Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial.
Roshan das Nair, Lucy E Bradshaw, Florence Ec Day and 7 others
PMID 30977398WHAT IT FOUND
Group memory rehabilitation plus usual care did not produce a clinically important improvement in self-reported everyday memory compared with usual care alone at the main follow-up.
Some objective and goal attainment outcomes favoured it, but the primary patient-reported memory result was not positive.
Key findings
01In the primary analysis of 129 participants receiving group memory rehabilitation plus usual care and 122 receiving usual care alone, the patient-reported everyday memory outcome showed no clinically important difference: adjusted difference was -2.1 points on the 28-item Everyday Memory Questionnaire - patient version at 6 months (95% CI -6.7 to 2.5, p = 0.37).
02Rivermead Behavioural Memory Test scores favoured the memory rehabilitation plus usual care arm at 6 months (adjusted difference 2.5 points, 95% CI 0.1 to 4.8), and goal attainment scores favoured it at 6 and 12 months, but mood and relative-reported everyday memory did not show clear differences.
03Memory rehabilitation cost £167 per participant; total costs were £27 lower than usual care but not statistically significant, and quality-adjusted life years were 0.011 lower but not statistically significant.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Participants and Assistant Psychologists delivering the intervention were not blinded, and the primary outcome was self-reported. A substantial minority did not provide primary outcome data, and those missing data had slightly lower education and more memory problems at baseline. The sample was heterogeneous, and the nature and severity of traumatic brain injury could not be described from medical notes. Groups were formed by availability rather than similar characteristics, which may have affected group cohesion and learning. The borderline/moderate memory subgroup finding was exploratory and not supported by an interaction test. Cost and quality-adjusted life year estimates had wide uncertainty.
Declared interests
Funded by the National Institute for Health Research Health Technology Assessment Programme. The funder had no role in study design, data collection, analysis, interpretation, or writing. The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the borderline/moderate memory subgroup finding as evidence that memory rehabilitation works for that group. The interaction test did not show evidence of subgroup differences, and the primary patient-reported memory outcome was not positive.