The Experiences of Social Connection and Isolation in Adults With Acquired Brain Injury: A Qualitative Systematic Review and Metasynthesis.

Background: During recovery from an acquired brain injury (ABI), social isolation is a common experience that can lead to adverse outcomes. Although social connection is known to play a critical role in alleviating these effects, the ways in which ABI survivors experience and prioritise connection and isolation are not well understood. This review aims to understand how these concepts are perceived, identify the valued outcomes, and examine the social contexts that shape these experiences.

Method: Peer-reviewed qualitative articles published before January 2025 were identified from a search of six databases and additional complementary searches. These encompassed the terms 'acquired brain injury', 'social connection and/or isolation' and 'qualitative'. Of 4651 papers identified, 37 were included. Each paper was categorised for the analytic process according to its relevance, resonance and rigour, with rigour assessed using the JBI standardised critical appraisal instrument. Thomas and Harden's 'thematic synthesis' framework was used to generate a metasynthesis rooted in a critical realist philosophy.

Results: Social isolation is a widespread issue characterised by loss, which originates from ABI-related impairments that hinder social engagement. Communication difficulties, stigma and other structural barriers exacerbate feelings of disconnection. Key elements of social connection included understanding, acceptance, emotional support, reciprocity and shared experiences. Relationships that embodied these qualities provided a sense of belonging, security and purpose, which encouraged individuals to redefine their identity and values, alleviating feelings of isolation.

Conclusion: This review demonstrates that social connection and isolation post-ABI stem from a variety of complex interpersonal and environmental factors. Future research should prioritise measuring and enhancing meaningful connections by focusing on relational quality, accessibility, and reducing systemic barriers, including stigma.

Patient Or Public Contribution: The project's focus was developed in consultation with members of the public who have lived experience with an ABI. A PPI member also supported the entire review process.