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Efficacy of Telerehabilitation for Adults With Traumatic Brain Injury: A Systematic Review

Ownsworth, Tamara, PhD; Arnautovska, Urska, BA(Hons); Beadle, Elizabeth, DPsy; Shum, David H. K., PhD; Moyle, Wendy, PhD

The Journal of Head Trauma Rehabilitation: July/August 2018 - Volume 33 - Issue 4 - p E33–E46
doi: 10.1097/HTR.0000000000000350
Focus on Clinical Research and Practice

Objective: To identify and appraise studies evaluating the efficacy of telerehabilitation for adults with traumatic brain injury (TBI).

Methods: A systematic search of Cochrane Library, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases was conducted from January 1980 to April 23, 2017, for studies evaluating the efficacy of telerehabilitation for adults with TBI. Two reviewers independently assessed articles for eligibility and rated methodological quality using 16 criteria related to internal validity, descriptive, and statistical characteristics.

Results: The review yielded 13 eligible studies, including 10 randomized controlled trials and 3 pre-/postgroup studies (n ≥ 10). These evaluated the feasibility and/or efficacy of telephone-based (10 studies) and Internet-based (3 studies) interventions. Overall, the evidence of efficacy was somewhat mixed. The most common study design evaluated the efficacy of telephone-based interventions relative to usual care, for which 4 of 5 randomized controlled trials reported positive effects at postintervention (d = 0.28-0.51). For these studies, improvements in global functioning, posttraumatic symptoms and sleep quality, and depressive symptoms were reported. The feasibility of Internet-based interventions was generally supported; however, the efficacy could not be determined because of insufficient studies.

Conclusions: Structured telephone interventions were found to be effective for improving particular outcomes following TBI. Controlled studies of Internet-based therapy and comparisons of the clinical and cost-effectiveness of in-person and telerehabilitation formats are recommended for future research.

School of Applied Psychology (Drs Ownsworth, Beadle, and Shum and Ms Arnautovska), School of Nursing and Midwifery (Dr Moyle), and Menzies Health Institute Queensland (Drs Ownsworth, Shum, and Moyle), Griffith University, Australia.

Corresponding Author: Tamara Ownsworth, PhD, School of Applied Psychology, Griffith University, Mt Gravatt Campus, Mt Gravatt, QLD 4122, Australia (

Funding from the NHMRC Centre of Research Excellence in Brain Recovery was utilized in conducting this systematic review.

The authors declare no conflicts of interest.

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