TBI INFORMATION SPOTLIGHT Systematic Reviews A systematic review is a formal, organized method for compiling, evaluating and summarizing all of the published research evidence related to a specific medical or health topic. Results of a systematic review provide the best information for making decisions about treatment, practice or behavior. The Model Systems Knowledge Translation Center (MSKTC) works with the Traumatic Brain Injury (TBI) Model Systems’ researchers to conduct systematic reviews on high priority health topics to inform clinical practice. Together, the MSKTC and TBI Model Systems have done four Systematic Reviews and another, TBI & Education, is being developed. Interventions for Fatigue after TBI In general, fatigue is not having the energy to do things. This often includes not having the energy to go out in the community or do normal, everyday activities. Many people with TBI have post-traumatic brain injury fatigue (PTBIF). So instead of going out in the community and doing everyday activities, they often spend more time sleeping. Sometimes PTBIF happens early on in recovery and goes away in time. But it can last longer. So it’s no surprise that people with prolonged PTBIF report a lower quality of life. This Systematic Review was done to see what’s known about managing PTBIF. Here’s what was found. 1. There’s not enough evidence to recommend or not recommend any treatments of PTBIF. 2. Modafinil, a medication to treat sleepiness, is not likely to be effective for PTBIF. 3. Piracetam, a supplement used to enhance memory, and bright blue light may reduce PTBIF. 4. Research is needed to see if cognitive behavioral therapy is effective for PTBIF. 4 uab.edu/tbi 5. Research is needed to find the benefits of promising treatment options, evaluate treatments for fatigue that have been shown to be effective in other populations, and develop new treatment options for PTBIF. Interventions for Post Traumatic Headache Headache is one of the most common problems after TBI. This Systematic Review was done to: • Find out what treatment options have been developed for post- traumatic headache (PTHA). • Find out what treatment options have been shown to be effective. • Identify any gaps in research for PTHA treatment options. • Suggest areas for future research to improve treatment options for persons with PTHA. Here’s what was found. 1. There’s no strong research evidence that supports a direction in the treatment of PTHA. 2. The Review offered guidelines for PTHA management based on primary headache categories and treatments. 3. It’s essential that well-designed studies be done to inform clinicians on management and prevention of PTHA. Screening and Brief Intervention for Substance Misuse among Patients with TBI Screening and brief interventions (SBI) are common in medical settings like emergency departments and trauma centers. Part 1 of an SBI is to ask a short list of questions to find out how severe substance use is and identify the appropriate treatment. Part 2 is a brief intervention (as few as 3 minutes) to increase insight and awareness about substance use and provide motivation to change misuse behaviors. Brain injuries are often caused by accidents that result from substance abuse. Yet, SBI has not yet been evaluated for persons who incur a brain injury. This Systematic Review was done to see if past SBI research included people with TBI and whether or not their outcomes were different from others without TBI who were seen in medical settings like emergency departments and trauma centers. Here’s what was found. 1. SBI wasn’t used for patients with more severe TBI and those who presented with enough confusion that they couldn’t give informed consent. 2. Future studies are needed to find out what prevents the use of SBI. 3. There’s a need to develop and evaluate ways to use the SBI for persons with neurobehavioral impairments who would likely benefit from brief interventions for substance misuse. Treatment for Depression Following TBI Depression is a feeling of sadness, loss, despair or hopelessness that doesn’t get better over time. It’s a medical condition that’s severe enough to hamper daily life. Depression is common after TBI. About 1/2 of people with TBI experience depression within the first year after injury, and about 2/3 experience it within 7 years. This systematic review was done to look treatments for depression and recommend areas for future research. Here’s what was found. 1. There’s been little high quality research on depression after TBI. 2. Serotonergic antidepressants and cognitive behavioral therapy seem to be the most commonly used treatments. 3. More research is needed to provide evidence-based treatment recommendations for depression following TBI.