Author Affiliations : Parkwood Institute Research, Lawson Health Research Institute (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman, Barua, Dr Mehta); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Dr MacKenzie, Dr Bateman, Dr Mehta); Parkwood Institute, St. Joseph's Health Care London, London (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman); Arthur Labatt School of Nursing, Western University, London, Ontario (Dr McIntyre); Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto (Dr Bayley); KITE Research Institute, University Health Network, Toronto (Dr Bayley); and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario (Dr Bayley)..
J Head Trauma Rehabil. 2024;39(5):369-381. doi: 10.1097/HTR.0000000000000971. Epub 2024 Sep 10.
To present an evidence-based review of randomized controlled trials (RCTs) evaluating interventions for the management of behavioral issues post moderate to severe traumatic brain injury (MSTBI), as part of an extensive database that has been conceptualized as a living systematic review.
Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO, up to and including December 2022, for articles published in the English language, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of RCT was assessed using the Physiotherapy Evidence Database (PEDro) scale, and level of evidence was assigned using a modified Sackett scale.
Forty-six RCTs examining interventions and outcome measures related to behavioral issues post-MSTBI were included. These studies collectively enrolled 3,267 participants. The majority of RCTs were conducted in the United States (n = 27; 58.7%) and 28 (60.9%) were conducted after 2010. Of these, 27 RCTs examined non-pharmacological interventions and 19 examined pharmacological interventions. Effective pharmacological treatments included amantadine and dexmedetomidine. Effective non-pharmacological interventions included sensory stimulation in the acute phase, anger self-management programs, peer mentoring, problem-solving, and emotional regulation. Psychotherapy showed conflicting evidence.
This evidence-based review provides a comprehensive overview of the research landscape of RCTs addressing behavior post-MSTBI. The findings from these RCTs may be valuable for health care professionals, researchers, and policymakers involved in the field of TBI and behavior.
呈现一项针对中度至重度创伤性脑损伤 (MSTBI) 后行为问题管理干预措施的随机对照试验 (RCT) 的循证综述，该综述是一个广泛数据库的一部分，该数据库被概念化为一个实时的系统综述。
根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，对 MEDLINE、PubMed、Scopus、CINAHL、EMBASE 和 PsycINFO 进行了系统搜索，以检索截至 2022 年 12 月发表的英文文章。使用物理治疗证据数据库 (PEDro) 量表评估 RCT 的质量，并使用改良的 Sackett 量表分配证据水平。
共纳入 46 项研究，这些研究涉及与 MSTBI 后行为问题相关的干预措施和结果测量，共纳入 3267 名参与者。大多数 RCT 在美国进行（n=27；58.7%），其中 28 项（60.9%）是在 2010 年后进行的。其中，27 项 RCT 研究了非药物干预，19 项研究了药物干预。有效的药物治疗包括金刚烷胺和右美托咪定。有效的非药物干预措施包括急性期的感觉刺激、愤怒自我管理计划、同伴指导、解决问题和情绪调节。心理治疗显示出相互矛盾的证据。
这项基于证据的综述提供了一个全面的 RCT 研究概述，涉及 MSTBI 后行为问题。这些 RCT 的结果可能对 TBI 和行为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价值。
