Avramovic Petra, Rietdijk Rachael, Attard Michelle, Kenny Belinda, Power Emma, Togher Leanne
Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
NHMRC Center of Research Excellence in Aphasia Rehabilitation, Australia.
J Neurotrauma. 2023 Feb;40(3-4):159-194. doi: 10.1089/neu.2021.0473. Epub 2022 Aug 29.
Traumatic brain injury (TBI) leads to cognitive linguistic deficits that significantly impact on quality of life and well-being. Digital health offers timely access to specialized services; however, there are few synthesized reviews in this field. This review evaluates and synthesizes reports of digital health interventions in TBI rehabilitation and caregiver education. Systematic searches of nine databases (PsycINFO, MEDLINE, CINAHL, Embase, Cochrane Library, Scopus, Web of Science Core Collection, speechBITE, and PsycBITE) were conducted from database inception to February 2022. Studies were included of interventions where the primary treatment focus (> 50%) was on improving communication, social, psychological or cognitive skills of people with TBI and/or communication partners. Data on participants, characteristics of the interventions, outcome measures and findings were collected. Risk of bias was accounted for through methodological quality assessments (PEDro-P and PEDro+, Risk of Bias in N-of-1 Trials) and intervention description. Qualitative data was analyzed using thematic synthesis. Forty-four articles met eligibility criteria: 20 randomized controlled trials, three single-case experimental designs, six non-randomized controlled trials, nine case series studies, and two case studies. Studies comprised 3666 people with TBI and 213 carers. Methodological quality was varied and intervention description was poor. Most interventions were delivered via a single digital modality (e.g., telephone), with few using a combination of modalities. Five interventions used co-design with key stakeholders. Digital health interventions for people with TBI and their caregivers are feasible and all studies reported positive outcomes; however, few included blind assessors. Improved methodological rigor, clearly described intervention characteristics and consistent outcome measurement is recommended. Further research is needed regarding multi-modal digital health interventions.
创伤性脑损伤（TBI）会导致认知语言缺陷，对生活质量和幸福感产生重大影响。数字健康提供了及时获得专业服务的途径；然而，该领域的综合综述较少。本综述评估并综合了数字健康干预在TBI康复和照顾者教育方面的报告。从数据库建立到2022年2月，对九个数据库（PsycINFO、MEDLINE、CINAHL、Embase、Cochrane图书馆、Scopus、科学网核心合集、speechBITE和PsycBITE）进行了系统检索。纳入的研究是那些主要治疗重点（>50%）为改善TBI患者和/或交流伙伴的沟通、社交、心理或认知技能的干预措施。收集了关于参与者、干预措施特征、结果测量和研究结果的数据。通过方法学质量评估（PEDro-P和PEDro+、单病例试验中的偏倚风险）和干预描述来考虑偏倚风险。使用主题综合法对定性数据进行分析。44篇文章符合纳入标准：20项随机对照试验、3项单病例实验设计、6项非随机对照试验、9项病例系列研究和2项病例研究。研究包括3666名TBI患者和213名照顾者。方法学质量参差不齐，干预描述较差。大多数干预措施是通过单一数字方式（如电话）实施的，很少使用多种方式的组合。五项干预措施与关键利益相关者进行了共同设计。针对TBI患者及其照顾者的数字健康干预是可行的，所有研究均报告了积极结果；然而，很少有研究纳入盲法评估者。建议提高方法学的严谨性，清晰描述干预特征并进行一致的结果测量。关于多模式数字健康干预还需要进一步研究。
