Effectiveness of specialized rehabilitation after mild traumatic brain injury: A systematic review and meta-analysis.
Marika C Möller, Jan Lexell, Karin Wilbe Ramsay
PMID 33492404WHAT IT FOUND
Specialized brain injury rehabilitation reduced post-concussion symptoms compared with usual care.
Cognitive behavioral therapy and interdisciplinary programmes showed small benefits for mood and activity. Evidence quality was low because participants knew which treatment they received, so effects may be exaggerated.
Key findings
01Cognitive behavioral therapy and problem-solving treatment significantly reduced post-mTBI symptoms, depression, and improved activity compared with usual care.
02Interdisciplinary rehabilitation significantly reduced post-mTBI symptoms compared with usual care, but did not show significant benefits for other outcomes.
03All included randomized controlled trials had some concerns regarding risk of bias, primarily due to lack of blinding.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Participants and outcome assessors were not blinded in most studies, which is difficult in rehabilitation trials but increases the risk of bias. The studies had small sample sizes and heterogeneous interventions, populations, and settings, which lowered the certainty of the evidence. Many outcome measures were self-reported, making them susceptible to subjective bias. Return to work and mortality data were rarely reported, limiting conclusions about these important outcomes.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume these treatments are definitively effective. The certainty of evidence is low to very low because participants knew which treatment they received, and effects were small. This means the observed benefits might be partly due to expectancy effects rather than the specific intervention.