A Cochrane review [Abstract] 1 included 19 studies with a total of 3480 patients with acquired brain injury (ABI). Within the subgroup of predominantly mild brain injury, most individuals made a good recovery when appropriate information was provided, without the need for additional specific interventions. For moderate to severe injury, patients benefited from formal intervention, and commencing rehabilitation early after injury results in better outcomes. For participants with moderate to severe ABI already in rehabilitation, more intensive programmes are associated with earlier functional gains, and continued outpatient therapy could help to sustain gains made in early post-acute rehabilitation. The context of multi-disciplinary rehabilitation appears to influence outcomes. The use of a milieu-oriented model, in which comprehensive cognitive rehabilitation takes place in a therapeutic environment and involves a peer group of patients, benefited the patients with severe brain injury. Specialist in-patient rehabilitation and specialist multi-disciplinary community rehabilitation may provide additional functional gains, but studies serve to highlight the particular practical and ethical restraints imposed on randomisation of severely affected individuals for whom no realistic alternatives to specialist intervention are available.
Comment:The quality of evidence is downgraded by inconsistency (heterogeneity in patients, interventions and outcomes).
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