Objective: To synthesize the best available evidence regarding the impact of non-surgical interventions on persistent symptoms after mild traumatic brain injury (MTBI). Data sources: MEDLINE and other databases were searched (2001–2012) with terms including ‘rehabilitation’. Inclusion criteria were original, peer-reviewed research published in English and other languages. References were also identified from the bibliographies of eligible articles. Study selection: Controlled trials and cohort and case-control studies were selected according to pre-defined criteria. Studies had to have a minimum of 30 MTBI cases and assess non-surgical interventions using clinically-relevant outcomes such as self-rated recovery. Data extraction: Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from the admissible studies into evidence tables. Data synthesis: The evidence was synthesized qualitatively according to the modified SIGN criteria. Recommendations were linked to the evidence tables using a best evidence synthesis. After 77 914 records were screened, only two of seven studies related to non-surgical interventions were found to have a low risk of bias. One studied the effect of a scheduled telephone intervention offering counselling and education on outcome and found a significantly better outcome for symptoms (6.6 differences in adjusted mean symptom score, 95% confidence interval (CI) = 1.2–12.0), but no difference in general health outcome 6 months. The other was a RCT of the effectiveness of 6 days of bed rest on post-traumatic complaints 6 months post-injury, compared to no bed rest, and found no effect. Conclusions: Some evidence suggests that early reassuring educational information is beneficial after MTBI. Well-designed intervention studies are required in order to develop effective treatments and improve outcomes for adults and children at risk for persistent symptoms after MTBI.
Brain Injury, 2014, Vol 28, Issue 5-6
Brain injury; Coordination; Rehabilitation
Main Research Area:
Tenth World Congress on Brain Injury, San Francisco, CA. March 19-22, 2014.