Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial

Abstract

Objective: To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury. Design: Multicentre, pragmatic, observer-blinded, randomized controlled trial in England. Setting: Community. Participants: People with memory problems following traumatic brain injury, aged 18–69 years, able to travel to group sessions, communicate in English, and give consent. Interventions: A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control). Main measures: The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization. Results: We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: –2.1, 95% confidence interval (CI): –6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient’s everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised. Conclusion: This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions.

Memory improvement in multiple sclerosis after an extensive cognitive rehabilitation program in groups with a multicenter double-blind randomized trial

“…In 2019, a randomized controlled trial with traumatic brain injury has been well conducted in memory rehabilitation. 28 All criteria were respected but non-significant results were observed in endpoint with a complaint memory scale. This result does not confirm that memory rehabilitation is not effective, but when 385 patients are included, it is difficult to report a positive outcome because a large sample reduces homogeneity of people and therefore statistical power.…”

Neuropsychological rehabilitation interventions for people with an acquired brain injury. A protocol for a systematic review of economic evaluation

“…Therefore, the purpose of this systematic review is (i) critically to consolidate and literature on economic evaluations of neuropsychological rehabilitation for several types of ABIs including stroke, traumatic brain injury, or ABI from non-progressive aetiologies; formal comparisons will be made by adjusting costs to a reference year (ii) assess the quality of available evidence, and (iii) use the findings of this systematic review to identify additional areas needed for improving the conduct and reporting of economic evaluations in ABI 25,26 . Therefore, a systematic literature review of non-pharmacological rehabilitation economic evaluations in ABIs is a way to summarize available knowledge in the field, to identify common characteristics of the existing studies, assess current reporting standards in adherence to best practice guidelines and highlight areas where more research is required.…”

Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: A Systematic Review of Economic Evaluations

“…Overall, there were costs of £1541.70 in the control group compared with £1388.90 in the intervention group-a saving of £152.80; nevertheless, these results were not statistically significant (P = .26). One memory rehabilitation study 47 generated less quality-adjusted life-years (QALYs), with 0.011 (95% CI 20.031 to 0.01) fewer QALYs generated than usual care, but this was not statistically significant (P = .44). The intervention reported cost savings of £27 per patient; nevertheless, these results were also not significant (95% CI 2455.13 to 401.34, P = .91).…”