Rehabilitation after trauma research group

Rehabilitation after trauma research group 

Leader: Nada Andelic

The Rehabilitation after trauma research group is derived from the Department of Physical Medicine and Rehabilitation at Oslo University Hospital (OUH). The goal of this research group is to generate knowledge of the mechanisms and consequences of trauma, patient care, trends and challenges in treatment and rehabilitation including the patient's healthcare needs focused on traumatic brain injury (TBI), multiple trauma and atraumatic subarachnoid hemorrhage (aSAH). The research conducted by this group is multidisciplinary, where collaboration between genetics, intensive care medicine, neurosurgery, neuroradiology, neuropsychology and rehabilitation has been established over the last 15 years.

The main aims of the research group for 2020-2025 is:

  • To better understand the mechanisms, course and consequences of TBI, aSAH and multiple traumas by using translational research strategy
  • To develop (and implement) cost-effective rehabilitation interventions to target TBI-related challenges in the short- and long-term after TBI
  • To improve collaboration and knowledge transfer between primary and secondary health care services to ensure seamless rehabilitation for trauma patients
  • To strengthen existing and initiate new national and international multicenter research collaborations

 The specific aims of the research group are to generate research-based knowledge of:

  • The organization of patient care and rehabilitation trajectories, including patients’ needs and use of health care services after trauma
  • Effective rehabilitation interventions to target trauma-related challenges in the short- and long-term; both holistic and specific interventions
  • Cost-effectiveness of effective interventions 
  • Build evidence-based efficient protocols for the implementation of new cost-effective rehabilitation interventions into existing guidelines and services
  • Collaboration between primary and secondary health care services 
  • Long-term outcomes and recovery process after aSAH
  • The biomarkers of TBI and the severity of injuries including morphological changes in the brain

Previous research projects and collaborators

Several large prospective cohort studies on adult populations with moderate-to-severe TBI residing in South-East Norway have been conducted in the last decade in collaboration with Sunnaas Rehabilitation Hospital (SRH) and Sørlandet Hospital, Kristiansand. Five PhD degrees have been completed. The studies have addressed the incidence and risk factors of TBI, and factors modulating the medical, emotional, neurocognitive and rehabilitation outcomes in a longitudinal perspective. As reestablishing optimal quality of life for persons with TBI is the ultimate goal of rehabilitation, the research has also focused on trajectories and predictors of health related quality of life. Because the TBI population is young and sustain disability that may have an impact across the entire life span, the studies included long-term follow-ups. Such designs have previously been lacking in international research. 

A national multicenter study on rehabilitation after severe TBI, involving all four regional university hospitals in Norway, has also been completed. It has added to our understanding of the epidemiology, olfactory dysfunction, course of recovery and functional recovery in adults and elderly with severe TBI. Genetic susceptibility and relevant biomarkers were also investigated.

Several interventional studies have been conducted, including early rehabilitation in a continuous chain of treatment after severe TBI, two PhD projects on vestibular rehabilitation after TBI, in addition to effect evaluation of early rehabilitation in patients with aSAH. 

In order to assess the underlying structural brain damage of patients with mild TBI, a PhD project utilizing advanced radiological methods (functional and volumetric MRI) in combination with genetic markers and clinical and neuropsychological evaluation has also been completed. 

In collaboration, the Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM) and the Department of Health Management and Health Economics, University of Oslo, Oslo, Norway, the University of Deusto, Bilbao, Spain and Virginia Commonwealth University, Richmond, USA, have developed a methodology for evaluating health economic TBI consequences and rehabilitation trajectories. The organization of services, their effectiveness and costs are also of major importance. Hence, the research group is a main consortium participant in CHARM, building a competency platform in rehabilitation services research.

Severe injuries have the greatest consequences for the individual, and their perspective on rehabilitation services and social factors that affect life after injury is important. The Norwegian Research Council (NRC) funded project "Transitions in rehabilitation: Biographical reconstruction, experiential knowledge and professional expertise", originating from Oslo Metropolitan University in collaboration with the Rehabilitation after trauma research group, may contribute to more knowledge in this area. 

