Comprehensive rehabilitation programmes in the chronic phase after severe brain injury: a systematic review.

OBJECTIVE: The aim of this study was to perform a systematic review of the effectiveness of comprehensive rehabilitation programmes for adults in the chronic phase after severe acquired brain injury. METHODS: PubMed, PsychINFO and PsychLit were searched for articles published between 1990 and 2008 and a quality assessment was performed. The comprehensive programmes were subdivided into neurobehavioral interventions, residential community reintegration and day-treatment programmes. The extracted data included study characteristics, patient characteristics and intervention characteristics. RESULTS: Thirteen studies met pre-established criteria. Two studies were randomized controlled trials, 5 were controlled comparative studies and 6 were uncontrolled longitudinal cohort studies. Overall, their methodological quality was limited. The investigated programmes led to substantial improvement in daily life functioning and community integration of severe chronic brain injury patients, with lasting effects at follow-up. Day-treatment programmes had the highest level of evidence. CONCLUSION: Comprehensive rehabilitation programmes appear to be effective in terms of a reduction in psychosocial problems, a higher level of community integration and an increase in employment. Although this is the first review to differentiate between specific programmes, clear-cut clinical recommendations cannot yet be set out due to limited methodological quality and poor description of patient and intervention characteristics. Specific recommendations for future studies are given