Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada; Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada; Institute for Work and Health, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
Arch Phys Med Rehabil. 2014 Mar;95(3 Suppl):S265-77. doi: 10.1016/j.apmr.2013.04.026.
The International Collaboration on Mild Traumatic Brain Injury (MTBI) Prognosis performed a comprehensive search and critical review of the literature from 2001 to 2012 to update the 2002 best-evidence synthesis conducted by the World Health Organization Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation Task Force on the prognosis of MTBI. Of 299 relevant studies, 101 were accepted as scientifically admissible. The methodological quality of the research literature on MTBI prognosis has not improved since the 2002 Task Force report. There are still many methodological concerns and knowledge gaps in the literature. Here we report and make recommendations on how to avoid methodological flaws found in prognostic studies of MTBI. Additionally, we discuss issues of MTBI definition and identify topic areas in need of further research to advance the understanding of prognosis after MTBI. Priority research areas include but are not limited to the use of confirmatory designs, studies of measurement validity, focus on the elderly, attention to litigation/compensation issues, the development of validated clinical prediction rules, the use of MTBI populations other than hospital admissions, continued research on the effects of repeated concussions, longer follow-up times with more measurement periods in longitudinal studies, an assessment of the differences between adults and children, and an account for reverse causality and differential recall bias. Well-conducted studies in these areas will aid our understanding of MTBI prognosis and assist clinicians in educating and treating their patients with MTBI.
国际轻度创伤性脑损伤(MTBI)预后协作组对 2001 年至 2012 年的文献进行了全面检索和批判性评价,以更新世界卫生组织神经创伤、预防、管理和康复协作中心关于 MTBI 预后的 2002 年最佳证据综合报告。在 299 项相关研究中,有 101 项被认为具有科学可接受性。自 2002 年工作组报告以来,MTBI 预后研究的文献方法质量并未得到改善。文献中仍存在许多方法学问题和知识空白。在这里,我们报告并就如何避免 MTBI 预后研究中的方法学缺陷提出建议。此外,我们还讨论了 MTBI 定义的问题,并确定了需要进一步研究的主题领域,以增进对 MTBI 后预后的理解。优先研究领域包括但不限于使用确证性设计、测量有效性研究、关注老年人、关注诉讼/赔偿问题、制定经过验证的临床预测规则、使用除住院患者以外的 MTBI 人群、继续研究反复脑震荡的影响、在纵向研究中增加更长的随访时间和更多的测量期、评估成年人和儿童之间的差异,以及考虑反向因果关系和差异回忆偏倚。在这些领域进行的良好研究将有助于我们理解 MTBI 预后,并帮助临床医生教育和治疗 MTBI 患者。
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