The Oslo Traumatic Brain Injury Outcome and Rehabilitation Research Group (OBIOR) is a research network encompassing the TBI research groups from OUH and SRH.

Main ongoing projects

Changes in physical, cognitive and emotional function 5 and 10 years after aneurysmal subarachnoid hemorrhage.

Principal investigators: Tonje Haug Nordenmark, PhD and Tanja Karic, PhD.

Funded by the Department of Physical Medicine and Rehabilitation, OUH.

The current study is a continuation of the study “Effect of early rehabilitation in patients with acute subarachnoid hemorrhage”. Patients treated for an aSAH at Oslo University Hospital in 2011-2012 were assessed in the acute phase, at 3 and 12 months post ictus as part of the original study, and were subsequently asked to participate in the 5- and 10-year follow-up. The main aim of the present study is to assess physical, cognitive and emotional function at 5 and 10 years after aSAH. A second aim is to describe quality of life and work-status along with the time-course of recovery from the acute stage after aSAH to the chronic phase. The project will try to develop a new questionnaire that specifically covers the problems involved in the post-aSAH syndrome. Selection of items will be based on the participants’ responses to the Rivermead Post-concussion Symptoms Questionnaire and the Mental Fatigue Scale.

The family as a resource for improved patient and family functioning after traumatic brain injury. A randomized controlled trial of a family centered intervention.

Principal investigator: Helene Lundgaard Søberg. PhD fellow: Mari S. Rasmussen.

Funded by “ExtraStiftelsen Helse og Rehabilitering”.

Because family members play an integral role in the patient's recovery, it is crucial to recognize the scope of the TBI experience and provide multidisciplinary rehabilitation within the context of the family system. This project is an RCT aimed to determine the effectiveness of a multi-professional theoretically based family-centered intervention, the Traumatic Brain Injury Family-Systems Intervention (TBIFSI), with the goal of improving self-efficacy and health-related quality of life. The project is conducted in collaboration between the Department of Physical Medicine and Rehabilitation at OUH, prof. Juan Arango-Lasprilla at BioCruces Health Research Institute, Cruces University Hospital, Bilbao, Spain, Bærum municipality and the National Association for the Traumatically Injured (Personskadeforbundet LTN). 

The effect evaluation of combined cognitive and vocational interventions after mild-to-moderate traumatic brain injury: a randomized controlled trial and qualitative process evaluation.

Principal Investigator: Nada Andelic. PhD fellows: Emilie Isager Howe and Silje C. R. Fure.

Funded by the NRC.

This project is a randomized controlled trial (RCT) which will explore the effect of combined manualized cognitive rehabilitation efforts and supported employment in real-life competitive work settings for patients with mild and moderate TBI who have not returned to work 8-12 weeks post-injury. The project combines rehabilitation and vocational science perspectives; it involves multidisciplinary collaboration, and explores the efficacy of increased cross-sectorial collaboration between specialized health care services and the welfare system. In addition, the study aims to generate knowledge of the return to work process for persons with TBI and the workplaces, and to disseminate this knowledge in order to create new multidisciplinary and collaborative practices. Project collaborators include OUH, SRH, Oslo Metropolitan University (the Work Research Institute), the Norwegian Labour and Welfare Administration (NAV; Department of Vocational Rehabilitation) and the National Association for the Traumatically Injured (Personskadeforbundet LTN). International collaborators are from Monash University, Melbourne, Australia, University of San Diego and Virginia Commonwealth University, Richmond, USA. 

Traumatic brain injury; needs and treatment options in the chronic phase. A randomized controlled community-based intervention.

Principal investigator: Cecilie Røe. PhD fellow: Ida M. H. Borgen. Postdoctoral fellows: Ingerid Kleffelgård, Solveig L. Hauger, Marit V. Forslund. 

Funded by the NRC.

