Integrated Rehabilitation Services for Children and Young People with ABI: a scoping review protocol

Acquired brain injury

Acquired Brain Injury (ABI) is an umbrella term for any injury to the brain occurring after birth, which may result from non-traumatic (e.g., stroke, anoxia, infection, tumor) or traumatic (TBI) (e.g., blow to the head from fall, assault, motor vehicle accident, sports injury) cause. ABI can be mild, moderate or severe in nature.^1,2 ABI is a significant contributor to acquired disability in children and young people globally and, as a result, is a substantial and enduring public health concern.^3–6 An estimated 49 million people are affected by traumatic brain injury (TBI) globally per year, resulting in an estimated 7.08 million Years Lived with Disability (YLD).⁷ These figures are projected to rise further in the coming years³ with a notable contributor to the trend, an increase in TBI/ABI among younger children.⁴ Paediatric ABI is a condition whose burden extends well beyond the acute period of injury^8–10 at considerable cost to the child or young person, their family, the health system, and the wider society.

Most ABIs during childhood are categorized as mild^4,6 however, any degree of ABI can result in changes to brain function, which can disrupt developmental trajectories^11,12 and lead to long-lasting emotional, cognitive, communication, and physical impairments^5,11,13 and chronic lifelong disability.⁸ The impact of ABI can affect all aspects of a child’s life; school^14–19 social life/friendships^2,20 leisure²¹ and family life^14,22–25 and can influence and limit future academic, vocational, and employment options.^26–28 Paediatric ABI can place a child or young person at risk of future mental health concerns, high-risk behaviours, and potential offending.^29–31 Paediatric ABI can significantly affect a child or young person’s quality of life and participation in society. Individual outcomes are often difficult to predict due to a complex and dynamic interplay between injury characteristics, pre-injury functioning, and social determinants such as gender, age, socioeconomic status¹³ and the availability as well as access to appropriate services and supports.^32,33 Moreover, seemingly good physical recovery may mask emerging cognitive, emotional, and behavioural challenges.⁹ The heterogenous nature and impact of paediatric ABI underscores the need for comprehensive services and supports that can address the evolving and multifaceted needs of children and young people across developmental stages and life domains.

Rehabilitation is the recommended treatment following paediatric ABI,^1,2,8,34,35 and is defined by the World Health Organisation as, ‘a set of interventions designed to optimise functioning and reduce disability … to enable participation in meaningful life roles”³⁶. At an individual level, best practice guidelines recommend rehabilitation that is goal-oriented, contextually relevant, child-and family centred, and developmentally appropriate,^5,37,38 with schools recognised as pivotal delivery settings.^1,9

Given the complexity of paediatric ABI, at a health system level, integrated rehabilitation is endorsed as the gold standard.^1,2,35,37,38 Integration is broadly understood as the organisation and delivery of services that are coordinated across settings, responsive to individual needs, and aligned across system levels.^39–41 In the context of paediatric ABI, this entails seamless transitions between acute, specialist, community care, and education settings and is delivered by interdisciplinary teams that support children and young people throughout their development, allowing re-entry to specific levels as needed. A growing body of evidence supports the effectiveness of integrated rehabilitation in improving functional outcomes, reducing care fragmentation, enhancing access, and delivering cost-efficiencies at a health system level by ensuring the right type of care is provided at the most appropriate level of complexity.^34,42,43

However, despite strong policy endorsement, health systems globally and in Ireland are challenged in the implementation of such models of integrated rehabilitation for children with ABI.^3,30,33,44 While some services are available, many children with paediatric ABI continue to experience unmet and unrecognised rehabilitation needs across both the acute and chronic phases of care.^{15,21,29,32,45,46} Services are experienced as fragmented and access is influenced by geographic location, cost barriers, conflicts with school or work schedules, limited professional knowledge of ABI, and broader social determinants of health.^{28,32,33,48–51}

Framing integration: Policy and conceptual frameworks

Integrated rehabilitation for children and young people with ABI is underpinned by a growing international policy and practice agenda that emphasises rights-based, coordinated, and person-centred care. The UN Convention on the Rights of Persons with Disabilities (UNCRPD) affirms the right to timely, accessible rehabilitation that supports independence and inclusion,⁵² while the WHO Framework for Integrated People-Centred Health Services promotes care systems that are coordinated, empowering, and inclusive.⁴⁰ Translating these principles into practice requires both conceptual and practical frameworks.

