Young Vanessa M, Hill Juan R, Patrini Michele, Negrini Stefano, Arienti Chiara
School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ 85051, USA.
Independent Researcher, San Diego, CA 92108, USA.
J Clin Med. 2022 May 10;11(10):2691. doi: 10.3390/jcm11102691.
The World Health Organization has identified an unmet global need for rehabilitation interventions concerning 20 non-communicable diseases, traumatic brain injury included. This overview compiles and synthesizes the quality and quantity of available evidence on the effectiveness of rehabilitation interventions for traumatic brain injury from Cochrane systematic reviews (CSRs). The results will be used to develop the Package of Interventions for Rehabilitation.
All CSRs on TBI tagged in the Cochrane Rehabilitation database published between August 2009 and September 2021 were included. Evidence mapping was implemented to extract study characteristics and evidence from the CSRs.
Six CSRs (42 studies; = 3983) examined the effectiveness of either non-pharmacological or pharmacological interventions after TBI. Among 19 comparisons, 3% were rated as high in quality of evidence, 9% moderate, 54% low, and 34% very low. Non-pharmacological interventions with moderate quality, hospital-based cognitive rehabilitation and cognitive didactic therapy, likely produced minimal to no changes in the return-to-work rate. Anti-epileptic drugs and neuroprotective agents resulted in a minimal difference to the frequency of late seizure episodes in post-traumatic epilepsy.
No prominent advances in treatment options were reported in any of the CSRs. The high rate of low and very low quality of evidence makes it difficult to ascertain the effectiveness of several recommended non-pharmacological interventions.
世界卫生组织已确定全球对20种非传染性疾病（包括创伤性脑损伤）的康复干预存在未满足的需求。本综述汇编并综合了Cochrane系统评价（CSRs）中关于创伤性脑损伤康复干预效果的现有证据的质量和数量。结果将用于制定康复干预包。
纳入2009年8月至2021年9月在Cochrane康复数据库中标记的所有关于创伤性脑损伤的CSRs。实施证据映射以从CSRs中提取研究特征和证据。
六项CSRs（42项研究；n = 3983）检查了创伤性脑损伤后非药物或药物干预的效果。在19项比较中，3%的证据质量被评为高，9%为中等，54%为低，34%为极低。质量中等的非药物干预，即基于医院的认知康复和认知教学疗法，可能对重返工作率产生极小至无变化。抗癫痫药物和神经保护剂对创伤后癫痫晚期发作频率的影响极小。
任何一项CSRs均未报告治疗选择有显著进展。低质量和极低质量证据的高比例使得难以确定几种推荐的非药物干预的有效性。
