Effectiveness of specialized rehabilitation after mild traumatic brain injury : A systematic review and meta-Analysis

Objective: To determine the effectiveness of specialized rehabilitation in adults with prolonged symptoms, or risk of prolonged symptoms, following mild traumatic brain injury. Data sources: Randomized controlled trials or nonrandomized controlled studies published between 1 Jan 2000 and 10 Mar 2019 in Cochrane Controlled Register of Trials, PubMed, EMBASE, CINAHL or PsycINFO. Meta-Analyses were performed for studies of similar interventions when identical or comparable outcomes were reported. Study selection and data extraction: Screening, data extraction, and risk of bias assessment were carried out by 2 independent researchers. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Data synthesis: A total of 9 studies were identified, which were divided into 3 subgroups. Results from meta-Analyses implied that problem-solving therapy and cognitive behavioural therapy reduce residual symptoms, improve psychological functioning, decrease depression, increase activity and participation, and improve quality of life, compared with usual care. The meta-Analyses also suggested that specialized interdisciplinary rehabilitation reduces residual symptoms. Conclusion: Persons with mild traumatic brain injury who are at risk of, or who experience, prolonged symptoms should be considered for specialist treatment, as they may experience positive effects from cognitive behavioural therapy, problem-solving therapy, or interdisciplinary team rehabilitation. Further research is required to strengthen the evidence