Multi‐disciplinary rehabilitation for acquired brain injury in adults of working age

摘要: BACKGROUND: Evidence from systematic reviews demonstrates that multi-disciplinary rehabilitation is effective in the stroke population, which older adults predominate. However, evidence base for effectiveness of following acquired brain injury (ABI) younger has not been established, perhaps because this scenario presents different methodological challenges research. OBJECTIVES: To assess effects ABI 16 to 65 years age. SEARCH METHODS: We ran most recent search on 14 September 2015. searched Cochrane Injuries Group Specialised Register, The Library, Ovid MEDLINE(R), MEDLINE(R) In-Process & Other Non-Indexed Citations, Daily and OLDMEDLINE(R), Embase Classic+Embase (OvidSP), Web Science (ISI WOS) databases, clinical trials registers, we screened reference lists. SELECTION CRITERIA: Randomised controlled (RCTs) comparing versus routinely available local services or lower levels intervention; an intervention settings, intensities timing onset. Controlled were included, provided they met pre-defined criteria. DATA COLLECTION AND ANALYSIS: Three review authors independently selected rated their quality. A fourth author would have arbitrated if consensus could be reached by discussion, but fact, did occur. As previous versions review, used method described Van Tulder 1997 rate quality perform a 'best evidence' synthesis attributing basis Risk bias assessments performed parallel using standard methodology. system more discriminative evaluation trials, so continued use it our primary evidence. subdivided terms severity injury, setting type offered. MAIN RESULTS: identified total 19 studies involving 3480 people. Twelve good seven quality, according van scoring system. Within subgroup predominantly mild 'strong suggested individuals made recovery when appropriate information was provided, without need additional specific interventions. For moderate severe showed benefit formal intervention, 'limited indicated commencing early after results better outcomes. participants with already rehabilitation, revealed intensive programmes are associated earlier functional gains, 'moderate outpatient therapy help sustain gains post-acute rehabilitation. context appears influence 'Strong supports milieu-oriented model patients comprehensive cognitive takes place therapeutic environment involves peer group patients. 'Limited shows specialist in-patient community may provide serve highlight particular practical ethical restraints imposed randomisation severely affected whom no realistic alternatives available. AUTHORS' CONCLUSIONS: Problems vary. Consequently, interventions combinations required meet needs problems. Patients who present acutely hospital follow-up advice. Those routine can assessed. Intensive lead whilst still emergency acute care supported limited balance between intensity cost-effectiveness yet determined. discharged access out-patient community-based needs. Group-based milieu (where undergo neuropsychological facing similar challenges) represents approach requiring injury. Not all questions addressed randomised other experimental approaches. example, trial-based literature does tell us treatments work best over long term, models service represent value money life-long care. In future, such will considered alongside practice-based gathered large longitudinal cohort conducted practice. Language: en