Occupational Therapy Practice in Adult Rehabilitation of Persistent Postconcussion Symptoms: A Scoping Review

Abstract

Importance: The role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS) following mild traumatic brain injury is an emerging practice area. Research that contributes to growing knowledge and understanding of the profession's role may increase the recognition and visibility of occupational therapy in concussion rehabilitation programs.

Objective: To identify and categorize (using World Health Organization International Classification of Functioning, Disability and Health [WHO ICF] One-Level Classification domains) existing literature that describes occupational therapy practice (including assessments and interventions) in the rehabilitation of adults with PPCS.

Data sources: Five scientific databases (MEDLINE, Embase, Emcare, PsycINFO, and CINAHL Complete) and gray literature were searched.

Study selection and data collection: Eligibility criteria included publications between 2013 and 2023, written in English, and within the peer-reviewed literature or on specified web domains (.gov, .edu, or .org).

Findings: Nineteen publications from 16 sources met eligibility criteria, consisting of quantitative studies (n = 6); case studies, series, or reports (n = 3); qualitative studies (n = 2); systematic or scoping literature reviews (n = 2); and gray literature sources (n = 3). The United States was the origin for many sources (n = 10). Assessments and interventions reported were heterogenous, mapping across 27 of the 30 WHO ICF One-Level Classifications.

Conclusions and relevance: Evidence to inform occupational therapy practice in adult PPCS rehabilitation is limited; however, some useful information about the assessments and interventions used by occupational therapists was found. At a time when considerable advancements in concussion rehabilitation are occurring, further research on evidence-informed occupational therapy practice is required. Plain-Language Summary: This study reviewed existing evidence about the role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS). It identifies and methodically documents a range of occupational therapy assessments and interventions described in the literature that may be used by occupational therapists within concussion rehabilitation programs or research. The study also categorizes these by using an internationally recognized taxonomy, the World Health Organization's International Classification of Functioning, Disability and Health. The review offers a novel synthesis of published evidence to guide occupational therapy practice and inform resource allocation in concussion rehabilitation. It also highlights the need for further research about the role of occupational therapy-including both high-quality evidence of current approaches and identification of future practice opportunities-in the rehabilitation of adults experiencing PPCS following brain injury.