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INTIMASY-TBI Guideline: Optimization of INTIMAcy, SexualitY, and Relationships Among Adults With Traumatic Brain
Eleni M Patsakos1, Samantha Backhaus, Kathryn Farris
1Author Affiliations: Rehabilitation Sciences, Institute, University of Toronto, Toronto, Ontario (Ms Patsakos and Dr Bayley); KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario (Ms Patsakos and Dr Bayley); Physical Medicine & Rehabilitation, School of Medicine, Indiana University, Indianapolis, Indiana (Drs Backhaus and Neumann); Shepherd Center, Atlanta, Georgia (Ms Farris); Kessler Institute for Rehabilitation, West Orange, New Jersey (Dr King); Faculty of Medicine, McGill University, Montreal, Quebec (Dr Moreno); and Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Dr Sander).
Introduction:
Traumatic brain injury (TBI) can negatively impact intimacy, relationships, and sexual functioning through changes in physical, endocrine, cognitive, behavioral, and emotional function. Without intervention, diminished intimacy and/or sexual functioning in individuals with TBI may persist. Although most health care professionals agree that sexuality and intimacy in relationships are significant concerns and should be addressed in rehabilitation, these concerns are not typically discussed during rehabilitation and discharge planning for people with TBI. To address this gap, an expert panel of North American clinicians and researchers convened to develop evidence-informed recommendations to assist clinicians in providing a framework and guidance on how clinicians can support individuals after TBI.
Methods:
A systematic search of multiple databases was conducted to identify relevant evidence published from 2010 to 2023. The INTIMASY-TBI Expert Panel developed recommendations for optimizing discussions and interventions related to intimacy and sexuality for people with TBI in rehabilitation and community-based programs. For each recommendation, the experts evaluated the evidence by examining the study design and quality to determine the level of evidence.
Results:
A total of 12 recommendations were developed that address the following topic areas: (1) interprofessional team training, (2) early education on the effects of TBI on intimacy, relationships, and sexuality, (3) creating individualized interventions, (4) education, assessment, and management of the causes of sexual dysfunction, and (5) providing written materials and relationship coaching to persons with TBI and their partners. Two recommendations were supported by Level A evidence, 1 was supported by Level B evidence, and 9 were supported by Level C (consensus of the INTIMASY-TBI Expert Panel) evidence. A decision algorithm was developed to assist clinicians in navigating through the recommendations.
Conclusion:
The INTIMASY-TBI Guideline is one of the first comprehensive clinical practice guidelines to offer strategies to trained clinicians to discuss the physical, psychosocial, behavioral, and emotional aspects of intimacy and sexuality with persons with TBI.
