Effectiveness of specialized rehabilitation after mild traumatic brain injury: A systematic review and meta-analysis.

Abstract

OBJECTIVE\nTo determine the effectiveness of special-ized rehabilitation in adults with prolonged symptoms, or risk of prolonged symptoms, following mild traumatic brain injury.\n\n\nDATA SOURCES\nRandomized controlled trials or non-randomized controlled studies published between 2000 and 10 March 2019 in Cochrane Controlled Register of Trials, PubMed, EMBASE, CINAHL or PsycINFO. Meta-analyses were performed for studies of similar interventions when identical or comparable outcomes were reported.\n\n\nSTUDY SELECTION AND DATA EXTRACTION\nScreening, data extraction, and risk of bias assessment were carried out by 2 independent researchers. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.\n\n\nDATA SYNTHESIS\nA total of 9 studies were identified, which were divided into 3 subgroups. Results from meta-analyses implied that problem-solving therapy and cognitive behavioural therapy reduce residual symptoms, improve psychological functioning, decrease depression, increase activity and participation, and improve quality of life, compared with usual care. The meta-analyses also suggested that specialized interdisciplinary rehabilitation reduces residual symptoms.\n\n\nCONCLUSION\nPersons with mild traumatic brain injury who are at risk of, or who experience, prolonged symptoms should be considered for specialist treatment, as they may experience positive effects from cognitive behavioural therapy, problem-solving ther-apy, or interdisciplinary team rehabilitation. Further research is required to strengthen the evidence.