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

Published online by Cambridge University Press:  04 May 2020

Heather Block Open the ORCID record for Heather Block [Opens in a new window] ,
Stacey George Open the ORCID record for Stacey George [Opens in a new window] ,
Steve Milanese ,
Janine Dizon ,
Henry Bowen  and
Felicity Jenkinson
Heather Block*
Affiliation:
Southern Adelaide Local Health Network, Flinders Medical Centre, Division of Allied Health, Bedford Park, South Australia, Australia Caring Futures Institute, College of Nursing and Health Sciences, Occupational Therapy, Flinders University, Bedford Park, South Australia, Australia
Stacey George
Affiliation:
Caring Futures Institute, College of Nursing and Health Sciences, Occupational Therapy, Flinders University, Bedford Park, South Australia, Australia
Steve Milanese
Affiliation:
International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
Janine Dizon
Affiliation:
International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
Henry Bowen
Affiliation:
International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
Felicity Jenkinson
Affiliation:
Northern Adelaide Local Health Network, Modbury Hospital, Division of Aged Care, Rehabilitation, and Palliative Care, Modbury, South Australia, Australia
*
*Corresponding author. Email: heather.block@sa.gov.au
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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.

Keywords

Traumatic brain injurycraniocerebral traumaagitationaggressionbehaviourneurobehaviouralpharmacologicalnon-pharmacologicaltreatment
Type
Review Article
Information
Brain Impairment , Volume 22 , Issue 1 , March 2021 , pp. 1 - 19
Copyright
© Australasian Society for the Study of Brain Impairment 2020

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Footnotes

‡

Article last updated 07 March 2024

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