Research Reports - A systematic review of psychological interventions for sleep and fatigue after mild traumatic brain injury

J Neurotrauma. 2017 Sep 12. [Epub ahead of print]

Sullivan K(1), Blaine H(2), Kaye SA(3), Theadom A(4), Haden C(5), Smith S(6).

This review evaluated the evidence for psychological interventions to improve
sleep and reduce fatigue after mild traumatic brain injury (TBI). Eight
electronic databases were searched up until August 2016 for studies that: (1)
included adults; (2) tested intervention effectiveness on sleep quality and
fatigue, post-acutely; (3) applied a broadly-defined psychological intervention
(e.g., cognitive behavioural therapy [CBT], counselling, or education). Only
randomized controlled trials were eligible for inclusion. Of the 698 studies
identified, four met the eligibility criteria and underwent data extraction.
These studies were assessed for risk of bias by two independent reviewers using
the Scottish Intercollegiate Guidelines Network Methodology Checklist 2 for
randomized controlled trials. One study applied CBT and three studies used
enhanced education to improve outcomes. Limited evidence and methodological bias
prevents strong conclusions about the effectiveness of psychological
interventions for sleep and fatigue after mild TBI. All but one study targeted
general postconcussion symptoms, rather than sleep or fatigue specifically. This
runs the risk that the potential benefits of a targeted approach are
underestimated in this literature, and future sleep and fatigue focussed
interventions are recommended. It is tentatively concluded that compared to
standard care or the provision of generic advice, small improvements in sleep and
fatigue are observed through psychological intervention post mild TBI. 

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