Measures Preestablished primary outcomes were disease-specific health-related quality of life (HRQOL; measured by the Quality of Life After Brain Injury [QOLIBRI] overall scale) and social participation (measured by the Participation Assessment With Recombined Tools–Objective [PART-O] social subscale). Preestablished secondary outcomes included generic HRQOL (measured by the EuroQol 5-dimension 5-level [EQ-5D-5L] questionnaire), difficulty with TBI-related problem management (target outcomes; mean severity calculated across 3 main self-identified problem areas that were individually measured using a 4-point Likert scale), TBI symptoms (measured by the Rivermead Post Concussion Symptoms Questionnaire [RPQ]), psychological distress (depression and anxiety; measured by the Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale [GAD-7], respectively), and functional competency (measured by the Patient Competency Rating Scale). Results Among 120 participants in the chronic phase of TBI, the median (IQR) age was 47.5 (31.0-55.8) years, and the median (IQR) time since injury was 4 (3-6) years; 85 (70.8%) were male. A total of 60 participants were randomized to the intervention group, and 60 were randomized to the control group. Between baseline and 12 months, no significant between-group effects were found for the primary outcomes of disease-specific HRQOL (QOLIBRI overall scale score: 2.82; 97.5% CI, −3.23 to 8.88; P = .30) or social participation (PART-O social subscale score: 0.12; 97.5% CI, −0.14 to 0.38; P = .29). At 12 months, the intervention group (n = 57) had significantly higher generic HRQOL (EQ-5D-5L score: 0.05; 95% CI, 0.002-0.10; P = .04) and fewer symptoms of TBI (RPQ total score: −3.54; 95% CI, −6.94 to −0.14; P = .04) and anxiety (GAD-7 score: −1.39; 95% CI, −2.60 to −0.19; P = .02) compared with the control group (n = 55). At 4 months only, the intervention group (n = 59) had significantly less difficulty managing TBI-related problems (target outcomes mean severity score: −0.46, 95% CI, −0.76 to −0.15; P = .003) compared with the control group (n = 59). No adverse events were reported. Conclusions and Relevance In this study, no significant results were observed for the primary outcomes of disease-specific HRQOL or social participation. However, the intervention group reported improvements in secondary outcomes (generic HRQOL and symptoms of TBI and anxiety) that were maintained at 12-month follow-up. These findings suggest that rehabilitation interventions could help patients even in the chronic phase of TBI. Trial Registration ClinicalTrials.gov Identifier: NCT03545594

• Sveinall, Håkon; Wenstad, Per Kristian; Fearon, Angela M.; Skyttemyr, Gjermund; Thornes, Elisabeth & Skaara, Helene Engberg [Show all 10 contributors for this article] (2023). The reliability and validity of the Norwegian version of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire (VISA-G-Norwegian) for patients with greater trochanteric pain syndrome. BMC Musculoskeletal Disorders. 24. doi: 10.1186/s12891-023-06901-0. Full text in Research Archive Show summary

  Background Greater Trochanteric Pain Syndrome (GTPS) is a common chronic musculoskeletal condition that may affect physical function, quality of life and sleep. The Victorian Institute of Sport Assessment-Gluteal questionnaire (VISA-G) has been developed as a Patient-Reported Outcome Measurement (PROM) to address pain, everyday activities, physical activities, and difficulty with weight bearing activities. The aim of the study was to test the reliability, validity and floor and ceiling effects of the Norwegian version of the VISA-G (VISA-G-Norwegian) in a population with GTPS in a specialist health care setting. Methods This psychometric evaluation of the VISA-G-Norwegian questionnaire were conducted with a prospective observational design. The VISA-G was translated into Norwegian following recommended guidelines. A subgroup repeated the VISA-G-Norwegian a week after the initial submission. For the reliability, the Intraclass Correlation Coefficient (ICC2.1), Standard Error of the Measurement (SEM) and the Smallest Detectable Change (SDC95%) were calculated. Internal consistency was measured using a Cronbach´s alpha. Floor and ceiling effects were evaluated, and construct validity was assessed with three a priori hypotheses. Results 78 participants were included in the study of which 47 stable participants undertook the test-retest reliability arm of the study. The ICC2.1 for the total score was 0.85 (95% CI 0.68, 0.92), SEM was 6.6 points and SDC95% 18.4 points. Cronbach`s alpha was 0.77 (95% CI 0.69, 0.84). No floor or ceiling effects were found in the total score, but ceiling effect was found in three of the eight items. For construct validity, one of the three hypotheses were confirmed. VISA-G-Norwegian correlated to the modified Harris Hip Score (mHHS), Oswestry Disability Questionnaire (ODI) and Numeric Pain Rating Scale (NPRS), 0.64, -0.75 and − 0.63 respectively. Conclusion The VISA-G-Norwegian has acceptable reliability and validity, despite ceiling effect of individual items. The large SDC95% should be considered when measuring change in similar cohorts with GTPS. For a potential future version, it would be recommended to consider response options for questions with ceiling effect and the comprehensibility of question eight. Trial registration Registered at ClinicalTrials.gov the 28/02/2020 (NCT04289922).

