Abstract
Objective
To systematically review evidence on the effects of timing and intensity of neurorehabilitation
on the functional recovery of patients with moderate to severe traumatic brain injury
(TBI) and aggregate the available evidence using meta-analytic methods.
Data Sources
PubMed, Embase, PsycINFO, and Cochrane Database.
Study Selection
Electronic databases were searched for prospective controlled clinical trials assessing
the effect of timing or intensity of multidisciplinary neurorehabilitation programs
on functional outcome of patients with moderate or severe TBI. A total of 5961 unique
records were screened for relevance, of which 58 full-text articles were assessed
for eligibility by 2 independent authors. Eleven articles were included for systematic
review and meta-analysis.
Data Extraction
Two independent authors performed data extraction and risk of bias analysis using
the Cochrane Collaboration tool. Discrepancies between authors were resolved by consensus.
Data Synthesis
Systematic review of a total of 6 randomized controlled trials, 1 quasi-randomized
trial, and 4 controlled trials revealed consistent evidence for a beneficial effect
of early onset neurorehabilitation in the trauma center and intensive neurorehabilitation
in the rehabilitation facility on functional outcome compared with usual care. Meta-analytic
quantification revealed a large-sized positive effect for early onset rehabilitation
programs (d=1.02; P<.001; 95% confidence interval [CI], 0.56–1.47) and a medium-sized positive effect
for intensive neurorehabilitation programs (d=.67; P<.001; 95% CI, .38–.97) compared with usual care. These effects were replicated based
solely on studies with a low overall risk of bias.
Conclusions
The available evidence indicates that early onset neurorehabilitation in the trauma
center and more intensive neurorehabilitation in the rehabilitation facility promote
functional recovery of patients with moderate to severe TBI compared with usual care.
These findings support the integration of early onset and more intensive neurorehabilitation
in the chain of care for patients with TBI.
Keywords
List of abbreviations:
GCS (Glasgow Coma Scale), GOSE (Glasgow Outcome Scale-Extended), RCT (randomized controlled trial), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 08, 2018
Footnotes
Supported by grants from the Daan Theeuwes Foundation and the Netherlands Organization for Scientific Research (grant no. 022.003.010).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
