Systematic Review of Caregiver and Dyad Interventions After Adult Traumatic Brain Injury.

The studies varied so much in injury severity, time since injury, intervention type, delivery method, session number, and outcomes that the authors could not combine them in a meta-analysis. Randomization was often poorly described, and no included study could blind the survivor or caregiver to the intervention. Only 6 of 14 studies described treatment fidelity well, and only 5 were considered high fidelity. Most studies followed participants for no longer than 1 year, so long-term benefit is unclear. The outcome measures were often taken from other conditions, and many studies did not describe whether the survivor or caregiver completed survivor questionnaires. Two of the strongest positive studies used the same occupational therapist, so their results may not generalize to other institutions. Only English-language studies were searched, and the included studies were from the United States, United Kingdom, Scotland, Canada, or Australia. Nonrandomized studies had higher risk of bias and often grouped participants by geography, convenience, or time since injury. There was no outcome measure that specifically captured caregiving burden in families with a TBI survivor. The secondary studies included other acquired brain injuries, and none were powered to detect whether the intervention worked better specifically after TBI.

Do not read this as evidence that caregiver interventions reliably improve TBI survivor function. The review is narrative, a meta-analysis was not possible, and the strongest positive findings were for caregiver outcomes in interventions that included several elements.