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Søberg, Helene L. & Røise, Olav [Show all 15 contributors for this article] (2023). Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan. Journal of Rehabilitation Medicine. ISSN 1650-1977. 55. doi: 10.2340/jrm.v55.6552. Full text in Research Archive Show summary

  Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan.<p> <p>Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score >9. <p>Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. <p>Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma.

• Hauger, Solveig Lægreid; Borgen, Ida Maria Henriksen; Forslund, Marit Vindal; Kleffelgård, Ingerid; Hadzic-Andelic, Nada & Løvstad, Marianne [Show all 9 contributors for this article] (2023). Participation in the Chronic Phase after Traumatic Brain Injury: Variations and Key Predictors. Journal of Clinical Medicine. 12(17). doi: 10.3390/jcm12175584. Full text in Research Archive
• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study. Injury Epidemiology. 10. doi: 10.1186/s40621-023-00431-y. Full text in Research Archive Show summary

  Background - Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries.<p> <p>Methods - A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020).<p> <p>Results - In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3–4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated.<p> <p>Conclusions - Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.

• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries. Journal of Clinical Medicine. 12(16). doi: 10.3390/jcm12165300. Full text in Research Archive Show summary

  This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.

• Bockhop, Fabian; Zeldovich, Marina; Cunitz, Katrin; Praag, Dominique Van; Vlegel, Marjolein van der & Beissbarth, Tim [Show all 258 contributors for this article] (2022). Measurement invariance of six language versions of the post-traumatic stress disorder checklist for DSM-5 in civilians after traumatic brain injury. Scientific Reports. 12(1), p. 1–15. doi: 10.1038/s41598-022-20170-2. Full text in Research Archive Show summary

  Traumatic brain injury (TBI) is frequently associated with neuropsychiatric impairments such as symptoms of post-traumatic stress disorder (PTSD), which can be screened using self-report instruments such as the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The current study aims to inspect the factorial validity and cross-linguistic equivalence of the PCL-5 in individuals after TBI with differential severity. Data for six language groups (n ≥ 200; Dutch, English, Finnish, Italian, Norwegian, Spanish) were extracted from the CENTER-TBI study database. Factorial validity of PTSD was evaluated using confirmatory factor analyses (CFA), and compared between four concurrent structural models. A multi-group CFA approach was utilized to investigate the measurement invariance (MI) of the PCL-5 across languages. All structural models showed satisfactory goodness-of-fit with small between-model variation. The original DSM-5 model for PTSD provided solid evidence of MI across the language groups. The current study underlines the validity of the clinical DSM-5 conceptualization of PTSD and demonstrates the comparability of PCL-5 symptom scores between language versions in individuals after TBI. Future studies should apply MI methods to other sociodemographic (e.g., age, gender) and injury-related (e.g., TBI severity) characteristics to improve the monitoring and clinical care of individuals suffering from PTSD symptoms after TBI.

• Holthe, Ingvil Laberg; Rohrer-Baumgartner, Nina; Svendsen, Edel Jannecke; Hauger, Solveig Lægreid; Forslund, Marit Vindal & Borgen, Ida Maria Henriksen [Show all 13 contributors for this article] (2022). Feasibility and Acceptability of a Complex Telerehabilitation Intervention for Pediatric Acquired Brain Injury: The Child in Context Intervention (CICI). Journal of Clinical Medicine. 11(9), p. 1–23. doi: 10.3390/jcm11092564. Full text in Research Archive Show summary

  The current study is a feasibility study of a randomized controlled trial (RCT): the Child in Context Intervention (CICI). The CICI study is an individualized, goal-oriented and home-based intervention conducted mainly through videoconference. It targets children with ongoing challenges (physical, cognitive, behavioral, social and/or psychological) after acquired brain injury (ABI) and their families at least one year post injury. The CICI feasibility study included six children aged 11–16 years with verified ABI-diagnosis, their families and their schools. The aim was to evaluate the feasibility of the intervention components, child and parent perceptions of usefulness and relevance of the intervention as well as the assessment protocol through a priori defined criteria. Overall, the families and therapists rated the intervention as feasible and acceptable, including the videoconference treatment delivery. However, the burden of assessment was too high. The SMART-goal approach was rated as useful, and goal attainment was high. The parents’ ratings of acceptability of the intervention were somewhat higher than the children’s. In conclusion, the CICI protocol proved feasible and acceptable to families, schools and therapists. The assessment burden was reduced, and adjustments in primary outcomes were made for the definitive RCT.

