Article Details

Research Database: Article Details

Citation:  Cullen, N., Chundamala, J., Bayley, M. & Jutai, J. (2007). The efficacy of acquired brain injury rehabilitation. Brain Injury, 21 (2), 113-132.
Title:  The efficacy of acquired brain injury rehabilitation
Authors:  Cullen, N., Chundamala, J., Bayley, M. & Jutai, J.
Year:  2007
Journal/Publication:  Brain Injury
Publisher:  Informa Healthcare
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  Not reported
Research design:  Systematic review / meta-analysis

Structured abstract:

Background:  There is very limited information available on how to assist individuals with acquired brain injury with return to work. Only 4 papers have published that review the literature on the efficacy of rehabilitation.
Purpose:  The purpose of this review was to investigate the efficacy of rehabilitation interventions in acquired brain injury to inform best practices and identify gaps in knowledge.
Setting:  This study is a systematic review. The included studies were undertaken in various locations and settings.
Study sample:  The study sample included nine studies involving adults with acquired brain injury.
Intervention:  There were multiple rehabilitation interventions. The review looked at studies that included the following interventions impact on work: inpatient rehabilitation, vocational rehabilitation, and supported employment.
Control or comparison condition:  There were no comparison or control conditions.
Data collection and analysis:  A systematic review of the literature from 1980–2005 was conducted. A comprehensive search of four electronic databases (CINAHL, EMBASE, MEDLINE and PsycINFO) was conducted covering the years 1980–2005. All studies on the treatment or intervention related to the rehabilitation of acquired brain injury were evaluated for inclusion in the review. Additional references were identified by reviewing select bibliographies. The assessment and methodology of each study was evaulated using the PEDro [5] scoring system for randomized controlled trials and the Downs and Black tool for non-randomized trials. Efficacy of an intervention was classified as strong (supported by at least two randomized controlled trials (RCTs)), moderate (supported by a single RCT), or limited (supported by other types of studies in the absence of RCTs).
Findings:  Based on the findings from a single RCT, there is moderate evidence that inpatient rehabilitation results in successful return to work and return to duty for the majority of military service members. There were three studies that looked at vocational rehabilitation: a cost-benefit analysis, a case series, and an outcome study. Reviews of these studies revealed that there is limited evidence that vocational rehabilitation results in greater total taxpayer benefits than either total program operational costs or government costs; that after vocational rehabilitation the majority of subjects have fair or good adjusted outcome; or that individuals with the most significant cognitive impairments benefit the most from vocational rehabilitation services. One study examined the effectiveness of supported employment. Based on this there is limited evidence that supported employment improves employment outcomes particularly individuals who are older, have more education, have no prior work experience or who have suffered more severe injuries.
Conclusions:  More and higher quality research is needed to inform clinical practices related to return to work. The methodology for future studies needs to be improved. Randomized controlled studies are needed to support the efficacy of interventions to assist individuals with acquired brain injury with employment.

Disabilities served:  Cerebral vascular accident (stroke)
Traumatic brain injury (TBI)
Interventions:  Supported employment
Vocational rehabilitation
Outcomes:  Return to work