Inclusion and Representation in Rehabilitation Research and Practice of Adults with Traumatic Brain Injury and Comorbid Depression: A Knowledge Translation Perspective
Bibliographic record
Abstract
Background: Depression is highly comorbid with traumatic brain injury (TBI). Adults with TBI and depression experience poorer health outcomes, greater disability, and unmet healthcare needs. Depression commonly precludes individuals from clinical trials; it is unknown how well they are prioritized throughout the evidence-to-practice pathway of knowledge translation (KT). Purpose: The purpose of this dissertation is to examine inclusion and representation of adults with comorbid depression in evidence-based TBI rehabilitation research and practice. Methods: Three studies and one conceptual paper were completed: 1) scoping review of the TBI rehabilitation sciences literature that measured depression to describe the representation of the target group; 2) critical analysis of two Canadian TBI clinical practice guidelines to examine how the target group is included in guideline development, recommendations, and evidence base;3) qualitative descriptive study to understand the target group’s experiences of their TBI rehabilitation; and, 4) conceptual paper to examine how the predominant evidence-based practice (EBP) model applies for the target group. Results: Adults with TBI and depression are underrepresented in the TBI rehabilitation sciences literature and under-included in the TBI clinical practice guidelines given the prevalence rates of post-TBI depression. The 13 qualitative study participants expressed values, preferences, and meaningful outcomes of rehabilitation in response to largely negative healthcare experiences, indicating a lack of patient-centred care. A re-conceptualized zonal EBP model with a lens of inclusion and representation was proposed and illustrated using adults with TBI and depression. Conclusions: Comorbid depression is rarely included and represented throughout the evidence-to-practice pathway. Providing evidence-based rehabilitation for adults with TBI and depression is difficult; patient values and perspectives should be emphasized. The zonal EBP model can be applied to comorbid groups to support clinical and KT approaches that are evidence-based and patient-centred.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.203 | 0.286 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.016 | 0.055 |
| Scholarly communication | 0.029 | 0.024 |
| Open science | 0.006 | 0.032 |
| Research integrity | 0.009 | 0.011 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".