Marika C. Möller, Jan Lexell, Karin Wilbe Ramsay
Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden. E-mail: marika.moller@sll.se
DOI: 10.2340/16501977-2791

Objective: To determine the effectiveness of specialized rehabilitation in adults with prolonged symptoms, or risk of prolonged symptoms, following mild traumatic brain injury.
Data sources: Randomized controlled trials or non-randomized controlled studies published between 1 Jan 2000 and 10 Mar 2019 in Cochrane Controlled Register of Trials, PubMed, EMBASE, CINAHL or PsycINFO. Meta-analyses were performed for studies of similar interventions when identical or comparable outcomes were reported.
Study selection and data extraction: Screening, data extraction, and risk of bias assessment were carried out by 2 independent researchers. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
Data synthesis: A total of 9 studies were identified, which were divided into 3 subgroups. Results from meta-analyses implied that problem-solving therapy and cognitive behavioural therapy reduce residual symptoms, improve psychological functioning, decrease depression, increase activity and participation, and improve quality of life, compared with usual care. The meta-analyses also suggested that specialized interdisciplinary rehabilitation reduces residual symptoms.
Conclusion: Persons with mild traumatic brain injury who are at risk of, or who experience, prolonged symptoms should be considered for specialist treatment, as they may experience positive effects from cognitive behavioural therapy, problem-solving therapy, or interdisciplinary team rehabilitation. Further research is required to strengthen the evidence.

The aim of this study was to determine what type of rehabilitation is most effective for prolonged symptoms in adults following mild traumatic brain injury. The study compared specialized rehabilitation, carried out by healthcare professionals specialized in brain injury rehabilitation, with less specialized rehabilitation, or no rehabilitation at all. Several established databases were searched, yielding 9 relevant studies. There was some evidence that problem-solving therapy and cognitive behavioural therapy reduce symptoms, improve psychological functioning, decrease depression, increase activity and participation, and improve quality of life compared with usual care. There was also some evidence that specialized interdisciplinary rehabilitation reduces residual symptoms. However, few studies assessed the same type of rehabilitation or used the same outcome measures. Further research is therefore required to strengthen the certainty of this evidence.

Appendix S1