Rehabilitation After Moderate‐To‐Severe Traumatic Injury: A Protocol for a Scoping Review

ABSTRACT

Background

Traumatic injury is a leading cause of death and disability worldwide. Advances in acute trauma care have improved survival rates, shifting the focus towards long‐term outcomes and the role of rehabilitation in recovery. Although rehabilitation is clearly defined by the World Health Organisation, substantial variation exists in both clinical practice and in the scientific literature. This scoping review will systematically map the literature on rehabilitation after moderate‐to‐severe traumatic injury and identify potential knowledge gaps to guide future research and clinical practice.

Methods

The scoping review will follow the Joanna Briggs Institute Methodology and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews. Eligible studies must explore rehabilitation services delivered by healthcare professionals across any healthcare setting along the trauma care pathway for adults (≥ 18 years) with moderate‐to‐severe traumatic injury. A systematic literature search will be conducted in MEDLINE, Embase, PsycINFO, The Cochrane Library, and CINAHL. Screening and data extraction will be performed independently by two reviewers using Covidence, with disagreements resolved by consensus.

Results

Descriptive characteristics of the included studies with data items (study characteristics, participant demographics, rehabilitation approach, care setting, reported outcomes, and key findings) will be summarised in a tabular form. A narrative synthesis will be conducted supported by visual representation to illustrate research patterns and highlight knowledge gaps.

Conclusion

This scoping review will provide an overview of existing literature on rehabilitation after moderate‐to‐severe traumatic injury and identify key areas where further research is needed.

1. Introduction

Traumatic injury is a leading cause of death and disability worldwide [1]. Over recent decades, advances in acute trauma care have improved survival rates [2], shifting both clinical and research attention towards long‐term outcomes and the role of rehabilitation in recovery [3].

Although rehabilitation is clearly defined by the World Health Organisation [4], both clinical practice and the scientific literature reveal considerable variation in the delivery of rehabilitation services for trauma patients, including differences in access, content, timing, and the healthcare settings in which these services are provided [5]. To address this heterogeneity and provide a comprehensive overview of the existing research landscape, this scoping review will systematically map the literature on rehabilitation after moderate‐to‐severe traumatic injury and identify potential knowledge gaps to guide future research and clinical practice.

2. Methods

2.1. Protocol and Registration

This protocol is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Protocols (PRISMA‐P) [6]. In addition, the study was registered in the Open Science Framework (registration: https://osf.io/y4q9p/) prior to the assessment of eligible studies and is currently under embargo. The registration and protocol will be made publicly available upon publication. Any potential amendments to the protocol will be continuously documented and uploaded to the Open Science Framework, and a summary of all protocol amendments will also be included in the final manuscript. The scoping review will be conducted using the Joanna Briggs Institute (JBI) Methodology [7, 8] and reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) [9]. A comprehensive search strategy will be developed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Searching (PRISMA‐S) checklist to ensure transparency and reproducibility [10].

2.2. Eligibility Criteria

Eligible studies must be available in full text and be published as original research articles reporting empirical data. Therefore, review articles, editorials, books, book chapters, and conference proceedings will be excluded. Studies will be included regardless of study design, methodology, language, or year of publication. Non‐English studies will be translated into English with the assistance of colleagues with appropriate language expertise.

Further eligibility criteria are structured according to the Population‐Concept‐Context (PCC) framework. Regarding the population criteria, studies must report data exclusively from adult patients (≥ 18 years), either as single‐patient data or as aggregated data in which age is reported as a range. Patients must have moderate‐to‐severe traumatic injuries, either defined by an Injury Severity Score between 9 and 75 [11], or by equivalent descriptors such as major, severe, or serious trauma. Traumatic injuries may be isolated (e.g., pelvis trauma) or involve multiple injuries. For studies reporting mixed trauma populations, inclusion will be allowed if traumatic brain injury (TBI), spinal cord injury (SCI), or burns constitute less than 50% of the total study population. If these injuries constitute 50% or more, only subgroup data for the remaining trauma population will be included, if reported separately.

In this review, concept and context are closely linked, and the eligibility criteria for both are outlined below. According to the WHO, rehabilitation is defined “as a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environment.” [4] For the purpose of this review, studies must include rehabilitation services aimed at assisting individuals living with disability following moderate‐to‐severe traumatic injury, regardless of the terminology used to describe the intervention (e.g., care approach, exercise programme). Rehabilitation may involve any non‐pharmacological unimodal or multimodal service delivered by healthcare professionals along the trauma care pathway, including acute, subacute, or long‐term phases of care. Although rehabilitation is often provided over a defined period, no restrictions will be imposed on the duration, intensity, therapeutic focus, or the clinical profession delivering it.

2.3. Information Sources and Search Strategy

The search strategy will comprise several initiatives, with the main component being a series of database searches. For this purpose, a comprehensive search string was developed. Initially, the author group generated a list of free‐text search terms through a brainstorming process, followed by preliminary electronic searches to identify relevant records from the existing literature. These records were used to identify additional free‐text search terms and appropriate database‐specific indexing terms, which were incorporated to improve both the sensitivity and precision of the search strategy. Based on this, and in collaboration with an academic librarian, a three‐block search string was constructed, reflecting the three central themes of the review: (1) traumatic injury (population), (2) rehabilitation (concept), and (3) care setting and phase of care (context). All identified free‐text search terms were checked for corresponding index terms, which were added for each database, if available. Within each block, free‐text search terms and their corresponding index terms were combined using the Boolean operator OR. Finally, the three blocks were combined using AND. The development of the search string was an iterative and dynamic process, continuously refined based on the results of the preliminary searches and ongoing discussions within the author group.

