Participation After Multidisciplinary Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults: A Systematic Review

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• 作者：Michelle Brasure ; PhD ; MLIS^a ; ^b ; ^c ; ^{brasu001@umn.edu" class="auth_mail" title="E-mail the corresponding author} ; Greg J. Lamberty ; PhD^d ; ^e ; Nina A. Sayer ; PhD^c ; ^e ; ^f ; Nathaniel W. Nelson ; PhD^g ; Roderick MacDonald ; MS^a ; ^c ; Jeannine Ouellette ; BS^a ; ^b ; Timothy J. Wilt ; MD ; MPH^a ; ^c ; ^f
• 关键词：Brain hemorrhage ; traumatic ; Brain injuries ; Brain injuries ; chronic ; Diffuse axonal injury ; Rehabilitation
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2013
• 出版时间：July 2013
• 年：2013
• 卷：94
• 期：7
• 页码：1398-1420
• 全文大小：280 K

文摘

To determine the effectiveness and comparative effectiveness of multidisciplinary rehabilitation programs for moderate to severe traumatic brain injury (TBI) in improving participation-related outcomes in adults. This article presents results of select key questions from a recent Agency for Healthcare Quality and Research comparative effectiveness review.

Data Sources

MEDLINE, Cochrane Central Register of Controlled Trials, and PsycINFO; hand searches of previous relevant reviews.

Study Selection

We included prospective controlled studies that evaluated the effectiveness or comparative effectiveness of multidisciplinary rehabilitation programs delivered to adults with moderate to severe TBI on their participation in life and community.

Data Extraction

We extracted data, assessed risk of bias, and evaluated strength of evidence. Participation was selected as our primary outcome and included measures of productivity (eg, return to employment or military service) and select scales measuring community integration. Only data from studies with a low or moderate risk of bias were synthesized.

Data Synthesis

Twelve studies met our inclusion criteria; of these, 8 were of low or moderate risk of bias (4 randomized controlled trials of 680 patients and 4 cohort studies of 190 patients, sample size 36–366). Heterogeneous populations, interventions, and outcomes precluded pooled analysis. Evidence was insufficient to draw conclusions about effectiveness. Evidence on comparative effectiveness often demonstrated that improvements were not different between groups; however, this evidence was low strength and may have limited generalizability.

Conclusions

Our review used a rigorous systematic review methodology and focused on participation after multidisciplinary rehabilitation programs for impairments from moderate to severe TBI. The available evidence did not demonstrate the superiority of one approach over another. This conclusion is consistent with previous reviews that examined other patient-centered outcomes. While these findings will have little clinical impact, they do point out the limited evidence available to assess effectiveness and comparative effectiveness while highlighting important issues to consider in future comparative effectiveness research on this topic.