Parkwood Institute Research, Lawson Research Institute, London, ON, Canada.
Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
NeuroRehabilitation. 2024;54(4):509-520. doi: 10.3233/NRE-240019.
Given the complexity of post-TBI medical, surgical, and rehabilitative care, research is critical to optimize interventions across the continuum of care and improve outcomes for persons with moderate to severe TBI.
To characterize randomized controlled trials (RCTs) of moderate to severe traumatic brain injury (TBI) in the literature.
Systematic searches of MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO for RCTs up to December 2022 inclusive were conducted in accordance with PRISMA guidelines.
662 RCTs of 91,946 participants published from 1978 to 2022 met inclusion criteria. The number of RCTs published annually has increased steadily. The most reported indicator of TBI severity was the Glasgow Coma Scale (545 RCTs, 82.3%). 432 (65.3%) RCTs focused on medical/surgical interventions while 230 (34.7%) addressed rehabilitation. Medical/surgical RCTs had larger sample sizes compared to rehabilitation RCTs. Rehabilitation RCTs accounted for only one third of moderate to severe TBI RCTs and were primarily conducted in the chronic phase post-injury relying on smaller sample sizes.
Further research in the subacute and chronic phases as well as increasing rehabilitation focused TBI RCTs will be important to optimizing the long-term outcomes and quality of life for persons living with TBI.
鉴于创伤性脑损伤（TBI）后医疗、手术和康复护理的复杂性，研究对于优化整个护理连续体中的干预措施并改善中重度 TBI 患者的结局至关重要。
描述文献中中重度创伤性脑损伤（TBI）的随机对照试验（RCT）。
按照 PRISMA 指南，对 MEDLINE、PubMed、Scopus、CINAHL、EMBASE 和 PsycINFO 进行了系统检索，纳入截至 2022 年 12 月的 RCT。
共纳入了 662 项 RCT，涉及 91946 名参与者，这些 RCT 均发表于 1978 年至 2022 年期间。每年发表的 RCT 数量稳步增加。报告最多的 TBI 严重程度指标是格拉斯哥昏迷量表（545 项 RCT，82.3%）。432 项（65.3%）RCT 侧重于医疗/手术干预，而 230 项（34.7%）则针对康复。与康复 RCT 相比，医疗/手术 RCT 的样本量更大。康复 RCT 仅占中重度 TBI RCT 的三分之一，主要在损伤后慢性期进行，样本量较小。
在亚急性期和慢性期开展更多研究，以及增加以康复为重点的 TBI RCT，对于优化 TBI 患者的长期结局和生活质量非常重要。
