Review of Intervention Effects on Activity and Participation in Adults with Brain Injury

Abstract

<h3>Objective(s)</h3> To determine which intervention elements may be most strongly associated with improvements in activity and participation among adults with acquired brain injury. <h3>Data Sources</h3> Articles were selected from PubMed and PsycINFO/Ovid. <h3>Study Selection</h3> Inclusion criteria: 1) RCT; 2) examined interventions in adults with brain injury; 3) included an activity or participation outcome measure. Exclusion criteria: 1) examined a pharmacological intervention. <h3>Data Extraction</h3> We first classified intervention elements into categories. Patterns of effect sizes were examined for each category of intervention element. We then examined effect sizes based on time of follow-up and type of outcome (home or community activities). <h3>Data Synthesis</h3> The search resulted in 39 included articles. We identified 11 categories of intervention elements, and each was associated with a wide range of effect sizes. Across all outcomes, metacognitive interventions (d=.08-2.9, 32.4% large effect sizes) and daily life skills interventions (d=.00-1.86, 18.8% large effect sizes) were the most strongly associated with improvements in activity-based outcomes. Cognitive training interventions were also associated with improvements in home activity performance (d=.04-1.76, 0% large effect sizes, 69.3% moderate effect sizes), while social skills training was associated with improvement in community activity performance (d=.00-.98, 10.7% large effect sizes). Physical activity interventions were least strongly associated with activity-based outcomes (d=.00-.35, 0% large or moderate effect sizes). Most studies examined results within 6 months of study admissions, and effect sizes beyond 6 months appeared smaller. <h3>Conclusions</h3> Interventions targeting impairments alone appear unlikely to influence activity-based outcomes, whether at home or in the community. Rather, interventions that include elements of explicit strategy use and task-specific training or practice may be necessary. Few of the included outcome measures comprehensively examined participation, but rather simply performance of community activities. Thus, the influence of these interventions on participation itself remains unclear. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.