• Borgen, Ida Maria Henriksen; Hauger, Solveig Lægreid; Forslund, Marit Vindal; Kleffelgård, Ingerid; Brunborg, Cathrine & Andelic, Nada [Show all 11 contributors for this article] (2022). Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury. Journal of Clinical Medicine. 11(4), p. 1–17. doi: 10.3390/jcm11040958. Full text in Research Archive Show summary

  Traumatic brain injury (TBI) is a heterogeneous condition with long-term consequences for individuals and families. Goal-oriented rehabilitation is often applied, but there is scarce knowledge regarding types of goals and goal attainment. This study describes goal attainment in persons in the chronic phase of TBI who have received an individualized, SMART goal-oriented and home-based intervention, compares goal attainment in different functional domains, and examines indicators of goal attainment. Goal attainment scaling (GAS) was recorded in the intervention group (n = 59) at the final session. The goal attainment was high, with 93.3% increased goal attainment across all goals at the final session. The level of goal attainment was comparable across domains (cognitive, physical/somatic, emotional, social). Gender, anxiety symptoms, self-reported executive dysfunction, and therapy expectations were indicators of goal attainment. These results indicate a potential for the high level of goal attainment in the ch

• Wilson, Lindsay; Horton, Lindsay; Polinder, Suzanne; Newcombe, Virginia F.J.; Steinbuechel, Nicole v. & Maas, Andrew I. R. [Show all 50 contributors for this article] (2022). Tailoring Multi-Dimensional Outcomes to Level of Functional Recovery after Traumatic Brain Injury. Journal of Neurotrauma. ISSN 0897-7151. 39(19-20), p. 1363–1381. doi: 10.1089/neu.2022.0013. Full text in Research Archive Show summary

  There is increasing emphasis on assessing multi-dimensional outcomes in traumatic brain injury (TBI), but achieving this aim is hampered by a plethora of overlapping assessment tools. There is a clear need for advice on the choice of outcomes and we examined level of functional recovery as a framework to guide selection of assessments. In this cohort study we analysed cross-sectional data from 2604 patients enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project. Patients were followed up 6 months after injury and assessed on the Glasgow Outcome Scale-Extended (GOSE), cognitive tests, and patient-reported outcomes. We describe assessment completeness and prevalence of impairment. Relationships between outcomes were visualized using UpSet plots and hierarchical cluster analysis. GOSE categories varied markedly for both completion rates, 34–91% for patient-reported outcomes and 9–81% for cognitive tests, and prevalence of impairment, 3–82% for patient-reported outcomes and 9–59% for cognitive tests. In complete case samples, the GOSE identified impairment in 59–61%, whereas the most impaired patient-reported outcome was the Short Form-12 version 2 (SF-12v2) Physical Component Summary (28% overall), and the most impaired cognitive test was Trail Making Test (TMT) Part A (19% overall). The findings show that degree of disability is a key context of use for cognitive tests and patient-reported outcomes. Level of functional recovery provides a guide to the feasibility of different types of assessment and the likelihood of impairment, and can help tailor suitable assessment approaches in clinical practice and research studies.

• Praag, Dominique L.G. Van; Wouters, Kristien; Eede, Filip Van Den; Wilson, Lindsay; Maas, Andrew I.R. & Åkerlund, Cecilia [Show all 250 contributors for this article] (2022). Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury. Brain and Spine. 2. doi: 10.1016/j.bas.2021.100854. Full text in Research Archive
• Fure, Silje Christine Reistad; Howe, Emilie; Andelic, Nada; Brunborg, Cathrine; Olsen, Alexander & Rike, Per-Ola [Show all 10 contributors for this article] (2022). Workplace Factors Associated With Return to Work After Mild-to-Moderate Traumatic Brain Injury. The journal of head trauma rehabilitation. ISSN 0885-9701. 38(1), p. 1–9. doi: 10.1097/HTR.0000000000000772. Full text in Research Archive Show summary

  Abstract Objective: Sociodemographic and injury-related predictors for return to work (RTW) after mild-to-moderate traumatic brain injury (TBI) have been extensively explored. However, there is a knowledge gap regarding work-related predictors of RTW. The main aim of this study was to explore work-related predictors of work participation 6 and 12 months after mild-to-moderate TBI. Setting: Data were collected at baseline 8 to 12 weeks after injury, and 3, 6, and 12 months after baseline, at a specialized TBI rehabilitation outpatient clinic at Oslo University Hospital, Oslo, Norway. Participants: Eligible patients had suffered a mild-to-moderate TBI 8 to 12 weeks previously, were employed 50% or more at time of injury, were between 18 and 60 years of age, and sick listed 50% or more at time of inclusion due to symptoms of TBI (based on the Rivermead Post-Concussion Symptoms Questionnaire). In total, 116 patients were included in a randomized controlled trial, of whom 113 were included in the 1-year analysis. Design: Patients were originally included in a randomized controlled trial. There were no between-group differences in RTW after 1 year. Thus, the participants were evaluated as one cohort in this study. Main measures: The primary outcome measure was work participation 1 year after study inclusion. Work-related predictors were chosen on the basis of previous research and expert opinion and entered into a multivariable linear regression model. The model controlled for sociodemographic and injury-related factors. Results: The best-fitting model explained 25% of variation in work participation at 1 year. Significant predictors were predictability, quantitative demands and rewards (recognition) at the workplace, private or public employment, symptom burden at baseline, and sex. Conclusion: In this study, several work-related predictors outperformed some of the established sociodemographic and injury-related predictors of RTW after TBI, thus stressing the need for further focus and research on amendable predictors of RTW after mild-to-moderate TBI.

