Participation after multidisciplinary rehabilitation for moderate to severe traumatic brain injury in adults: A systematic review

Michelle Brasure, Greg J. Lamberty, Nina A Sayer, Nathaniel W. Nelson, Roderick MacDonald, Jeannine Ouellette, Timothy J Wilt

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations

Abstract

Objective: 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.

Original languageEnglish (US)
Pages (from-to)1398-1420
Number of pages23
JournalArchives of Physical Medicine and Rehabilitation
Volume94
Issue number7
DOIs
StatePublished - Jul 2013

Bibliographical note

Funding Information:
Supported by the Agency for Healthcare Quality and Research Effective Healthcare program (contract no. HHSA-290-2007-10064-I ).

Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.

Keywords

  • Brain hemorrhage, traumatic
  • Brain injuries
  • Brain injuries, chronic
  • Diffuse axonal injury
  • Rehabilitation

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