Underrepresentation of Participants From Marginalized Racial and Ethnic Groups: A Secondary Analysis of the Cognitive Rehabilitation Literature.
Jessica Kersey, Patricia Garcia, Emily Evans and 8 others
PMID 40678291WHAT IT FOUND
Most influential brain injury rehabilitation studies either did not report participant race or showed White non-Hispanic patients were severely overrepresented.
Eligibility rules like English fluency and high literacy likely excluded marginalized groups, meaning current practice standards may not apply equally to all patients.
Key findings
01Of the 65 studies analyzed, only 27 reported on their enrolled samples' race and ethnicity.
02In the 27 studies that did report demographics, White non-Hispanic participants were severely overrepresented (at least 85% of the sample) in 10 studies, and mildly overrepresented in 9 studies.
03Common eligibility criteria such as fluency in English, baseline education and literacy requirements, and exclusion of co-occurring psychiatric conditions may disproportionately exclude participants from racially and ethnically marginalized groups.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The analysis is restricted to US-based studies, so findings may not apply to other countries. It is a secondary analysis of a 2019 review, so it may not reflect more recent efforts to improve diversity in clinical trials. Race and ethnicity data were self-reported or researcher-assigned in the original studies, with no standardized method across papers. The analysis excluded case studies and series, which may have had different demographic profiles.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not conclude that cognitive rehabilitation interventions are ineffective for marginalized groups. This study found that these groups were underrepresented in the research, not that the treatments failed for them. The lack of data means we do not know if the interventions work equally well across different populations.