• Tyrdal, Mari Kristine; Veierød, Marit Bragelien; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Robinson, Hilde Stendal (2022). Neck and back pain: Differences between patients treated in primary and specialist health care. Journal of Rehabilitation Medicine. ISSN 1650-1977. 54, p. jrm00300–jrm00300. doi: 10.2340/jrm.v54.363. Full text in Research Archive Show summary

  Objective: To describe and compare patients with neck and back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway. Design: Cross-sectional study using data from the FYSIOPRIM database in PHC and the Norwegian Neck and Back Registry in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated. Results: A total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common from 3 to 12 months’ pain duration. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psychological distress. Conclusion: This is the first study comparing register data in patients with neck and back pain treated in PHC and SHC. Differences were found in pain and health-related quality of life, but levels of psychological distress were similar between patients treated in PHC and those treated in SHC. LAY ABSTRACT Patients with neck or back pain have high levels of healthcare utilization, both in primary and specialist healthcare. The aim of this study was to investigate patients referred and treated by physiotherapists in primary healthcare and by specialists in specialist healthcare in Norway, to evaluate differences in the demographics, lifestyle and clinical factors of patients treated in each healthcare setting. Included patients had been diagnosed with neck or back pain from 2014 to 2018, and were aged ≥18 years. Patients in specialist care had more pain and lower health-related quality of life, but similar levels of psychological distress to those treated in primary healthcare. Furthermore, patients treated in specialist healthcare had lower socioeconomic status (education, workload, social benefits) compared with those treated in primary healthcare.

• Røe, Cecilie; Bautz-Holter, Erik; Andelic, Nada; Søberg, Helene L.; Nugraha, Boya & Gutenbrunner, Christoph [Show all 10 contributors for this article] (2022). Organization of Rehabilitation Services in Randomized Controlled Trials: Which Factors Influence Functional Outcome? A Systematic Review. Archives of Rehabilitation Research and Clinical Translation. 4(2). doi: 10.1016/j.arrct.2022.100197. Full text in Research Archive Show summary

  Objective To identify factors related to the organization of rehabilitation services that may influence patients’ functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions. Data Sources A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019. Study Selection In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0. Data Synthesis In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results. Conclusions Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.

• Thomas, Ilias; Dickens, Alex M.; Posti, Jussi P.; Czeiter, Endre; Duberg, Daniel & Sinioja, Tim [Show all 255 contributors for this article] (2022). Serum metabolome associated with severity of acute traumatic brain injury. Nature Communications. 13(1), p. 1–15. doi: 10.1038/s41467-022-30227-5. Full text in Research Archive Show summary

  Complex metabolic disruption is a crucial aspect of the pathophysiology of traumatic brain injury (TBI). Associations between this and systemic metabolism and their potential prognostic value are poorly understood. Here, we aimed to describe the serum metabolome (including lipidome) associated with acute TBI within 24 h post-injury, and its relationship to severity of injury and patient outcome. We performed a comprehensive metabolomics study in a cohort of 716 patients with TBI and non-TBI reference patients (orthopedic, internal medicine, and other neurological patients) from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We identified panels of metabolites specifically associated with TBI severity and patient outcomes. Choline phospholipids (lysophosphatidylcholines, ether phosphatidylcholines and sphingomyelins) were inversely associated with TBI severity and were among the strongest predictors of TBI patient outcomes, which was further confirmed in a separate validation dataset of 558 patients. The observed metabolic patterns may reflect different pathophysiological mechanisms, including protective changes of systemic lipid metabolism aiming to maintain lipid homeostasis in the brain.

• Vlegel, Marjolein van der; Mikolić, Ana; Hee, Quentin Lee; Kaplan, Z.L. Rana; Helmrich, Isabel R.A. Retel & Veen, Ernest van [Show all 255 contributors for this article] (2022). Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study. Injury. ISSN 0020-1383. 53(8), p. 2774–2782. doi: 10.1016/j.injury.2022.05.009. Full text in Research Archive Show summary

  Introduction The incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI. Methods We used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury. Results Of 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms. Conclusion The rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.

