Research Reports - Complementary and alternative interventions for fatigue management after traumatic brain injury

Ther Adv Neurol Disord. 2017 May;10(5):229-239. doi: 10.1177/1756285616682675.
Epub 2017 Feb 1.

Xu GZ(1), Li YF(2), Wang MD(3), Cao DY(4).

BACKGROUND: We systematically reviewed randomized controlled trials (RCTs) of
complementary and alternative interventions for fatigue after traumatic brain
injury (TBI).
METHODS: We searched multiple online sources including ClinicalTrials.gov, the
Cochrane Library database, MEDLINE, CINAHL, Embase, the Web of Science, AMED,
PsychINFO, Toxline, ProQuest Digital Dissertations, PEDro, PsycBite, and the
World Health Organization (WHO) trial registry, in addition to hand searching of
grey literature. The methodological quality of each included study was assessed
using the Jadad scale, and the quality of evidence was evaluated using the
Grading of Recommendations, Assessment, Development and Evaluation (GRADE)
system. A descriptive review was performed.
RESULTS: Ten RCTs of interventions for post-TBI fatigue (PTBIF) that included 10
types of complementary and alternative interventions were assessed in our study.
There were four types of physical interventions including aquatic physical
activity, fitness-center-based exercise, Tai Chi, and aerobic training. The three
types of cognitive and behavioral interventions (CBIs) were cognitive behavioral
therapy (CBT), mindfulness-based stress reduction (MBSR), and computerized
working-memory training. The Flexyx Neurotherapy System (FNS) and cranial
electrotherapy were the two types of biofeedback therapy, and finally, one type
of light therapy was included. Although the four types of intervention included
aquatic physical activity, MBSR, computerized working-memory training and
blue-light therapy showed unequivocally effective results, the quality of
evidence was low/very low according to the GRADE system.
CONCLUSIONS: The present systematic review of existing RCTs suggests that aquatic
physical activity, MBSR, computerized working-memory training, and blue-light
therapy may be beneficial treatments for PTBIF. Due to the many flaws and
limitations in these studies, further controlled trials using these interventions
for PTBIF are necessary. 

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