The searches will be conducted in five electronic databases: MEDLINE (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), The Cochrane Library (via Wiley), and CINAHL (via EBSCOhost), covering the period from database inception to search date. Preliminary search strings for Embase and MEDLINE are provided in the Supporting Information, and the final search strings from all electronic databases will be included in the final manuscript. To complement the database searches, supplementary searches will be conducted in Google Scholar. Five separate searches will be conducted, each combining key terms from the three thematic blocks: (1) traumatic injury‐rehabilitation‐healthcare facility, (2) physical trauma‐rehabilitation‐hospital, (3) moderate‐to‐severe traumatic injury‐rehabilitation‐medical centre, (4) major trauma‐rehabilitation‐municipality, and (5) multitrauma‐rehabilitation‐community. For each search, the first 100 records will be screened for eligibility by the first author using a conservative approach.

Finally, both forward citation tracking (via Google Scholar) and manual backward citation tracking of all included studies and relevant reviews will be performed to identify any additional eligible studies. If the final search is more than 6 months old at the time of manuscript submission, an updated search will be conducted to ensure the inclusion of the most recent publications.

2.4. Study Records

2.4.1. Data Management and Selection Process

The Covidence platform will be used to manage all identified references, remove duplicates, and facilitate the study selection process [12]. The review team will consist of four reviewers. Each record will be independently screened by two reviewers for titles and abstracts using the eligibility criteria outlined above. Studies deemed potentially relevant will be retrieved in full text and assessed in detail by two independent reviewers. Reasons for exclusion of full text papers will be recorded. Any disagreements will be resolved through discussion between the two reviewers, and if necessary, through consultation with the wider review team until consensus is reached. The overall study selection process will be documented and summarised using a PRISMA flow diagram.

2.4.2. Data Collection and Data Items

Data will be extracted from the included studies using a pilot tested standardised form, which will capture relevant information on the following data items:

1. Study characteristics ‐ for example, study design, year of publication, and country of origin

2. Participant demographics ‐ for example, age, gender, and trauma mechanism

3. Rehabilitation approach ‐ for example, type and modality

4. Care setting

5. Reported outcomes

6. Key findings

Data extraction will be carried out independently by two reviewers, with any discrepancies resolved through consensus.

2.5. Outcomes

The included studies may report a broad range of outcomes, including survival, physical recovery, psychological and cognitive functioning, quality of life, social and vocational reintegration, and healthcare utilisation. All outcomes relevant to the objective of this scoping review will be identified and described.

2.6. Data Synthesis

Descriptive characteristics of the included studies with data items (study characteristics, participant demographics, rehabilitation approach, care setting, reported outcomes, and key findings) will be summarised in a tabular form. In addition, a narrative synthesis will be conducted to provide a structured, textual interpretation of the results. This will be supported by visual representations to enhance clarity, illustrate research patterns, and highlight knowledge gaps.

2.7. Quality of Evidence

A systematic critical appraisal of risk of bias, methodological quality, and evidence quality will not be conducted. However, an overall discussion of strengths and limitations of the body of evidence will be undertaken in the discussion section.

3. Discussion

This scoping review has several important strengths. The use of a predefined protocol, a systematic and comprehensive search strategy without restrictions on language or publication year, and adherence to the PRISMA‐ScR guidelines contribute to the methodological rigour, transparency, and reproducibility of the review. Furthermore, the multidisciplinary composition of the study group, including medical doctors, a physiotherapist, and a psychologist, ensures a broad and diverse perspective on the topic of rehabilitation. Nevertheless, certain limitations are anticipated. Grey literature will not be included, which may result in the exclusion of some relevant but unpublished findings. Additionally, the expected heterogeneity across the included studies may complicate data synthesis and limit direct comparisons. However, this variation reflects the fragmented research landscape on rehabilitation after traumatic injury and reinforces the need for this scoping review. By systematically mapping the existing literature, this scoping review will provide a valuable overview of the body of evidence and identify knowledge gaps, which can inform future research. Ultimately, the findings will support the development of a stronger foundation for high‐quality studies and promote the implementation of evidence‐based rehabilitation strategies in clinical practice.

4. Conclusion

This scoping review will provide a comprehensive overview of the existing literature on rehabilitation after moderate‐to‐severe traumatic injury and identify key research challenges and knowledge gaps to inform future research and clinical practice.

Author Contributions

All authors contributed to the conception, design, critical revisions, and final approval of the protocol. Liva Thoft Jensen, MD, and PhD student was responsible for drafting the protocol under the particular supervision of Jan Christensen and Sophie Lykkegaard Ravn. Liva Thoft Jensen will serve as the guarantor of the review.

Funding

The authors have nothing to report.

Ethics Statement

Ethical approval is not required for this scoping review, as the study will solely involve aggregated data from existing literature. The scoping review is expected to be completed and submitted to an international, peer‐reviewed, scientific journal by mid‐2026.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Supporting Information.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.