• Howe, Emilie; Zeldovich, Marina; Andelic, Nada; Steinbuechel, Nicole von; Fure, Silje Christine Reistad & Borgen, Ida Maria Henriksen [Show all 51 contributors for this article] (2022). Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study. BMC Health Services Research. 22(1), p. 1–16. doi: 10.1186/s12913-022-08908-0. Full text in Research Archive Show summary

  Background Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall

• Mørk, Marianne; Hoksrud, Aasne Fenne; Søberg, Helene L.; Zucknick, Manuela; Heide, Marte & Groven, Karen Synne [Show all 7 contributors for this article] (2022). “Psychometric properties of the Norwegian foot function index revised short form”. BMC Musculoskeletal Disorders. 23(1), p. 1–10. doi: 10.1186/s12891-022-05374-x. Full text in Research Archive Show summary

  Background Foot disorders affect up to one quarter of the adult population. Plantar fasciopathy is a common cause of foot pain associated with decreased activity level and quality of life. Patient-reported outcome measures are important in assessing the burden of a condition as well as in research on the effects of interventions. The Foot Function Index revised short form (FFI-RS) is a region specific questionnaire frequently used in research. This study aimed to cross-culturally adapt the FFI-RS into Norwegian and to test its psychometric properties. Methods The FFI-RS was translated into Norwegian (FFI-RSN) following international guidelines. 139 patients with foot disorders (88% with plantar fasciopathy) were included at baseline to measure internal consistency, explorative factor analysis, construct validity and floor and ceiling effects. 54 patients were included after 1 week for test-retest reliability and smallest detectable change analyses. 100 patients were included for responsiveness and minimal important change at 3 months. Results Cronbach’s alpha for internal consistency was 0.97 and factor analysis supported the use of the total score of the FFI-RSN. Two out of three predefined hypotheses were confirmed by assessing the construct validity with Spearman’s correlation coefficient. Quadratic weighted Kappa for test-retest reliability showed 0.91 (95% CI 0.86–0.96) and the smallest detectable change was 6.5%. The minimal important change was 8.4% and the area under the receiver operating characteristic curve for responsiveness was 0.78 (95% CI 0.69–0.87). We found no floor or ceiling effects on the total score of the FFI-RSN. Conclusions The present study showed excellent reliability of the FFI-RSN and supports the use of the total score of the questionnaire. Furthermore, we found the FFI-RSN to have acceptable responsiveness in relation to change in general health. Smallest detectable change, minimal important change and responsiveness were presented as novel results of the total score of the FFI-RS. FFI-RSN can be used to evaluate global foot health in clinical or research settings with Norwegian patients suffering from plantar fasciopathy. Trial registration Clinical Trials.gov NCT04207164. Initial release 01.11.19.

• Nugraha, Boya; Engen, Grace; Røe, Cecilie; Kirkevold, Marit; Søberg, Helene L. & Andelic, Nada [Show all 7 contributors for this article] (2022). Development of a Minimum Reporting Set of Contextual Factors for Rehabilitation Studies: A Delphi Study. Journal of Rehabilitation Medicine. ISSN 1650-1977. 54, p. 1–9. doi: 10.2340/jrm.v54.2033. Full text in Research Archive Show summary

  Objective: To identify the most important categories of the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0) for a minimum reporting data set.Methods: A 2-step Delphi survey was used. Rehabilitation experts from all world regions including physicians, nurses, neuropsychologists, physiotherapists, and others, were invited to participate. In the first round, all participants were asked to rate the categories and subcategories of the ICSOR 2.0 with the following criteria: Being relevant for study outcomes; Being distinctive among different rehabilitation settings; Being feasible to use and reported by objective figures or other clear characterization. All categories that were rated relevant, distinctive and feasible by more than 60% of respondents from the first round were included in the second round.Results: The most important and relevant factors for the minimum reporting set in rehabilitation services regarding the provider were: human resources, context, technical resources, quality assurance and management, location of provider, and ownership. Regarding the service delivery, the most important and relevant factors were: target group, rehabilitation team, aspect of time and intensity,setting, location of service delivery, modes of referral, facility and reporting and documentation.Conclusion: Several categories were identified, and reduction in these through discussions and iterative voting at workshops and consensus conferences is needed before finalizing the reporting set. LAY ABSTRACTA goal of this Delphi study was to identify the most important parameters of the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0), to characterize rehabilitation services and identify important missing categories needed in a minimum reporting set. The most important and relevant factors for developing a minimum reporting set regarding the provider were: humanresources, context, technical resources, quality assurance and management, location of provider, and ownership. Regarding service delivery the most important and relevant factors were: target group, rehabilitation team, aspect of time and intensity, setting, location of service delivery, modes of referral, facility and reporting and documentation. These factors should be discussed further, and a final set should be developed in workshops through discussion and iterative voting.

