Quality Appraisal of Systematic Reviews for Behavioral Treatments of Attention Disorders in Traumatic Brain Injury

Abstract

Objective: This review appraised the quality of systematic reviews (SRs) and meta-analyses (MAs) to summarize research on behavioral interventions for attention disorders in persons with traumatic brain injury. Methods: A search of 7 databases revealed 15 MAs/SRs reporting outcomes for attention treatments in traumatic brain injury. Two examiners independently coded the quality of reviews with the Critical Appraisal of Systematic Review or Meta-Analysis and the Evidence in Augmentative and Alternative Communication Systematic Review Scale. Results: The findings of both scales were highly correlated. Four reviews were conducted with high methodologic rigor indicated by a score of 60% or greater on both scales. No other study scored above 45%. Among the well-conducted SRs/MAs, evidence for direct attention training effects was limited to basic attention exercises, with little generalization to functional activities. Strategy training for activities and tasks requiring attentional abilities had a stronger evidence base in 1 rigorous MA. Conclusions: This appraisal provides valuable practice information. The conclusions of 4 rigorous reviews suggest that there is only limited positive scientific support for the effects of attention treatments for traumatic brain injury. Future SRs/MAs would benefit from adherence to review guidelines.

Improved Mild Closed Head Traumatic Brain Injury Outcomes With a Brain-Computer Interface Amplified Cognitive Remediation Training

“…As a retrospective chart review, the study did not use control subjects, and therefore obtaining measures of M 1 and M 2 are not directly available. However, several studies have determined that the estimated change in cognitive test-retest scores ranges between 0.25 and 0.33 of a typical standard deviation [ 29 , 31 ]. Applied to standard scores, M 1 , M 2 values would range between 3.75 and 5.0.…”

Improved mTBI outcomes with a BCI Amplified CRT Training: A retrospective chart review

“…The RCI technique used to correct for practice effects and measurement error is defined as (( X 2 − X 1 − ( M 2 − M 1 ))/SDD [74,75] where X 1 is the measured pretest score, X 2 the post-test score, SDD the standard deviation of the group test-retest difference, X 1 the control group mean pretest score, and X 2 the control group mean post-test score. As a retrospective chart review, the study did not use control subjects and therefore obtaining measures of M 1 and M 2 are not directly available.…”

“…As a retrospective chart review, the study did not use control subjects and therefore obtaining measures of M 1 and M 2 are not directly available. However, several studies have determined that the estimated change in cognitive test retest scores range between .25 and .33 of a typical standard deviation [74-76]. Applied to standard scores, M 1 M 2 values would range between 3.75 and 5.0.…”

Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan

“…Fourteen of those reviews demonstrated effectiveness (Bogdanova et al, 2016;Cicerone et al, 2005;Cicerone et al, 2011;Elliott and Parente, 2014;Fritz, Cheek, and Nichols-Larsen, 2015;Hallock et al, 2016;Kennedy et al, 2008;Lambez and Vakil, 2021;Little, Byrne, and Coetzer, 2021;O'Neil-Pirozzi, Kennedy, and Sohlberg, 2016;Park, Maitra, and Martinez, 2015;Radomski et al, 2016;Rodríguez-Rajo et al, 2018;Rohling et al, 2009), and two demonstrated no effect Virk et al, 2015). Additionally, three reviews had mixed findings (Cicerone et al, 2019;Roitsch et al, 2019;Steel, Elbourn, and Togher, 2021), and four characterized the evidence as uncertain (Ali, Viczko, and Smart, 2020;Brassel et al, 2021;Geraldo et al, 2018;Schrijnemaekers et al, 2014). Two systematic reviews assessed the effect of behavioral rehabilitation on cognitive outcomes, demonstrating effectiveness in the general adult population (Little, Byrne, and Coetzer, 2021) and uncertain conclusions in populations restricted to veterans (Wilson et al, 2016).…”