Kennedy Mary R T, Coelho Carl, Turkstra Lyn, Ylvisaker Mark, Moore Sohlberg McKay, Yorkston Kathryn, Chiou Hsin-Huei, Kan Pui-Fong
Department of Speech-language-Hearing Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
Neuropsychol Rehabil. 2008 Jun;18(3):257-99. doi: 10.1080/09602010701748644.
A systematic review of studies that focused on the executive functions of problem solving, planning, organising and multitasking by adults with traumatic brain injury (TBI) was performed through 2004. Qualitative and quantitative methods were used to evaluate the 15 studies that met inclusion criteria. Demographic variables, design and intervention features, and impairment and activity/participation outcomes (ICF) (World Health Organization, 2001) were documented. Five randomised control treatment (RCT) studies used step-by-step, metacognitive strategy instruction (MSI) and outcomes were evaluated in a meta-analysis. Effect sizes (ESs) from immediate impairment outcomes after MSI and "control" intervention were similar to each other, and both were significantly larger than chance. ESs from immediate activity/participation outcomes after MSI were significantly larger than the ESs from control intervention, and both were significantly larger than chance. These results, along with positive outcomes from the other group, single-subject design and single case studies, provided sufficient evidence to make the clinical recommendation that MSI should be used with young to middle-aged adults with TBI, when improvement in everyday, functional problems is the goal (Level A) (American Academy of Neurology, 2004). Although maintenance effects were generally positive, there was insufficient data quantitatively to evaluate this. Furthermore, there was insufficient evidence to make clinical recommendations for children or older adults. Intervention that trained verbal reasoning and multi-tasking was promising, although the evidence is insufficient to make clinical recommendations at this time. Additional research needs were highlighted.
截至2004年，对关注创伤性脑损伤（TBI）成年患者解决问题、规划、组织和多任务处理等执行功能的研究进行了系统综述。采用定性和定量方法对符合纳入标准的15项研究进行评估。记录了人口统计学变量、设计和干预特征，以及损伤和活动/参与结果（国际功能、残疾和健康分类）（世界卫生组织，2001年）。五项随机对照治疗（RCT）研究采用逐步元认知策略指导（MSI），并在荟萃分析中评估结果。MSI和“对照”干预后即时损伤结果的效应量（ESs）彼此相似，且均显著大于随机概率。MSI后即时活动/参与结果的ESs显著大于对照干预的ESs，且两者均显著大于随机概率。这些结果，连同其他组、单受试者设计和单病例研究的阳性结果，提供了充分的证据，从而做出临床推荐：当以改善日常功能问题为目标时，MSI应用于年轻至中年的TBI成年患者（A级）（美国神经病学学会，2004年）。虽然维持效应总体呈阳性，但定量数据不足以对此进行评估。此外，没有足够的证据为儿童或老年人提出临床建议。训练言语推理和多任务处理的干预措施很有前景，尽管目前证据不足，无法提出临床建议。文中强调了进一步的研究需求。