• Tverdal, Cathrine Buaas; Brunborg, Cathrine; Helseth, Eirik; Andelic, Nada; Koch, Marte Ellersgaard & Røe, Cecilie [Show all 8 contributors for this article] (2022). Referrals to early specialized rehabilitation after traumatic brain iinjury during the Covid-19 pandemic. Journal of Rehabilitation Medicine. ISSN 1650-1977. 54:jrm00334, p. 1–9. doi: 10.2340/jrm.v54.2203. Full text in Research Archive Show summary

  Objective: To quantify potential changes in direct referral to early specialized rehabilitation during the COVID-19 pandemic and the injury pattern of patients hospitalized with traumatic brain injury (TBI) at a level 1 trauma centre.Methods: In this registry-based study, data were retrieved from the Oslo TBI Registry-Neurosurgery and included adult patients with injury-related intracranial findings admitted to Oslo University Hospital (OUH). The study focused on a period of time when OUH was in any level of preparedness because of the COVID-19 pandemic; March 2020 to August 2021. For comparison, the study used patients hospitalized for TBI in 2018 and 2019.Results: A total of 1,310 hospitalized patients with TBI were divided into 2 groups; pre-pandemic and pandemic. Direct referral to early rehabilitation was maintained. Patient volume remained stable, and there were no differences between the groups regarding patient characteristics and acute management, although there was a significantly higher proportion of TBIs secondary to electric scooter accidents in the pandemic group. Results from univariable and multivariable logistic regression showed a multifaceted reality, but younger age, none or mild preinjury comorbidity and severe disability due to TBI at discharge from acute care remained stable strong predictors of direct referral to rehabilitation.Conclusion: For patients with moderate-severe TBI, the direct pathway to early specialized rehabilitation was maintained during 2020–21. However, the pandemic continued and the long-term impact for rehabilitation services is not yet known. LAY ABSTRACTAfter traumatic brain injury, early rehabilitation is important in order to achieve optimal functional outcome. The COVID-19 pandemic has put the health services under pressure, and hospitals in Norway were reorganized to be able to treat a large number of patients with COVID-19. Therefore, this study investigated to what extent the transfer to early rehabilitation has been affected and whether there have been changes in volume and characteristics of patients admitted to hospital with traumatic brain injury. In conclusion, the direct pathway to early rehabilitation was maintained during the pandemic years 2020 and 2021. Moreover, there was no change in the number of hospital admissions or patient characteristics, and acute management was maintained. However, the true long-term consequences for rehabilitation are not yet known.

• Hauger, Solveig Lægreid; Borgen, Ida Maria Henriksen; Løvstad, Marianne; Lu, Juan; Forslund, Marit Vindal & Kleffelgård, Ingerid [Show all 8 contributors for this article] (2022). Community-Based Interventions after Acquired Brain Injury - A Systematic Review of Intervention Types and Their Effectiveness. The journal of head trauma rehabilitation. ISSN 0885-9701. 37(5), p. E355–E369. doi: 10.1097/HTR.0000000000000765. Full text in Research Archive Show summary

  Objectives: Comprehensive review of existing types and effectiveness of community-based interventions delivered to adults (mean age 18-65 years) with long-lasting (≥6 months) difficulties following acquired brain injury (ABI). Design: Systematic review of controlled intervention studies published until February 2021. Main Measures: Systematic searches in databases (MEDLINE, PsycINFO, Database of Abstracts of Reviews of Effects [Cochrane Library], and Cochrane Central Register of Controlled Trials [Cochrane Library]) and inclusion of English peer-reviewed full-text articles; randomized or controlled community-based intervention studies; sample size of 20 or more participants; and 3 or more intervention sessions. Two reviewers independently extracted data for the synthesis and assessed the methodological quality. Data extraction included study characteristics, demographics of participants, content and dose of intervention, outcome measures, and findings. Result: The search returned 7386 publications, of which 49 eligible studies were included, revealing a diverse range of community-based interventions and a myriad of outcome measures applied for assessing functional capacities, participation, and quality of life in the chronic phase of ABI. Intervention types encompassed 14 holistic, 23 physical, and 12 specific interventions. A large heterogeneity regarding intervention frequency and intensity was found. Meta-analyses performed on the holistic, physical, and specific interventions did not indicate any significant pooled effects but showed highly variable effects between individuals, both in persons with traumatic and nontraumatic brain injuries. Conclusions: Because of lack of pooled effects within types of community-based interventions, specific evidence-based recommendations within holistic, physical, and specific interventions designed to mitigate long-lasting ABI problems cannot be made. This review highlights the need for future studies to address methodological issues concerning larger sample size, lack of clear description interventions and comparator, missing reports of effects in change scores, need for consistent use of recommended outcome measures, and investigating the wide variety in intervention responsiveness among participants with ABI. Systematic review registration: PROSPERO (CRD42019124949).

