Cicerone Keith D, Mott Tasha, Azulay Joanne, Sharlow-Galella Mary A, Ellmo Wendy J, Paradise Susan, Friel John C
Department of Cognitive Rehabilitation, JFK-Johnson Rehabilitation Institute, Edison, NJ 08820, USA.
Arch Phys Med Rehabil. 2008 Dec;89(12):2239-49. doi: 10.1016/j.apmr.2008.06.017.
To evaluate the effectiveness of comprehensive, holistic neuropsychologic (NP) rehabilitation compared with standard, multidisciplinary rehabilitation for people with traumatic brain injury (TBI).
Randomized practical controlled trial.
Postacute brain injury rehabilitation center within a suburban rehabilitation hospital.
Participants with TBI were recruited from clinical referrals and referrals from the community. Sixty-eight participants who met inclusion criteria were randomly allocated to treatment conditions. Most participants (88%) had sustained moderate or severe TBI, and greater than half (57%) were more than 1 year postinjury at the beginning of treatment.
Treatment was conducted 15 hours per week for 16 weeks. Standard neurorehabilitation consisted primarily of individual, discipline specific therapies (n=34). Intensive cognitive rehabilitation emphasized the integration of cognitive, interpersonal, and functional interventions within a therapeutic environment (n=34).
Primary outcomes were the Community Integration Questionnaire (CIQ) and Perceived Quality of Life scale (PQOL). Secondary outcomes included NP functioning, perceived self-efficacy, and community-based employment.
NP functioning improved in both conditions. Intensive cognitive rehabilitation participants showed greater improvements on the CIQ (effect size [ES]=0.59) and PQOL (ES=0.30) as well as improved self-efficacy for the management of symptoms (ES=0.26) compared with standard neurorehabilitation treatment. These gains were maintained at the 6-month follow-up. Standard neurorehabilitation participants showed improved productivity at the 6-month follow-up associated with the need for continued rehabilitation.
Improvements seen after intensive cognitive rehabilitation may be related to interventions directed at the self-regulation of cognitive and emotional processes and the integrated treatment of cognitive, interpersonal, and functional skills. The results show the effectiveness of comprehensive holistic NP rehabilitation for improving community functioning and quality of life after TBI compared with standard rehabilitation.
评估与标准多学科康复相比，综合、整体神经心理学（NP）康复对创伤性脑损伤（TBI）患者的有效性。
随机实用对照试验。
郊区康复医院内的急性脑损伤后康复中心。
TBI患者从临床转诊和社区转诊中招募。68名符合纳入标准的参与者被随机分配到治疗组。大多数参与者（88%）遭受了中度或重度TBI，超过一半（57%）在治疗开始时受伤超过1年。
每周进行15小时，共16周的治疗。标准神经康复主要包括个体化、特定学科的治疗（n = 34）。强化认知康复强调在治疗环境中整合认知、人际和功能干预（n = 34）。
主要结局是社区融合问卷（CIQ）和生活质量感知量表（PQOL）。次要结局包括NP功能、自我效能感和社区就业情况。
两种治疗条件下NP功能均有改善。与标准神经康复治疗相比，强化认知康复参与者在CIQ（效应量[ES]=0.59）和PQOL（ES = 0.30）方面有更大改善，以及在症状管理的自我效能感方面有所提高（ES = 0.26）。这些改善在6个月随访时得以维持。标准神经康复参与者在6个月随访时显示出与持续康复需求相关的生产力提高。
强化认知康复后出现的改善可能与针对认知和情感过程自我调节以及认知、人际和功能技能综合治疗的干预措施有关。结果表明，与标准康复相比，综合整体NP康复对改善TBI后的社区功能和生活质量有效。
