Quality of evidence of rehabilitation interventions in long-term care for people with severe disorders of consciousness after brain injury: A systematic review.

Abstract

OBJECTIVE: To characterize existing rehabilitation interventions for patients with disorders of consciousness in long-term care and to evaluate the quality of evidence of these interventions. DATA SOURCES: Databases MEDLINE, Embase, CINAHL, the Cochrane Library, CareLit and SoLit from January 2003 until July 2013. STUDY SELECTION: Studies were selected that focused on rehabilitation interventions for patients in a coma, vegetative state or minimally conscious state who were living in a long-term care setting. Interventions related to rehabilitation nursing, physical therapy, occupational therapy, and speech therapy were described. A total of 53 publications was included. DATA EXTRACTION: Two authors independently extracted the data and assessed the quality of reporting using the National Service Framework (NSF) for Long Term Neurological Conditions (LTNC). DATA SYNTHESIS: Out of all extracted rehabilitation interventions 12 categories were generated and described. Out of 53 publications 28 (52.8%) contained expert-based evidence and 25 (47.2%) presented research-based evidence. CONCLUSION: There are a multitude of different rehabilitation interventions for individuals with disorders of consciousness, which are established in clinical practice and supported by expert opinion. However, evidence regarding these interventions is weak and recommendations are strictly limited. The findings of this review may represent a basis for further research.