259522 Randomized Controlled Trials in Cognitive Rehabilitation for Adults with Traumatic Brain Injury

Sunday, October 28, 2012

Kelli Williams Gary, PhD, MPH, OTR/L , School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA
Juan Lu, MD, PhD, MPH , Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA
Janet Niemeier, PhD, ABPP (RP) , Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA
John Ward, MD , Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA
Kate L. Lapane, PhD , Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA
Approximately, 5.3 million Americans with traumatic brain injury (TBI) are living with long-term disabilities. Cognitive rehabilitation is a common treatment to restore neurobehavioral and psychosocial function following TBI. We conducted a comprehensive literature review on randomized controlled trials (RCTs) for adult TBI over the past 30 years during the post-acute recovery phase. Our aims were to (1) understand the needs of the heterogeneous TBI population, (2) study trends, commonality and differences among different cognitive rehabilitation interventions and (3) optimize strategies for effective care. Medline, PsycINFO and CINAHL databases were searched, yielding 1176 peer reviewed publications. Of those, 45 RCTs were conducted during the post-acute phase. Twenty-four were cognitive rehabilitation trials, which were classified as comprehensive interdisciplinary models, cognitive or academic exercises and communication skills training, compensatory techniques and computer-assisted training, education, and psychotherapy and behavior modification. The results indicated 22 out of 24 RCTs produced positive treatment effects in various settings. Several trends are worth noting: (1) multidisciplinary inpatient cognitive rehabilitation approaches appeared more effective than the standard programs among moderate and severe TBI samples; (2) higher intensity of rehabilitation treatment was more effective than less intensive methods; and (3) early educational counseling was helpful in reducing TBI-related symptoms with significantly better overall outcomes even with single session treatment. However, the evidence gathered is mostly from small and less representative samples. Moreover, lack of uniformity in data collection, well defined treatment windows and common outcome measurements made the study applications less generalizable and the comparison between these studies difficult.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1. Identify cognitive intervention approaches in post-acute TBI rehabilitation. 2. Analyze trends, commonality and differences among different cognitive rehabilitation strategies for individuals with TBI. 3. Discuss the challenges related to targeted trial mechanisms, designs and settings, data elements and analysis methods in cognitive rehabilitation RCTs following TBI.

Keywords: Traumatic Brain Injury, Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have authored and coauthored several research articles on traumatic brain injury. I have also worked as a co-investigator on an acute neurobehavioral traumatic brain injury intervention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.