Health Services Research
HSR 3: Social and Medical Complexity
Pallavi Muluk (she/her/hers)
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania, United States
Data Sources: Ovid Medline, Ovid APA PsycInfo, Elsevier Embase were searched in June-July, 2021 and November, 2022.
Study Selection: Included articles were observational, empirical studies available in English with a sample of participants who sustained a TBI in childhood (< 18 years) and reported on the association between rehabilitation service use with individual and/or contextual characteristics. Randomized controlled trials, editorials, and reviews were excluded. Using DistillerSR software, two reviewers independently screened studies by title and abstract, then by full text. Conflicts were resolved by discussion amongst reviewers.
Data Extraction: One reviewer extracted data on study design, participant demographics, characteristics of rehabilitation service use, and strength of association between individual and contextual characteristics assessed with service use.
Of the 4,223 results screened, 26 met inclusion criteria. Data were summarized using narrative synthesis. Rehabilitation service use post-injury was primarily assessed via unvalidated measures. TBI severity was the most frequently reported individual factor associated with greater rehabilitation use, followed by non-capitated or private/commercial insurance plans, non-Hispanic ethnicity, longer hospital stays, and older age. Service use was inconsistently associated with sex. One study examined contextual factors and found that rural residence was associated with higher rates of physical and occupational therapy while urban residence was associated with speech therapy, psychiatry, and psychology services.
Greater rates of rehabilitation utilization post-pediatric TBI are associated with greater TBI severity, insurance status, and ethnicity. Results should be interpreted with caution as current measures of rehabilitation use remain unstandardized and unvalidated. There is a lack of literature examining the impact of contextual factors on service utilization. Addressing demographic and financial disparities and understanding how a child’s community impacts service use are essential next steps in promoting equitable recovery from pediatric TBI.