1 The Faculty of Medicine, Aalborg University, VBN2 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN3 Klinik Hoved-Orto, The Faculty of Medicine, Aalborg University, VBN4 Neurologi, The Faculty of Medicine, Aalborg University, VBN
A 2-year post injury follow-up study
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.