Brett Caroline Elizabeth, Sykes Catherine, Pires-Yfantouda Renata
a Department of Psychology , University of Edinburgh , Edinburgh , UK.
b Department of Psychology , City University London , London , UK.
Neuropsychol Rehabil. 2017 Sep;27(6):959-982. doi: 10.1080/09602011.2015.1090459. Epub 2015 Sep 29.
Rehabilitation in adults with acquired brain injury is often hampered by a lack of client engagement with the rehabilitation process, leading to frustration, withdrawal of services and poorer recovery. Motivation, apathy and awareness are potential mechanisms underlying engagement, but few studies have suggested potential intervention techniques. A systematic review of the literature was carried out to identify and evaluate interventions designed to increase rehabilitation engagement in adults with acquired brain injury. Database searches used the following terms: rehabilitation, brain injury, and compliance/engagement/adherence in PsychInfo, Medline, Cinahl, Embase, AMED, Web of Knowledge, PsycBite, Cochrane clinical trials, and clinicaltrials.org. Hand searches were conducted of reference lists and relevant journals. Fifteen studies were included in the review. Intervention techniques fell into two broad categories: behavioural modification techniques and cognitive/meta-cognitive skills. Contingent reward techniques were most effective at increasing adherence and compliance, while interventions enabling clients' active participation in rehabilitation appeared to increase engagement and motivation. The review highlighted methodological and measurement inconsistencies in the field and suggested that interventions should be tailored to clients' abilities and circumstances.
获得性脑损伤成人患者的康复治疗常常因患者对康复过程缺乏参与度而受阻，进而导致沮丧情绪、服务中断以及康复效果不佳。动机、冷漠和意识是参与度背后的潜在机制，但很少有研究提出潜在的干预技术。我们对文献进行了系统综述，以识别和评估旨在提高获得性脑损伤成人患者康复参与度的干预措施。数据库检索使用了以下术语：康复、脑损伤以及PsychInfo、Medline、Cinahl、Embase、AMED、Web of Knowledge、PsycBite、Cochrane临床试验和clinicaltrials.org中的依从性/参与度/坚持性。我们还对手头参考文献列表和相关期刊进行了检索。该综述纳入了15项研究。干预技术主要分为两大类：行为改变技术和认知/元认知技能。偶然奖励技术在提高依从性和顺从性方面最为有效，而能使患者积极参与康复治疗的干预措施似乎能提高参与度和动机。该综述强调了该领域在方法和测量方面的不一致性，并建议干预措施应根据患者的能力和情况进行调整。
