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Hanafy S, Xiong C, Chan V, Sutton M, Escobar M, Colantonio A, Mollayeva T. Comorbidity in traumatic brain injury and functional outcomes: a systematic review. Eur J Phys Rehabil Med 2021; 57:535-550. [PMID: 33541041 PMCID: PMC10396401 DOI: 10.23736/s1973-9087.21.06491-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Comorbidities in people with traumatic brain injury (TBI) may negatively impact injury recovery course and result in long-term disability. Despite the high prevalence of several categories of comorbidities in TBI, little is known about their association with patients' functional outcomes. We aimed to systematically review the current evidence to identify comorbidities that affect functional outcomes in adults with TBI. EVIDENCE ACQUISITION A systematic search of Medline, Cochrane Central Register of Controlled Trials, Embase and PsycINFO was conducted from 1997 to 2020 for prospective and retrospective longitudinal studies published in English. Three researchers independently screened and assessed articles for fulfillment of the inclusion criteria. Quality assessment followed the Quality in Prognosis Studies tool and the Scottish Intercollegiate Guidelines Network methodology recommendations. EVIDENCE SYNTHESIS Twenty-two studies of moderate quality discussed effects of comorbidities on functional outcomes of patients with TBI. Cognitive and physical functioning were negatively affected by comorbidities, although the strength of association, even within the same categories of comorbidity and functional outcome, differed from study to study. Severity of TBI, sex/gender, and age were important factors in the relationship. Due to methodological heterogeneity between studies, meta-analyses were not performed. CONCLUSIONS Emerging evidence highlights the adverse effect of comorbidities on functional outcome in patients with TBI, so clinical attention to this topic is timely. Future research on the topic should emphasize time of comorbidity onset in relation to the TBI event, to support prevention, treatment, and rehabilitation. PROSPERO registration (CRD 42017070033).
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Affiliation(s)
- Sara Hanafy
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada - .,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada - .,Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada -
| | - Chen Xiong
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada
| | - Vincy Chan
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mitchell Sutton
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Michael Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Tatyana Mollayeva
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Acquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Meyer T, Tilly C. Reporting of patients' characteristics in rehabilitation trials: an analysis of publications of RCTs in major clinical rehabilitation journals. Eur J Phys Rehabil Med 2020; 56:829-835. [PMID: 33215907 DOI: 10.23736/s1973-9087.20.06710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The reporting of patients' characteristics in randomized-controlled trials (RCTs) is one important dimension to improve the clinical replicability or transferability of study results into clinical practice. AIM Based on a previously developed framework for reporting on patient characteristics, the aim of this study was to determine whether and how patients' characteristics are presented in RCTs of major rehabilitation journals. DESIGN A literature search in eight high-impact medical rehabilitation journals was conducted. SETTING Any setting. POPULATION A rehabilitation patient group. METHODS Papers were included if they presented results on a RCT on rehabilitation patients. We excluded pilot or feasibility studies. We extracted information related to the description of personal, clinical and diagnosis-specific characteristics, comorbidities, and functioning according to the ICF (body functions and structures, activities and participation and context personal/environmental factors). RESULTS From a total of 129 papers initially identified we finally included 100 papers. Patient groups were almost exclusively defined by clinical diagnostic groups. Age and gender were the most prominent persons' characteristics (100% / 99% reported), followed by marital (22%), educational (15%) and occupational status (14%). Clinical characteristics usually relate to the respective diagnosis; general characteristics were reported on the duration of illness or symptoms (62%), to a lesser degree on BMI (45%) and/or weight (32%) and height (27%). One out of five papers report on comorbidities of the patients (20%). Information of body functions were present in almost every paper (98%), and nearly two third reported at least some aspect of activities and participation at baseline (63%). CONCLUSIONS The present analysis shows that there is a need to further the development of appropriate standards for the reporting of patient characteristics in rehabilitation trials. CLINICAL REHABILITATION IMPACT In future it should help rehabilitation practitioners to decide whether the patients in a study and their own patients share features similar enough to allow for transferability of results.
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Affiliation(s)
- Thorsten Meyer
- Research Unit Rehabilitation Sciences, Health Services Research in Rehabilitation, School of Public Health, Bielefeld University, Bielefeld, Germany -
| | - Christiane Tilly
- Research Unit Rehabilitation Sciences, Health Services Research in Rehabilitation, School of Public Health, Bielefeld University, Bielefeld, Germany
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