Xu Gang-Zhu, Li Yan-Feng, Wang Mao-De, Cao Dong-Yuan
Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Stomatological Hospital, Xi'an Jiaotong University and First Affiliated Hospital of Xi'an Medical University, Xi'an, China.
First Affiliated Hospital of Xi'an Medical University, China.
Ther Adv Neurol Disord. 2017 May;10(5):229-239. doi: 10.1177/1756285616682675. Epub 2017 Feb 1.
We systematically reviewed randomized controlled trials (RCTs) of complementary and alternative interventions for fatigue after traumatic brain injury (TBI).
We searched multiple online sources including ClinicalTrials.gov, the Cochrane Library database, MEDLINE, CINAHL, Embase, the Web of Science, AMED, PsychINFO, Toxline, ProQuest Digital Dissertations, PEDro, PsycBite, and the World Health Organization (WHO) trial registry, in addition to hand searching of grey literature. The methodological quality of each included study was assessed using the Jadad scale, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. A descriptive review was performed.
Ten RCTs of interventions for post-TBI fatigue (PTBIF) that included 10 types of complementary and alternative interventions were assessed in our study. There were four types of physical interventions including aquatic physical activity, fitness-center-based exercise, Tai Chi, and aerobic training. The three types of cognitive and behavioral interventions (CBIs) were cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and computerized working-memory training. The Flexyx Neurotherapy System (FNS) and cranial electrotherapy were the two types of biofeedback therapy, and finally, one type of light therapy was included. Although the four types of intervention included aquatic physical activity, MBSR, computerized working-memory training and blue-light therapy showed unequivocally effective results, the quality of evidence was low/very low according to the GRADE system.
The present systematic review of existing RCTs suggests that aquatic physical activity, MBSR, computerized working-memory training, and blue-light therapy may be beneficial treatments for PTBIF. Due to the many flaws and limitations in these studies, further controlled trials using these interventions for PTBIF are necessary.
我们系统回顾了针对创伤性脑损伤（TBI）后疲劳的补充和替代干预措施的随机对照试验（RCT）。
我们检索了多个在线资源，包括ClinicalTrials.gov、Cochrane图书馆数据库、MEDLINE、CINAHL、Embase、科学网、AMED、PsychINFO、Toxline、ProQuest数字论文库、PEDro、PsycBite以及世界卫生组织（WHO）试验注册库，此外还手动检索了灰色文献。使用Jadad量表评估每项纳入研究的方法学质量，并使用推荐分级、评估、制定与评价（GRADE）系统评估证据质量。进行了描述性综述。
我们的研究评估了10项针对TBI后疲劳（PTBIF）的干预措施的随机对照试验，这些试验包括10种补充和替代干预措施。有四种身体干预类型，包括水上体育活动、健身中心锻炼、太极拳和气功训练。三种认知和行为干预（CBI）是认知行为疗法（CBT）、基于正念的减压疗法（MBSR）和计算机化工作记忆训练。Flexyx神经疗法系统（FNS）和颅电疗法是两种生物反馈疗法，最后，纳入了一种光疗法。尽管四种干预措施，包括水上体育活动、MBSR、计算机化工作记忆训练和蓝光疗法显示出明确有效的结果，但根据GRADE系统，证据质量为低/极低。
本次对现有随机对照试验的系统综述表明，水上体育活动、MBSR、计算机化工作记忆训练和蓝光疗法可能是治疗PTBIF的有益方法。由于这些研究存在许多缺陷和局限性，有必要进一步进行使用这些干预措施治疗PTBIF的对照试验。
