Evidence for the management of challenging behaviours in patients with acute traumatic brain injury or post-traumatic amnesia: An Umbrella Review

Heather Block, Stacey George, Steve Milanese, Janine Dizon, Holly Bowen-Salter, Felicity Jenkinson

Research output: Contribution to journalReview article

Abstract

Objective: To synthesise the current best evidence on both pharmacological and non-pharmacological behaviour management interventions for adult patients in the acute hospital setting with traumatic brain injury (TBI) or post-traumatic amnesia (PTA).Data Sources:A comprehensive search of 10 electronic databases was completed.Study Selection:Systematic reviews (SRs) published in English before September 2018 were included. Initial search resulted in 4604 citations, 2916 for title and abstract screening with duplicates removed, and 2909 articles failed to meet the inclusion criteria leaving seven reviews for inclusion. Five reporting pharmacological management approaches, two reporting non-pharmacological management approaches, and one reporting both pharmacological and non-pharmacological management approaches.Data Extraction:Methodological quality was assessed independently by two reviewers using the Critical Appraisal Skills Programme Tool for SRs. Data were extracted from the studies based on the recommendations of the Joanna Briggs Institute (JBI) Methodology for JBI Umbrella Reviews.Data Synthesis:The SRs were of low-to-moderate quality overall. High-quality SRs were characterised by low numbers of studies and significant biases. The evidence relating to pharmacological interventions demonstrates low level and variable quality. The evidence relating to non-pharmacological interventions was limited and of low quality.Conclusions:The current evidence for the management of challenging behaviours in patients with acute TBI/PTA is generally equivocal, potentially reflecting the heterogeneity of patients with TBI and their clinical behaviours. More studies with rigorous methodologies are required to investigate the most suitable pharmacological and non-pharmacological behavioural interventions for the acute phase of TBI or PTA.

Original languageEnglish
Number of pages19
JournalBRAIN IMPAIRMENT
Early online date4 May 2020
DOIs
Publication statusE-pub ahead of print - 4 May 2020

Keywords

  • aggression
  • agitation
  • behaviour
  • craniocerebral trauma
  • Keywords:
  • neurobehavioural
  • non-pharmacological
  • pharmacological
  • Traumatic brain injury
  • treatment

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