Conceptually, integration is recognised as a multidimensional construct^53–55 that can be categorised by type (e.g., organisational, functional, service, clinical), intensity (e.g., full integration, coordination, linkage), and level (e.g., micro, meso, macro).^39,55 The International Federation of Integrated Care (IFIC) Nine Pillars framework⁴¹ offers a comprehensive model for designing and implementing integrated care, spanning domains such as governance, workforce, digital solutions, and financing. This framework aligns closely with the Institute for Healthcare Improvement (IHI) Quintuple Aim,⁵⁶ which sets out five goals for health systems: improving population health, enhancing patient experience, reducing costs, supporting workforce well-being, and promoting equity.

These frameworks are particularly relevant in the context of paediatric ABI, where care must be developmentally responsive, cross-sectoral, and sustained over time. Together, they provide a valuable lens through which to examine how integrated rehabilitation is currently conceptualised and delivered with the potential for the knowledge generated to support future service development.

Ireland’s Model of Care for Paediatric Specialist Rehabilitation³⁸ outlines a tiered approach to rehabilitation across acute, specialist, and community settings; however, implementation of the model of care has been limited, and services are not as well developed as those for adults.^34,57,58 While Sláintecare,⁵⁷ Ireland’s national health reform programme, aims to bring transformative change in health and social care services - promoting integrated, rights-based care aligned with the UNCRPD and WHO IPCHS framework - targeted service integration for CYP, including those with ABI, remains functionally less developed than for other populations in Ireland.^34,44 The gap between national policy frameworks and current service provision suggests the importance of examining how rehabilitation for CYP with ABI is currently understood and implemented globally.

Rationale for review

While continuity and coordination of rehabilitation for children and young people with ABI are widely recognised as essential, the implementation of these principles into practice - and how best to achieve integrated rehabilitation across healthcare levels and other sectors - remains unclear. Existing evidence syntheses have focused on specific transitions for children and young people with ABI, such as hospital-to-school reintegration,⁵⁹ access to follow-up care⁶⁰ and post-concussive follow-up.⁶¹ Additional reviews have examined specific care co-ordination approaches, such as the implementation of care coordinator personnel⁶² and care coordination tools⁶³ for broader populations of youth with complex healthcare needs. However, these reviews do not address integration of rehabilitation across the full continuum of care or the range of ABI severity and aetiology, which is needed to inform national service design.

A preliminary search of databases (PubMed, JBI Evidence Synthesis and Cochrane) in October 2025 identified no scoping reviews on how integrated rehabilitation has been conceptualised, operationalised, and evaluated for children and young people with ABI, confirming a gap in synthesised evidence on the topic. Therefore, a scoping review is warranted to map the breadth of the available evidence, clarify key concepts and characteristics, and identify knowledge gaps to inform research that has the potential to inform service development in the Irish context. Scoping reviews are particularly suited to this purpose, as they aim to explore the extent, range, and nature of evidence on a topic⁶⁴ and can support conceptual clarity for planning, conducting or applying research.⁶⁵

The aim of this scoping review is to map and synthesise the existing literature on integrated rehabilitation for children and young people with acquired brain injury, with a focus on how it is conceptualised, implemented and evaluated. The findings may help to clarify key concepts, identify gaps in the evidence base, and inform future research and service development, with relevance for child- and family-centred, coordinated rehabilitation following paediatric ABI.

Protocol and registration

The proposed scoping review will be conducted in accordance with the evidence synthesis guidelines from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis,⁶⁴ which builds upon the original scoping review conceptual framework proposed by Arksey and O’Malley,⁶⁶ and incorporates methodological refinements recommended by Levac et al.⁶⁷ The protocol has been structured using the PRISMA-ScR Protocols checklist⁶⁸ (Appendix 1) and has been registered on Open Science Framework (https://doi.org/10.17605/OSF.10/9M6WU).

