Methodological Quality of Research on Cognitive Rehabilitation After Traumatic Brain Injury

Abstract 

Cicerone KD, Azulay J, Trott C. Methodological quality of research on cognitive rehabilitation after traumatic brain injury.

Objective

To evaluate the methodological quality of research on cognitive rehabilitation after traumatic brain injury (TBI).

Data Sources

Secondary analysis of studies identified in prior systematic reviews of cognitive rehabilitation.

Study Selection

Randomized controlled trials (RCTs) and observational studies involving exclusively or primarily participants with TBI.

Data Extraction

Criteria for evaluating methodological quality were adapted from prior reviews of rehabilitation research. These criteria were modified to be relevant to cognitive rehabilitation research. Sixteen criteria for evaluating the quality of RCTs were applied: 8 relating to the internal validity of studies, 5 descriptive criteria, and 3 statistical criteria. Twelve of these criteria were used to evaluate non-RCT observational studies.

Data Synthesis

Thirty-two RCTs and 21 observational studies were independently reviewed and rated by 2 of the authors. Initial agreement between raters for individual studies ranged from 57% to 100%. Interrater reliabilities based on the kappa statistic indicated moderate to substantial agreement.

Conclusions

Several high-quality RCTs support the effectiveness of interventions for attention, communication skills, and executive functioning after TBI. Several high-quality observational studies support the effectiveness of comprehensive-holistic rehabilitation after TBI, including improvements in participation outcomes. The proposed criteria appear useful for evaluating the quality of research on cognitive rehabilitation and improving the design and reporting of future research in this area.

Key Words: Brain injuries, Rehabilitation, Review [publication type]

List of Abbreviations: ITT, intent-to-treat, RCT, randomized controlled trial, TBI, traumatic brain injury