• Helmrich, Isabel Rosalie Arianne Retel; Klaveren, David Van; Andelic, Nada; Lingsma, Hester; Maas, Andrew & Menon, David [Show all 11 contributors for this article] (2022). Discrepancy between disability and reported well-being after traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry. ISSN 0022-3050. 93(7), p. 785–796. doi: 10.1136/jnnp-2021-326615. Full text in Research Archive Show summary

  Background Following traumatic brain injury (TBI), the clinical focus is often on disability. However, patients’ perceptions of well-being can be discordant with their disability level, referred to as the ‘disability paradox’. We aimed to examine the relationship between disability and health-related quality of life (HRQoL) following TBI, while taking variation in personal, injury-related and environment factors into account. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. Disability was assessed 6 months post-injury by the Glasgow Outcome Scale-Extended (GOSE). HRQoL was assessed by the SF-12v2 physical and mental component summary scores and the Quality of Life after Traumatic Brain Injury overall scale. We examined mean total and domain HRQoL scores by GOSE. We quantified variance in HRQoL explained by GOSE, personal, injury-related and environment factors with multivariable regression. Results Six-month outcome assessments were completed in 2075 patients, of whom 78% had mild TBI (Glasgow Coma Scale 13–15). Patients with severe disability had higher HRQoL than expected on the basis of GOSE alone, particularly after mild TBI. Up to 50% of patients with severe disability reported HRQoL scores within the normative range. GOSE, personal, injury-related and environment factors explained a limited amount of variance in HRQoL (up to 29%). Conclusion Contrary to the idea that discrepancies are unusual, many patients with poor functional outcomes reported well-being that was at or above the boundary considered satisfactory for the normative sample. These findings challenge the idea that satisfactory HRQoL in patients with disability should be described as ‘paradoxical’ and question common views of what constitutes ‘unfavourable’ outcome.

• Howe, Emilie; Andelic, Nada; Fure, Silje Christine Reistad; Røe, Cecilie; Søberg, Helene L. & Hellstrøm, Torgeir [Show all 12 contributors for this article] (2022). Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial. BMC Health Services Research. 22(22). doi: 10.1186/s12913-022-07585-3. Full text in Research Archive Show summary

  Background: Traumatic brain injury (TBI) represents a fnancial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes. Methods: One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER). Results: The mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary beneft (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU. Conclusions: Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.

• Maas, Andrew I. R.; Menon, David K.; Manley, Geoffrey; Abrams, Mathew; Åkerlund, Cecilia & Andelic, Nada [Show all 50 contributors for this article] (2022). Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurology. ISSN 1474-4422. 21(11), p. 1004–1060. doi: 10.1016/S1474-4422(22)00309-X. Full text in Research Archive

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• Aars, Nils Abel; Brandseth, Oda Lekve; Bardal, Ingvild; Stevelink, Sharon; Sanatkar, Samineh & Trichet, Laurent Olivier [Show all 14 contributors for this article] (2025). Cohort profile: the Norwegian Neck and Back Registry (NNRR): a medical quality registry for patients with neck and back complaints. BMJ Open. 15(3). doi: 10.1136/bmjopen-2024-096992. Full text in Research Archive
• Melås, Thea Morin; Bjørneboe, John Andreas; Juel, Niels Gunnar; Wefring, Maren Lunder; Skatteboe, Sigrid & Killingmo, Rikke Munk [Show all 14 contributors for this article] (2024). Self-management versus usual care for greater trochanteric pain syndrome: protocol for a randomized controlled trial with nested qualitative interviews (the HIPS trial). Full text in Research Archive
• Forslund, Marit Vindal; Borgen, Ida Maria Henriksen; Karic, Tanja; Kleffelgård, Ingerid; Hauger, Solveig Lægreid & Løvstad, Marianne [Show all 11 contributors for this article] (2024). Validity of the Norwegian Version of the Needs and Provision Complexity Scale (NPCS) in Patients with Traumatic Brain Injury and Atraumatic Subarachnoid Hemorrhage. Journal of Clinical Medicine. 13(3). doi: 10.3390/jcm13030752. Full text in Research Archive
• Rasmussen, Mari Storli; Andelic, Nada; Selj, Joanna Nordhagen; Danielsen, Vilde Marie; Løvstad, Marianne & Howe, Emilie Isager [Show all 30 contributors for this article] (2024). Self-management support program delivered in the sub-acute phase after traumatic injury-study protocol for a pragmatic randomized controlled trial. Trials. 25(1), p. 639–639. doi: 10.1186/s13063-024-08492-0. Full text in Research Archive Show summary

  Background Traumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury. Methods This study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure. Discussion This RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers. Trial registration The study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

• Rohrer-Baumgartner, Nina Marit; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; DAHL, HILDE MARGRETE; Borgen, Ida Maria Henriksen & Strand-Saugnes, Anine Pernille [Show all 13 contributors for this article] (2024). Results from a randomized controlled trial of an individualized and goal-oriented intervention in the chronic phase of pediatric acquired brain injury: the Child in Context Intervention (CICI). Full text in Research Archive
• Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Rohrer-Baumgartner, Nina Marit; Hauger, Solveig; Borgen, Ida Maria Henriksen & Forslund, Marit Vindal [Show all 12 contributors for this article] (2024). Acceptability of an individualized and goal-oriented intervention in the chronic phase of pediatric acquired brain injury: the Child in Context intervention (CICI). Full text in Research Archive
• Forslund, Marit Vindal; Borgen, Ida Maria Henriksen; Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Hauger, Solveig Lægreid & Løvstad, Marianne [Show all 7 contributors for this article] (2023). Symposium: Goal-Oriented and Individualized Rehabilitation after Brain Injury. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Borgen, Ida Maria Henriksen; Egeland, Jens & Wade, Shari L. [Show all 8 contributors for this article] (2023). Families´self-reported challenges in daily life in the chronic stage of pediatric brain injury. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Strand-Saugnes, Anine; Røe, Cecilie & Wade, Shari L. [Show all 13 contributors for this article] (2022). The Child in Context Intervention (CICI) Study: Protocol for a Randomized Controlled Trial Evaluating the Effectiveness of a Goal-Oriented and Individualized Rehabilitation for Children With Chronic Acquired Brain Injury. Full text in Research Archive
• Søberg, Helene L.; Moksnes, Håkon Øgreid; Anke, Audny Gabriele Wagner; Røise, Olav; Røe, Cecilie & Aas, Eline [Show all 20 contributors for this article] (2022). Erratum: Rehabilitation Needs, Service Provision, and Costs in the First Year following Traumatic Injuries: Protocol for a Prospective Cohort Study ((JMIR Res Protoc (2021) 10: 4 (e25980) DOI: 10.2196/25980). JMIR Research Protocols. 11(3). doi: 10.2196/37723. Full text in Research Archive
• Søberg, Helene L.; Andelic, Nada; Røe, Cecilie & Kirkevold, Marit (2022). Users’ Perspectives on Important Factors in the Organization of Services in Rehabilitation – a Focus Group Study of User Organization Representatives in Norway. Full text in Research Archive
• Hauger, Solveig Lægreid; Borgen, Ida Maria Henriksen; Løvstad, Marianne; Lu, Juan; Forslund, Marit Vindal & Kleffelgård, Ingerid [Show all 8 contributors for this article] (2022). Community-based Interventions after Acquired Brain Injury -a Systematic Review of Interventions including Family Members. Full text in Research Archive
• Rohrer-Baumgartner, Nina; Holthe, Ingvil Laberg; Svendsen, Edel Jannecke; Røe, Cecilie; Egeland, Jens & Borgen, Ida Maria Henriksen [Show all 21 contributors for this article] (2022). Rehabilitation for children with chronic acquired brain injury in the Child in Context Intervention (CICI) study: study protocol for a randomized controlled trial. Trials. 23. doi: 10.1186/s13063-022-06048-8. Full text in Research Archive Show summary

  Background: Pediatric acquired brain injury (pABI) is associated with long-term cognitive, behavioral, social, and emotional problems, which may affect the quality of life, school, and family functioning. Yet, there is a lack of evidence-based community-centered rehabilitation programs for chronic pABI and these children do not systematically receive comprehensive rehabilitation. The Child In Context Intervention (CICI) study is a pragmatic randomized controlled trial (RCT) for children with chronic pABI, which aims to evaluate the effectiveness of an individualized and goal-oriented intervention targeting everyday functioning of the child and family. Methods: Children aged 6–16 years with MRI/CT-verified intracranial abnormalities will be included in the CICI study if they have persistent self- or parent-reported cognitive, emotional, and/or behavioral challenges 1 year or more after insult and attend school regularly. A total of 70 families will be randomized 1:1 to an intervention or a control group. The intervention consists of seven family sessions, one parent seminar, and four school sessions delivered over approximately 6 months. The parent seminar will be held in person, and the other sessions will mainly be video based. The children’s and families’ self-reported major challenges in everyday life will be targeted using SMART goals. Evidence-based strategies, when available, will be applied to achieve the goals, combined with psychoeducation. Goal attainment scaling (GAS) will be used to evaluate goal attainment. Data is collected at baseline and after approximately 6 and 9 months. External assessors are blinded to group allocation. Primary outcomes are parent-reported brain injury symptoms in children and parenting self-efficacy at 9 months of follow-up. Secondary outcomes include child-reported brain injury symptoms, quality of life, executive functioning in daily life, parent emotional symptoms, family functioning, and unmet family health care needs. A process evaluation will be conducted. Discussion: The current study provides an innovative approach to rehabilitation for children in the chronic phase of ABI and their families. This complex intervention may contribute to the development of evidence-based, high-quality rehabilitation for a large patient group, which is underrepresented in clinical research. It may also improve collaboration between specialized rehabilitation facilities, schools, and local health care services. Inclusion for the trial started in April 2021.

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