Stage 1: Identifying the research question

The scoping review question was guided by the PCC mnemonic (population, concept, context): Population: children and young people under 18 years of age with an acquired brain injury; Concept: ‘integrated rehabilitation’ defined as rehabilitation involving active professional input (e.g., guiding, monitoring, adapting or evaluating therapeutic interventions), with integration occurring across disciplines, level of care (acute, specialist tertiary, community) and/or sectors (e.g., health, education); Context: services and settings where rehabilitation is delivered (e.g., hospital, tertiary specialist centred, community, education).

Review question: How are integrated rehabilitation services for children and young people with acquired brain injury described, implemented, and evaluated in the literature?

Review objectives:

Eligibility criteria

Eligibility for inclusion and exclusion was informed by the PCC framework above as outlined in Table 1. Studies not meeting the inclusion criteria were excluded from the review.

Stage 2: Identifying the relevant studies

Types of sources

This scoping review will consider peer-reviewed empirical studies and relevant grey literature. Grey literature may include policy documents, government or organisational reports, service evaluations, theses and dissertations and advocacy publications where they report on the implementation or evaluation of integrated rehabilitation services. All types of empirical study designs will be included. The reference lists of included studies will be screened to identify additional relevant studies.

Search strategy

As recommended by the JBI Manual for Evidence Synthesis⁶⁴ a three-step process for applying a search strategy will be implemented.

Step 1: An initial limited search of MEDLINE (PubMed) and CINAHL (via EBSCOhost) was undertaken to identify relevant articles. Keywords in titles and abstracts of retrieved articles along with index terms used to describe these articles, were analysed to inform the search string development. Search strings were refined in collaboration with an Information Specialist and adapted for each database. A copy of a draft search strategy is shown in Table 2, and a full search strategy for PubMed is presented in Appendix 2.

Step 2: A second search of all included databases (PubMed, PsycINFO, CINAHL Plus, Cochrane Database of Systematic Reviews, Embase, and ERIC) will be undertaken using all the identified key words and index terms.

Step 3: Reference lists of included sources will be searched for additional relevant studies not captured through database searching, recognising that variability in terminology and indexing may limit retrieval. Authors of primary sources will be contacted for further information as appropriate. A targeted grey literature search will be undertaken using selected repositories (e.g., GreyNet) and organisational and government websites to identify policy documents, service evaluations, and other relevant non-peer reviewed sources. This will ensure a comprehensive overview of the evidence and minimise publication bias, recognising that relevant information on integrated rehabilitation may be reported outside peer-reviewed literature. Details of the grey literature search, including sources consulted and rationale for inclusion will be documented in the review.

Searches will be restricted to literature published from 2010 onwards, reflecting the emergence of integrated rehabilitation as a structured approach in health service design, ensuring relevance to current policy priorities.^38,40,52 English-language publications only will be included due to resource limitations for translation. In line with the JBI guidance⁶⁴ additional keywords and sources may be incorporated into the search in an iterative manner as familiarity with the literature increases; any such refinements will be clearly reported in the review.

By combining multiple bibliographic databases, targeted grey literature searches, screening of reference lists, and contacting authors as needed, the strategy is designed to maximise comprehensiveness, minimise publication bias, and ensure retrieval of relevant studies for this scoping review.

Stage 3: Study selection

Following the planned searches, all identified citations will be collated and uploaded into EndNote version 21, and any duplicates will be removed. The systematic review software tool Covidence (www.covidence.org) will be used for screening the retrieved literature. Following the JBI guidance⁶⁴ pilot testing will be undertaken by two reviewers independently screening a random sample of 25 titles and abstracts from included sources using the eligibility criteria and the definitions document. The reviewers will then meet to discuss any discrepancies and, if necessary, refine the eligibility criteria and definitions document. Screening of the remaining evidence will begin once 75% (or greater) agreement is achieved between the reviewers. Any disagreements will be resolved with the involvement of a third reviewer. Full-text screening of sources will be performed by the same reviewers using the same process, including pilot testing. The reviewers will meet at the beginning, middle, and final stages of the screening process to discuss the challenges and resolve uncertainties.

