Research Reports - Effectiveness of occupation and activity-based interventions for people with traumatic brain injury

Miia Rahja, Laura Jolliffe

Aust Occup Ther J, 65: 73–74

Objective: To establish the effectiveness of occupation and activity-based interventions to improve everyday activities and areas of occupation and social participation for people with traumatic brain injury (TBI).

Design: Systematic review. The review met criteria for AMSTAR 2 (Shea et al., 2017) domains 1, 2, 3, 5, 6, 9, 13 and 14, partially met criteria for domain 4, failed to meet criteria for domains 7, 8, 10 and 16. Domains 11, 12 and 15 were not applicable as no meta-analysis was conducted.

Methods of review: The search strategy was developed with a medical research librarian. Databases searched: Medline, PsycINFO, CINAHL, OTseeker and the Cochrane Database of Systematic Reviews. Risk of bias was assessed using well-recognised appraisal tools.

Selection criteria: Studies included: Level I, II and III evidence as described by Sackett, Rosenberg, Muir Gray, Haynes and Richardson (1996). Exact search date was not reported. Review included studies published between 2008-2013 and in English. Population: Adults with TBI. Interventions: Occupation and activity-based interventions (which did not have to be delivered by an occupational therapist). Outcome of interest: The effects on everyday activities, occupations and/or social participation.

Results: The search resulted in 1044 abstract screens, 60 full-text manuscript reviews and 19 study inclusions (level I – 10, level II – 4, level III – 5). Moderate evidence was found for a range of multi- and interdisciplinary rehabilitation approaches and community-based rehabilitation programs to improve occupational performance and participation outcomes for people who have moderate to severe TBI. These programs included post-acute rehabilitation, behavioural management and community re-integration programs; all provided by occupational therapists or other rehabilitation professionals. From these programs, no one specific approach or setting was clearly more effective than another. Moderate evidence was also found for activity-based interventions focussed on client-centred goals and delivered in relevant environmental contexts. There was limited research evaluating treatment approaches focussed on improving social skills and community mobility.

Authors’ conclusions: The findings support the use of various intervention approaches across different settings to improve occupational and social participation for people who have sustained a TBI. In the absence of rigorous research studies, therapists need to rely on their clinical reasoning skills to make decisions regarding the best treatment for their clients, taking into consideration client preferences, programs and resources available. The extent to which occupational therapy contributes to improved outcomes needs to be further evaluated, including the timing, frequency and duration of service.

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