The Evidence Base of Neuropsychological Rehabilitation in Acquired Brain Impairment (ABI): How Good is the Research?

Abstract

In the context of evidence-based clinical practice (EBCP), the reliability of empirical data is largely determined by the methodological quality of research design. PsycBITE™ (Psychological Database of Brain Impairment Treatment Efficacy) is a web-based database listing all published, empirical reports on the effectiveness of nonpharmacological interventions for the psychological consequences of acquired brain impairment (ABI). The aim of this study was to survey the listings of PsycBITE™ and examine the methodological quality of the reports it contains. Reports listed in PsycBITE™ include systematic reviews (SRs), randomised controlled trials (RCTs), non-RCTs, case series (CSs) and single-subject designs (SSDs). They are indexed according to research design, neurological group, patient age group, target area and intervention type. The PEDro Scale is used to rate the methodological quality of RCTs, nonRCTs and CSs, with maximum obtainable methodological quality rating (MQR) of 10/10, 8/10 and 2/10 respectively. A search identified 1298 reports indexed in PsycBITE™. The largest proportion was SSDs (39%), followed by CSs (22%), RCTs (21%), non-RCTs (11%) and SRs (7%). The majority of reports was concerned with stroke (41%), traumatic brain injury (29%) and Alzheimer's and related dementias (22%). The most frequently investigated deficits were communication/language/speech disorders (24%); independent/self-care activities (19%); behaviour problems (17%); memory impairments (17%); anxiety, depression, stress, adjustment (15%). Approximately half of the RCTs, non-RCTs and CSs were rated for methodological quality. Mean MQR scores for RCTs, non-RCTs and CSs were 4.49, 2.85 and 1.15 respectively. While some PEDro criteria were met by a high proportion of RCTs and non-RCTs (≥ 70%), other criteria were only met by a small proportion of reports (as low as 1.6%). There was no significant difference in MQR scores between RCTs focusing on different neurological groups or target areas. Furthermore, there was no discernible improvement in MQR score for RCTs published over the last three decades. The methodological quality of studies investigating the efficacy of rehabilitation interventions in ABI has been consistently modest over several decades. This is largely attributable to poor adherence to fundamental tenets of research design, and requires urgent remediation. RCTs (and to a lesser extent, non-RCTs) are research methodologies which can potentially yield a high level of evidence, but only if they are adequately designed. PsycBITE™ has the facility to raise awareness of these issues and be instrumental in promoting EBCP in the field of ABI.

Assessment and Treatment of Cognition and Communication Skills in Adults With Acquired Brain Injury via Telepractice: A Systematic Review

“…In addition, methodological issues reported in this EBSR and by others who have analyzed the methodological quality of ABI research (e.g., Perdices et al, 2006;Togher et al, 2009) should also be addressed. Findings from those types of studies will provide specific information about telepractice equivalence; however, questions such as "Which patients are most likely to benefit from telepractice?"…”

Perspectives on evidence based practice in ABI rehabilitation. “Relevant Research”: Who decides?

“…As a result, an ethical dilemma is created when funding sources use these conclusions to deny services. In 2006, Perdices et al [41] conducted a review of 1298 empirical studies indexed in a web-based resource for brain injury research called PsycBITE TM . They found that the largest proportion of rehabilitation studies were single subject design (39%), followed by case series (22%), randomized control trials (21%), non-randomized control trials (11%) and systematic reviews (7%).…”

“…Single Subject Design (SSD) tends to be the predominant model of intervention research for this pop-ulation, not because large randomized control studies are a novel concept in rehabilitation but because the complexities and interplay of human communication, cognition, emotion and behaviour, ABI, and individual circumstances combine to make single subject design more applicable to a wider variety of treatment circumstances [28,41,63]. Perdices et al [41] presented the advantages of single subject design studies and asserted that sophisticated (experimental) SSD's incorporating, among other things, multiple baselines across subjects, as well as randomization of the order of active treatment phases, can potentially provide a level of evidence comparable to that of RCT's.…”

“…Perdices et al [41] presented the advantages of single subject design studies and asserted that sophisticated (experimental) SSD's incorporating, among other things, multiple baselines across subjects, as well as randomization of the order of active treatment phases, can potentially provide a level of evidence comparable to that of RCT's. In fact, should a clinician be researching interventions for an individual that closely resembles the profile of the subject in a successful SSD, then it may be more clinically rational and responsible to choose the SSD intervention (Class III evidence) than an intervention guided by a population based evidence statement (Class I evidence, RCT) [63].…”

Rehabilitation after traumatic brain injury : an Australian context

“…The database currently contains almost 2,000 records meeting selection criteria and is continually updated. All types of research methodology are included systematic reviews, clinical trials, case series and single case experimental designs, and a review of the contents of the database is provided in Perdices et al 2006 . Reports are rated for methodological quality and results of searches are ranked in order of methodological design and methodological quality not alphabetically by author, as occurs with other generic databases .…”