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Systematic review of interventions for fatigue after traumatic brain injury: a NIDRR traumatic brain injury model
Joshua B Cantor1, Teresa Ashman, Tamara Bushnik
1Icahn School of Medicine at Mount Sinai, New York (Drs Cantor and Dijkers); Shepherd Center, Atlanta, Georgia (Dr Ashman); Rusk Rehabilitation, NYU Langone School of Medicine, New York (Drs Bushnik and Gumber); Model Systems Knowledge Translation Center and American Institutes for Research, Washington, District of Columbia (Dr Cai); McGuire Veterans' Affairs Medical Center and Polytrauma Rehabilitation Center Traumatic Brain Injury Model System Collaboration, Richmond, Virginia (Dr Farrell-Carnahan); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Hart); and Ohio State University Wexner Medical Center, Columbus (Dr Rosenthal).
Objective:
To conduct a systematic review of the evidence on interventions for posttraumatic brain injury fatigue (PTBIF).
Methods:
Systematic searches of multiple databases for peer-reviewed studies published in English on interventions targeting PTBIF as a primary or secondary outcome through January 22, 2014. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies.
Results:
The searches yielded 1526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study.
Conclusions:
Despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF.