From the Editor
AS SEEN ON The Journal of Head Trauma Rehabilitation's (JHTR's) cover page, “Knowledge Informing Care” is the tagline of our journal. The series of articles in this topical issue “Optimizing Cognitive Rehabilitation” harvests knowledge informing the clinical practice of cognitive rehabilitation from extant evidence-based research. Building upon previous evidence-based reviews and guidelines as well as conducting their own literature review using an explicit methodology, the authors suggest clinical practice guidelines (CPGs) for cognitive interventions supported by evidence available at the time of manuscript development. Going beyond prior evidence-based reviews, they also provide treatment algorithms and introduce the concept of audit tools to monitor implementation of CPGs.
The topical issue editors recognize that, by itself, publication of guidelines does not necessarily change clinical practice. The topical issue editors are quick to acknowledge that clinicians must also consider their clinical judgment, patient preferences, and contextual factors when adopting CPGs for implementation. However, reading traumatic brain injury (TBI) evidence-based reviews often raises a clinician's awareness of Zeitgeist for the changes that are happening conceptually and instrumentally in the world of TBI rehabilitation. This issue manifestly broadcasts such Zeitgeist awareness. The journal editors recognize that the quality of studies available for an evidence-based review may vary due to multiple factors. Paraphrasing the statement of Forrest Gump's mother about a box of chocolates: You never quite know what flavor you might be getting. Good-quality studies may yield evidence that supports the flavor of a practice option. Better studies go beyond practice options to higher-level clinical guidelines. Highest in the flavor hierarchy are top-quality studies that yield evidence supporting standards of care. Certainly, there will be differences of opinion about the flavors of the recommended CPGs in this issue. However, in our view, the issue editors and authors of JHTR (29:4) have done an outstanding job identifying the research literature on cognitive rehabilitation that supports the various flavors of their recommendations. They have assembled a remarkable set of resources for rehabilitation clinicians who can take advantage of the comprehensiveness of these resources, deposited in one place, to make their clinical judgments regarding the degree to which these recommendations are evidence-based and relevant for treating persons with TBI. Perhaps, a more apt generalization regarding these CPGs is that they are supported by a continuum of information ranging from evidence-informed (softer) knowledge to evidence-based (harder) knowledge, all of which brings us full circle to the aspect of JHTR's mission—“knowledge informing care.”
—Nathaniel H. Mayer, MD