Authors' objectives:

To examine the evidence for effectiveness of rehabilitation methods at various phases in the course of recovery from traumatic brain injury (TBI) in adults. Specifically, we addressed five questions about the effectiveness of (1) early rehabilitation in the acute care setting, (2) intensity of acute inpatient rehabilitation, (3) cognitive rehabilitation, (4) supported employment, and (5) care coordination (case management).

Authors' results and conclusions: A total of 3,098 references were specified for inclusion. After removal of duplicates, 569 applied to questions 1 and 2, 600 applied to question 3, 392 applied to question 4, and 975 applied to question 5. Eighty-seven articles pertaining to questions 1 and 2, 114 articles for question 3, 93 articles for question 4, and 69 articles for question 5 passed the eligibility screen. Sixty-seven additional articles were recommended for inclusion by experts or were obtained from reference lists of review articles. There was weak evidence from Class III studies that early rehabilitation during the acute admission reduces the rehabilitation length of stay. Studies of the intensity of acute inpatient rehabilitation had inconsistent results and used study designs that, despite appropriate use of statistical methods to adjust for severity, had serious limitations because of confounders. Controlled trials of cognitive rehabilitation had mixed results, with the strongest evidence (Class I) supporting the use of prosthetic aids to memory. Well-done, prospective observational studies (Class II) support the use of supported employment within the context of well-designed, well-coordinated programs. From one Class II clinical trial, there was no support for case management, but two well-done Class III studies support the use of case management to produce functional improvements.

Authors' recommendations: Population-based studies are needed to examine the overall impact of TBI and the differences in outcomes associated with different rehabilitation strategies. Future studies of cognitive rehabilitation and case management should focus on health outcomes of importance to people with TBI and their families.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/tbisumm.htm

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)