# Consensus-Driven Evaluation of Current Practices and Innovation Feasibility in Chronic Brain Injury Rehabilitation

## TL;DR

This study explores current practices and potential innovations in chronic brain injury rehabilitation in Spain, emphasizing the importance of patient-centered care and hybrid models.

## Contribution

The study introduces a novel digital Delphi method to combine patient and professional perspectives for co-designing rehabilitation innovations.

## Key findings

- Patients and professionals showed both alignment and divergence in views on tele-rehabilitation and hybrid care models.
- Expert consensus prioritized feasible interventions like online orthopedic renewal services and educational video resources.
- Recommendations include systemic involvement of rehabilitation teams and improved communication tools for patient-centered care.

## Abstract

Background: Chronic Brain Injury (CBI) is a lifelong condition requiring continuous adaptation by patients, families, and healthcare professionals. Transitioning rehabilitation toward patient-centered and self-management approaches is essential, yet remains limited in Spain. Methods: We conducted a two-phase consensus study in collaboration with the Spanish Society of Physical Medicine and Rehabilitation (SERMEF) and the Spanish Federation of Brain Injury (FEDACE). In Phase 1, surveys were distributed to patients (214 invited; 95 complete responses, 44.4%) and physiatrists (256 invited; 106 valid responses, 41.4%) to capture perceptions of current rehabilitation practices, including tele-rehabilitation. Differences and convergences between groups were analyzed using a Synthetic Factor (F). In Phase 2, a panel of 21 experts applied a real-time eDelphi process (SmartDelphi) to assess the feasibility of proposed innovations, rated on a six-point Likert scale. Results: Patients and professionals showed both alignment and divergence in their views. Patients reported lower involvement of rehabilitation teams and expressed more reluctance toward replacing in-person care with telemedicine. However, both groups endorsed hybrid models and emphasized the importance of improved communication tools. Expert consensus prioritized feasible interventions such as online orthopedic renewal services, hybrid care models, and educational video resources, while less feasible options included informal communication platforms (e.g., WhatsApp) and bidirectional teleconsultations. Recommendations were consolidated into five domains: (R1) systemic involvement of rehabilitation teams in chronic care, (R2) patient and caregiver education, (R3) self-management support, (R4) communication tools, and (R5) socialization strategies. Conclusions: This study demonstrates the value of combining patient and professional perspectives through digital Delphi methods to co-design innovation strategies in CBI rehabilitation. Findings highlight the need to strengthen communication, provide structured education, and implement hybrid care models to advance patient-centered rehabilitation. The methodology itself fostered engagement and consensus, underscoring its potential as a tool for participatory healthcare planning.