Improving outcomes of rehabilitation treatments for traumatic brain injury: The development of an online database

Objectives: Traumatic brain injury (TBI) is the signature injury of the Iraq and Afghanistan conflicts and a major public health issue that affects soldiers and civilians alike. This study seeks to identify gaps in research, determine areas for improvement in study design, and identify standards of care for TBI rehabilitation. Methods: TBI rehabilitation treatments were divided into four categories: behavioral, cognitive, functional, and physical. Published studies within the four categories were identified through PubMed and PsycINFO literature searches. The studies were reviewed and analyzed using a standardized algorithm which was developed into an online Oracle database. Studies were classified and assigned a level of evidence based on the American Academy of Neurology (AAN) classification guidelines. Results: Published studies are generally small and lack blinding and randomization. Due to these limitations, few studies meet AAN Class I guidelines, and thus standards of care within TBI rehabilitation cannot be satisfactorily determined. Conclusions: Steps to improve the quality of future TBI studies include increasing study size, utilizing randomization and double-blinding, and increasing funding of large multi-center studies. This will inform the development of effective standards of care for TBI rehabilitation across the life spectrum.