A systematic review of psychological treatments for mild traumatic brain injury: An update on the evidence

Snell, Deborah L.; Surgenor, Lois J.; Hay-Smith, E. Jean C.; Siegert, Richard J.

doi:10.1080/13803390801978849

Cited by 128 publications

(87 citation statements)

References 53 publications

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“…Included in the online supplemental materials, Appendix A includes the references for all 131 studies. cognitive outcomes (Comper, Hutchison, Magrys, Mainwaring, & Richards, 2010), and two summarized experimental mTBI treatments (Comper, Bisschop, Carnide, & Tricco, 2005;Snell, Surgenor, Hay-Smith, & Siegert, 2009). Table 2 summarizes quantitative study information (e.g., study quality, sample size) as well as reported overall effect size estimates for each meta-analysis and their associated U 1 /2 and U G /2 statistics.…”

Section: Resultsmentioning

confidence: 99%

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

2014

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Mild Traumatic Brain Injury (mTBI), also known as concussion, has become a growing public health concern, prevalent in both athletic and military settings. Many researchers have examined post-mTBI neuropsychological outcomes, leading to multiple meta-analyses amalgamating individual study results. Objective: Considering the plethora of meta-analytic findings, the next logical step stands as a systematic review of meta-analyses, effectively reporting key moderators that predict post-mTBI neuropsychological outcomes. Method: A systematic review of reviews yielded 11 meta-analyses meeting inclusion criteria (i.e., English-language systematic reviews/meta-analyses covering post-mTBI observational cognitive research on late adolescents/adults), with their findings qualitatively synthesized based on moderator variables (i.e., cognitive domain, time since injury, past head injury, participant characteristics, comparison group, assessment technique, and persistent symptoms). Results: The overall effect sizes ranged for both general (range: .07-.61) and sports-related mTBI (range: .40 -.81) and differed both between and within cognitive domains, with executive functions appearing most sensitive to multiple mTBI. Cognitive domains varied in recovery rates, but overall recovery occurred by 90 days postinjury for most individuals and by 7 days postinjury for athletes. Greater age/education and male gender produced smaller effects sizes, and high school athletes suffered the largest deficits post-mTBI. Controlgroup comparisons yielded larger effects than within-person designs, and assessment techniques had limited moderating effects. Conclusions: Overall, meta-analytic review quality remained low with few studies assessing publication or study quality bias. Meta-analyses consistently identified adverse acute mTBI-related effects and fairly rapid symptom resolution. Future meta-analyses should better operationally define cognitive constructs to produce more consistent effect estimates across domains. Keywords: mTBI, concussion, mild traumatic brain injury, cognition, neuropsychologySupplemental materials: http://dx.doi.org/10.1037/neu0000037.supp Mild Traumatic Brain Injury (mTBI), also known as concussion, stands as a prevalent neurotrauma within the general population , increasingly common in both athletic (Coronado, McGuire, Faul, Sugerman, & Pearson, 2012) and military settings (Iverson, Langlois, McCrea, & Kelly, 2009). The rates and consequences of mTBI have become progressively more publicized, both in sports (Moser, 2007) and in modern conflicts (Hayward, 2008). Highly prevalent in American football (Gessel, Fields, Collins, Dick, & Comstock, 2007), mTBI now represents a signature injury of the sport. Although its seriousness has been historically underestimated, repeated mTBIs among young athletes have been linked to significant neurodegeneration long after retiring from play (Gavett, Stern, & McKee, 2011;Guskiewicz et al., 2005;McKee et al., 2009). In 2011, Dave Duerson, a former American football safety, took his o...

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Section: Resultsmentioning

confidence: 99%

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

2014

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“…Unfortunately, treatments for PCS are limited and the timing, intensity and need for various treatment components remain unclear (Snell, Surgenor, HaySmith & Siegert, 2009). Moreover, although educational efforts may be beneficial if administered close in time with the injury (Snell et al, 2009), less is known about treatments for persistent PCS. Clearly, if persistent PCS (particularly headaches, balance problems or dizziness, and memory problems) are the mechanism accounting for the relationship between TBI and PTSD/depression, then improved treatments for persistent PCS need to be developed in order to better serve returning Veterans and others who have sustained TBIs.…”

Section: Discussionmentioning

confidence: 99%

Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans.

Morissette

Woodward

Kimbrel

et al. 2011

Rehabilitation Psychology

113

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Objective-A substantial proportion of the more than 2 million service members who have served in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the non-specific nature of postconcussive symptoms (PCS) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCS, and symptoms of PTSD and depression among returning OEF/OIF Veterans.Design-Two-hundred and thirteen OEF/OIF Veterans (87% male) completed a semi-structured screening interview assessing deployment-related TBI and current, persistent PCS. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression.Results-Nearly half (46%) of sampled Veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCS that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of three models of the relationships among TBI, combat exposure, persistent PCS, PTSD, and depression. Consistent with hypotheses, the best fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by non-overlapping persistent PCS.Implications-These findings highlight the importance of addressing persistent PCS in order to facilitate the functional recovery of returning war Veterans.Understanding the long-term effects of traumatic brain injury (TBI) has important public health implications. Estimates suggest that one to two million Americans sustain a TBI annually (Faul, Xu, Wald, & Coronado, 2010;Gerberding & Binder, 2003;Sosin, Sniezek, & Thurman, 1996;Thurman, Alverson, Dunn, Guerrero, & Sniezek, 1999;. Moreover, the large number of Veterans of the wars in Iraq and Afghanistan add to the global incidence of TBI. Since the inception of the current conflicts in Iraq and Afghanistan, more than two million U.S. troops have been deployed as part of (Stein & McAllister, 2009;Vanderploeg, Curtiss, Luis, & Salazar, 2007; Zaloshnja, Miller, Langlois, & Selassie, 2008). U.S. Department of Veterans AffairsIn general, following sports-related mTBI, post-injury cognitive effects (i.e., performance on neuropsychological tests) tend to resolve within 5-7 days (Guskiewicz et al., 2003), and PCS generally resolve within 2 weeks (Carroll et al., 2004). For mTBIs arising from non-sportsrelated events, post-injury cognitive effects tend to resolve within several weeks to 3 months (e.g., Belanger, Curtis, Demery, Lebowitz, & Vanderploeg, 2005;Carroll et al., 2004); however, PCS following mTBI may persist for one year post-injury or longer in adult civilian (Carroll et al., 2004) and Veteran (Stein & McAllister, 2009) samples. Despite the expectation of full recovery in most...

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“…[16][17][18] However, not much information is found in the literature related to the effects of early MTBI intervention for patients, even though evidence suggests promise for educational support and intervention when provided early after an injury. 18 …”

Section: Review Of the Literaturementioning

confidence: 99%

Mild Traumatic Brain Injury: Are ED Providers Identifying Which Patients Are at Risk?

Stuart

Mandleco

Wilshaw

et al. 2012

Journal of Emergency Nursing

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A systematic review of psychological treatments for mild traumatic brain injury: An update on the evidence

Cited by 128 publications

References 53 publications

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans.

Mild Traumatic Brain Injury: Are ED Providers Identifying Which Patients Are at Risk?

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