Methodology

Literature Search Strategy

An extensive literature search using multiple databases (CINAHL, PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO) was conducted for articles published in the English language between 1980–August 2016 that evaluate the effectiveness of any intervention/treatment related to ABI. The references from key review articles, meta-analyses, and systematic reviews were reviewed to ensure no articles had been overlooked. For certain modules that lacked research evidence the gray literature as well as additional databases may have been searched in order to ensure the topic was covered as comprehensively as possible.

Specific subject headings related to ABI were used as the search terms for each database. These search terms were selected with the assistance of a medical staff librarian. The search was broadened by using each specific database’s subject headings, this allowed for all other terms in the database’s subject heading hierarchy related to ABI to also be included. The database subject headings used as search terms for CINAHL were “brain injuries” and “head injuries”; for EMBASE, “brain injury” and “head injury”; for MEDLINE, “brain injuries” and “craniocerebral trauma”; and for PsycINFO “brain injuries” and “traumatic brain injury”. Additional keywords were used specific to each module.

Study Inclusion Criteria

Every effort was made to identify all relevant articles that evaluated rehabilitation interventions/treatments, with no restrictions as to the stage of recovery or the outcome assessed. For each module, the individual database searches were pooled and all duplicate references were removed. Each article title was then reviewed; titles that appeared to involve ABI and a treatment/intervention were selected. The abstracts from these selected reference titles were then reviewed by two independent reviewers to determine if the studies met the inclusion criteria. The remaining articles were reviewed in full.  To be included in ERABI, consensus must be reached by the two reviewers for each article based on the set criteria; a third independent reviewer was available to settle any discrepancies.

Studies meeting the following criteria were included: (1) published in the English language, (2) at least 50% of the population included participants with ABI, (3) at least three participants, (4) participants had a moderate to severe brain injury, and (5) involved the evaluation of a treatment/intervention with a measurable outcome. Both prospective and retrospective studies were considered, as were studies that used either experimental (randomized trials) or non-experimental designs (prospective and retrospective controlled trials, single group interventions, and retrospective studies). Articles which did not meet our definition of ABI (Table 1.1) were excluded.

Data Extraction

Once an article was selected for full review, the following data was extracted: author(s), place and date of publication, inclusion and exclusion criteria, sample size, participant characteristics (i.e., type of injury, severity, sex, age, time since injury), treatment/intervention, outcome measure(s), and results. This data was summarized using large tables. Articles evaluating similar treatments were then grouped together. 

Methodological Quality Assessments of Randomized Controlled Trials

The methodological quality of all RCTs was assessed using the Physiotherapy Evidence Database (PEDro) rating scale developed by the Centre for Evidence-Based Physiotherapy in Australia (Moseley et al. 2002; http://www.pedro.fhs.usyd.edu.au/FAQs/Scale/scaleitems.htm). The PEDro is an 11-item scale; a point is awarded for each satisfied criterion, yielding a score out of ten. The first criterion relates to external validity, with the remaining ten items relating to the internal validity of the clinical trial. The first criterion, eligibility criteria, is not included in the final score.  A higher score is representative of a study with better methodological quality. Each RCT was assessed by two independent reviewers, with any discrepancies in scoring settled by a third reviewer.