This project is an RCT study which will explore a goal-oriented and patient-centered rehabilitation program for patients with chronic TBI. The project is based on current knowledge of common symptom profiles, as well as individually identified symptoms and functional limitations. The project will be conducted in the patient’s home environment, and will include the patient’s family and local health care providers if feasible. The results will be analyzed with regards to effect, process, and cost-benefit. The study aims to improve patients’ mental and physical health, as well as reducing the burden of their self-reported TBI-related problems in everyday life. Project findings will have innovation potential in establishing new modes of collaboration and knowledge transition between specialized acute and post-acute neurosurgical and rehabilitation facilities, and rehabilitation services in the municipalities. Collaborators include OUH, SRH, the National Association for the Traumatically Injured (Personskadeforbundet LTN), Norwegian Research School for Research and development of municipal health and Care (MUNI-Health-Care), Norwegian University of Science and Technology Gjøvik and the University of North Norway. International collaborations are from Philadelphia Research and Education Foundation and Virginia Commonwealth University, Richmond, USA. 

OSU6162 in the treatment of fatigue and other neuropsychological sequelae after aneurysmal subarachnoidal hemorrhage – a double-blind, randomized, placebo-controlled study.

Principal Investigators: Angelika Sorteberg (Neurosurgical Department, OUH) and Tonje Haug Nordenmark (Department of Physical Medicine and Rehabilitation, OUH). PhD fellow: Elin Western.

Funded by Haugans Hus AS.

This project is a double-blind, randomized, placebo controlled study of the effect of a dopamine D2-receptor antagonist (OSU6162) on fatigue after aneurysmal SAH. The primary aim is to assess the effect of OSU6162 on sequelae after SAH, especially fatigue. In addition, an evaluation of the safety and tolerance of the treatment will be conducted. The project is performed in collaboration with the Neurosurgical Department at OUH. International collaborator is The Sahlgrenska Academy in Sweden. 

Rehabilitation needs, service provision and costs in the first year following traumatic injuries 

Principal investigator: Nada Andelic. Project leader at The University Hospital of North Norway (UNN): Audny Anke. PhD fellows: Håkon Moksnes (OUH) and Christoph Schäfer (UNN). 

Funded by the Regional Health Authority South East Norway.

Studies assessing rehabilitation needs, service use and associated costs following traumatic injuries are scarce. This study will use data from the National Trauma Registry to estimate the prevalence of rehabilitation needs at country level. A cost estimation of rehabilitation interventions, healthcare, and social services and informal care will be performed. The study focusses on the first year following trauma, when patients might be expected to gain functional independence because of specialized and community-based rehabilitation efforts. The study combines perspectives of under-researched areas of trauma, rehabilitation and services research, and health-economics in a mixed-methods approach. It involves multidisciplinary research teams, national and international collaborations, and explores the effects of organization, structure of care, and geographical region on patients’ outcomes, rehabilitation needs, family caregiver burden, and costs. It also explores the patients’ and their families’ experience with rehabilitation and healthcare services and perception of rehabilitation needs, hereby providing important information of use to health professionals, users and policy makers. The results will be of interest beyond the trauma population as this group represents patients with multi-faceted, long-term disabilities, and consequently, ongoing needs for rehabilitation services and support.

Center-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI)

Principal investigator at the OUH Study Site and national coordinator: Nada Andelic.

Funded by the European Union's Seventh Framework Programme for Research and Development.

Members of the present research network are currently participating in a large-scale study funded by the European Union, the CENTER-TBI, 2013-2020 (https://www.center-tbi.eu/). CENTER-TBI aims to collect information on the injuries, clinical care and outcome of over 5000 patients across the European Union. The project is led by Profs. Andrew Maas (Belgium) and David Menon (UK) and involves TBI researchers from over 20 countries and 70 study sites. The main aims of the project are to improve the characterization and classification of TBI and health care delivery and treatment of TBI through the identification of the most effective clinical interventions and the provision of high quality evidence in support of treatment recommendations and guidelines. Our research network is particularly involved in Work Package 14 “Transition of care”, exploring structural variations in timing of transitions and clinical interventions approaches across Europe, and the effect of this on patient outcomes.

 
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