Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.
Neuropsychol Rev. 2023 Jun;33(2):374-392. doi: 10.1007/s11065-022-09544-5. Epub 2022 Jun 10.
Agitation is common in the early recovery period following traumatic brain injury (TBI), known as post-traumatic amnesia (PTA). Non-pharmacological interventions are frequently used to manage agitation, yet their efficacy is largely unknown. This systematic review aims to synthesize current evidence on the effectiveness of non-pharmacological interventions for agitation during PTA in adults with TBI. Key databases searched included MEDLINE Ovid SP interface, PubMed, CINAHL, Excerpta Medica Database, PsycINFO and CENTRAL, with additional online reviewing of key journals and clinical trial registries to identify published or unpublished studies up to May 2020. Eligible studies included participants aged 16 years and older, showing agitated behaviours during PTA. Any non-pharmacological interventions for reducing agitation were considered, with any comparator accepted. Eligible studies were critically appraised for methodological quality using Joanna Briggs Institute Critical Appraisal Instruments and findings were reported in narrative form. Twelve studies were included in the review: two randomized cross-over trials, three quasi-experimental studies, four cases series and three case reports. Non-pharmacological interventions were music therapy, behavioural strategies and environmental modifications, physical restraints and electroconvulsive therapy. Key methodological concerns included absence of a control group, a lack of formalised agitation measurement and inconsistent concomitant use of pharmacology. Interventions involving music therapy had the highest level of evidence, although study quality was generally low to moderate. Further research is needed to evaluate non-pharmacological interventions for reducing agitation during PTA after TBI.Systematic review registration number: PROSPERO (CRD42020186802), registered May 2020.
颅脑损伤（TBI）后早期恢复期（称为创伤后遗忘期，PTA）常出现激越。常采用非药物干预措施来控制激越，但这些干预措施的疗效知之甚少。本系统评价旨在综合目前关于 TBI 成人 PTA 期间非药物干预措施治疗激越的有效性证据。检索的主要数据库包括 MEDLINE Ovid SP 界面、PubMed、CINAHL、Excerpta Medica Database、PsycINFO 和 CENTRAL，并额外在线查阅主要期刊和临床试验注册处，以确定截至 2020 年 5 月已发表或未发表的研究。合格研究纳入了 PTA 期间出现激越行为的 16 岁及以上参与者。任何减少激越的非药物干预措施均可纳入研究，接受任何对照措施。采用 Joanna Briggs 研究所批判性评估工具对合格研究进行方法学质量评估，并以叙述形式报告研究结果。本研究共纳入 12 项研究：2 项随机交叉试验、3 项准实验研究、4 项病例系列研究和 3 项病例报告。非药物干预措施包括音乐治疗、行为策略和环境改变、躯体约束和电抽搐治疗。主要的方法学问题包括缺乏对照组、缺乏正式的激越测量以及药物治疗的同时使用不一致。涉及音乐治疗的干预措施具有最高水平的证据，但研究质量普遍较低或中等。需要进一步研究评估 TBI 后 PTA 期间减少激越的非药物干预措施。系统评价注册编号：PROSPERO（CRD42020186802），于 2020 年 5 月注册。
