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


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


METHODS
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.


METHODS
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.


RESULTS
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.
Minnesota Evidence-based Practice Center, Minneapolis, MN 55455, USA. brasu001@umn.edu
Michelle
M
Brasure
Greg J
GJ
Lamberty
Nina A
NA
Sayer
Nathaniel W
NW
Nelson
Roderick
R
Macdonald
Jeannine
J
Ouellette
Timothy J
TJ
Wilt
D001930:Brain Injuries / Q000534:rehabilitation*; D002986:Clinical Trials as Topic; D057186:Comparative Effectiveness Research; D004526:Efficiency; D006801:Humans; D007398:Interpersonal Relations; D017063:Outcome Assessment, Health Care; D012046:Rehabilitation / Q000379:methods*; D015599:Trauma Severity Indices