Narrative review of clinical practice guidelines for treating people with moderate or severe traumatic brain injury.
Lynn H Gerber, Rati Deshpande, Ali Moosvi and 4 others
PMID 34057100WHAT IT FOUND
Only 17 clinical practice guidelines for moderate-to-severe TBI rehabilitation met rigorous vetting standards since 2010.
Most guidelines focus on symptom control rather than functional recovery, and many published documents labeled as guidelines lack the necessary systematic review process to be trustworthy.
Key findings
01A search of databases and websites for clinical practice guidelines published between 2010 and 2020 identified only 17 documents that met strict criteria for addressing rehabilitation in moderate-to-severe TBI and following an established vetting process.
02When evaluated against the AGREE II template, only four of these 17 guidelines met all six quality domains, with the most common failure being a lack of editorial independence.
03Six of the included guidelines addressed only symptom control (such as spasticity or depression) without linking these interventions to functional outcomes, while nine used functional measures as primary or secondary outcomes.
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
The review excluded mild TBI and concussion, so findings do not apply to that larger population. Only guidelines published from 2010 to 2020 were included, potentially missing older but still relevant standards. The definition of 'rehabilitation' was strict, requiring specific functional interventions, which may have excluded useful general care guidelines. The authors did not assess the actual effectiveness of the recommended interventions, only the quality of the guidelines themselves.
Declared interests
The authors declared no conflicts of interest. The work was funded through a subcontract to Inova Health System from the American Institutes for Research, supported by NIDILRR Federal Grants.
The easy way to misread this
Do not assume that a document titled 'Clinical Practice Guideline' is trustworthy or evidence-based. This review found that many such publications are actually literature reviews without rigorous vetting, and even among those that met inclusion criteria, most failed to demonstrate full editorial independence.