Author Affiliations: Parkwood Institute Research, Lawson Health Research Institute (Drs Flores-Sandoval, Teasell, and MacKenzie, Ms Barua, and Drs Mehta and Bateman); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Drs Teasell, MacKenzie, Mehta, and Bateman); Parkwood Institute, St. Joseph's Health Care London, London, Ontario (Drs Bateman, Teasell, and MacKenzie); Arthur Family Labatt School of Nursing, Faculty of Health Sciences, Western University, London, Ontario (Dr McIntyre); Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, KITE Research Institute, University Health Network, Toronto, Ontario, and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario (Dr Bayley).
J Head Trauma Rehabil. 2024;39(5):342-358. doi: 10.1097/HTR.0000000000000984. Epub 2024 Sep 10.
To present an evidence-based review of randomized controlled trials (RCTs) evaluating interventions for mental health post-moderate to severe traumatic brain injury (post-MSTBI), as part of an extensive database that has been conceptualized as a living systematic review.
Systematic searches were conducted for RCTs published in the English language in MEDLINE, PubMed, Scopus, CINAHL, EMBASE, and PsycINFO, up to and including December 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale, and the level of evidence was assigned using a modified Sackett scale.
Eighty-seven RCTs examining mental health interventions and outcome measures post-MSTBI were included. These studies collectively enrolled 6471 participants. A total of 41 RCTs (47.1%) were conducted in the United States and 56 studies (64.4%) were published after 2010. A total of 62 RCTs (71.3%) examined nonpharmacological interventions and 25 RCTs (28.7%) examined pharmacological interventions. Effective pharmacological treatments included desipramine and cerebrolysin; methylphenidate and rivastigmine showed conflicting evidence. Cognitive behavioral therapy (CBT) was found to be effective for hopelessness, stress, and anxiety, compared to usual care; however, it may be as effective as supportive psychotherapy for depression. CBT combined with motivational interviewing may be as effective as CBT combined with nondirective counseling for depression, stress, and anxiety. Acceptance and commitment therapy was effective for anxiety, stress, and depression. Tai Chi, dance, and walking appeared to be effective for depression and stress, while other nonpharmacological treatments such as peer mentoring showed limited effectiveness.
This evidence-based review provides a comprehensive overview of the research landscape of RCTs addressing mental health post-MSTBI. The findings from these RCTs may be valuable for health care professionals, researchers, and policymakers involved in the field of mental health and neurorehabilitation.
作为一个广泛的数据库的一部分，呈现一份基于证据的综述，该数据库是对评估中度至重度创伤性脑损伤（post-MSTBI）后心理健康干预措施的随机对照试验（RCT）的综述，该数据库被概念化为一个实时系统综述。
根据系统评价和荟萃分析的首选报告项目的指南，在 MEDLINE、PubMed、Scopus、CINAHL、EMBASE 和 PsycINFO 中以英文发表的 RCT 进行系统搜索，截至 2022 年 12 月。使用物理治疗证据数据库量表评估 RCT 的方法学质量，并使用改良的 Sackett 量表分配证据水平。
共纳入 87 项评估 post-MSTBI 后心理健康干预措施和结局指标的 RCT，共纳入 6471 名参与者。共有 41 项 RCT（47.1%）在美国进行，56 项研究（64.4%）发表于 2010 年后。共有 62 项 RCT（71.3%）检查了非药物干预，25 项 RCT（28.7%）检查了药物干预。有效的药物治疗包括去甲丙咪嗪和脑活素；哌甲酯和利伐斯的明的证据存在冲突。认知行为疗法（CBT）在治疗无望、压力和焦虑方面比常规护理更有效；然而，它对抑郁症的疗效可能与支持性心理治疗相当。CBT 联合动机访谈可能与 CBT 联合非指导性咨询对抑郁症、压力和焦虑的疗效相当。接受和承诺疗法对焦虑、压力和抑郁有效。太极拳、舞蹈和散步似乎对抑郁和压力有效，而其他非药物治疗，如同伴指导，效果有限。
本循证综述提供了对评估 post-MSTBI 后心理健康的 RCT 研究现状的全面概述。这些 RCT 的结果可能对从事心理健康和神经康复领域的医疗保健专业人员、研究人员和政策制定者具有重要意义。