The results of the search and study inclusion process will be reported in full in narrative format and presented in a PRISMA-ScR flow diagram detailing the number of citations identified, duplicates removed, sources screened, full-text articles assessed and included sources, including any additional sources identified through reference list screening. Separate appendices will provide details of included sources and brief notes of the excluded sources with reason for exclusion.⁶⁴

Stage 4: Charting the data

Data will be extracted from the papers included in the scoping review by one reviewer and checked by a second reviewer using a data extraction tool developed by the research team and aligned with the review question. A summary of the data items to be extracted is presented in Table 3, and the full extraction form is provided in Appendix 3. The extraction will capture study characteristics (e.g., author, year, country, design), setting and target population, and characteristics of integrated rehabilitation approaches including reported definitions, level of integration (micro, meso, macro),³⁹ intensity (if reported), and any underpinning philosophies or frameworks. Reported outcomes will be mapped to the IHI Quintuple Aim framework,⁵⁶ and implementation factors will be aligned with the IFIC Nine Pillars of Integrated Care framework.⁴¹ Public and patient involvement will be captured and reported if described in the studies.

In accordance with the JBI Manual for Evidence Synthesis⁶⁴ the extraction tool will be pilot tested by the two reviewers on a small subset of the included studies (2–3 studies) to ensure all relevant results are extracted. Following this initial pilot, the tool will be applied to a larger subset of studies (approximately 10% of retrieved studies) to confirm consistent application between reviewers. The reviewers will then meet for discussion with disagreements between the reviewers resolved through discussion or by a third reviewer. The extraction form and process may be modified iteratively as required, and all modifications will be detailed in the scoping review and the final framework made available in the completed review to support transparency. Where appropriate, authors of the papers will be contacted to request missing or additional data, where required. Consistent with JBI guidance⁶⁴ individual sources of evidence will not be critically appraised.

Stage 5: Collating, summarising and reporting of results

This review will be analysed descriptively. Data extracted from included sources will be synthesised qualitatively and quantitatively aligned with the review objectives as recommended for data analysis in scoping reviews.⁶⁹ Quantitative synthesis will include numerical summaries (e.g., counts by year, country, healthcare setting and level of integration).³⁹ These summaries will also include frequencies of reported outcomes, implementation strategies, and other measurable features of integrated rehabilitation. A framework-based qualitative content analysis will be undertaken with outcomes mapped to the IHI Quintuple Aim framework⁵⁶ and implementation factors categorised according to the IFIC Nine Pillars of Integrated Care.⁴¹ Data will initially be coded deductively according to these pre-defined frameworks. Where extracted information does not align with the frameworks, inductive coding will be applied to capture emergent concepts, ensuring novel insights are not overlooked.

This approach to data analysis and presentation allows for a structured and transparent synthesis of heterogenous evidence, highlighting patterns across settings and levels, implementation strategies and processes, reported outcomes and factors influencing integration. Any modification to the planned approach to data synthesis will be clearly described in the final scoping review, along with a clear rationale for these changes.

Stage 6: Expert consultation

Expert consultation is an optional but recommended step in scoping reviews to enhance comprehensiveness, validity, relevance of the review and knowledge translation.^66,67 Recent guidance highlights a move toward broader engagement and co-creation with knowledge users.⁷⁰ For this review, consultation will be limited to advisory input from research experts, clinicians, and a PPI group to support interpretation and relevance of findings. No identifiable data will be collected, and no ethics approval is required at this stage. This review forms part of a proposed research programme examining how integrated rehabilitation for children and young people with acquired brain injury is enabled through a national tertiary service. Additional consultation with patients and other knowledge users will be incorporated in later stages of the wider research programme under full ethics review.

Study status

Database searches have been completed, and study selection is underway.

Ethics

Ethical approval is not required for this scoping review.