Article

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. DATA SOURCES: MEDLINE,
Cochrane Central Register of Controlled Trials, and PsycINFO; hand searches of
previous relevant reviews. STUDY SELECTION: 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. DATA EXTRACTION: 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. DATA SYNTHESIS: 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.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS