Critical appraisal of systematic reviews of executive function treatments in TBI

To appraise the quality of systematic reviews (SRs) and meta-analyses (MAs) that summarize the treatment literature for executive function (EF) impairments following traumatic brain injury (TBI).

We used five data sources (PubMed; PsycINFO; ANCDS.org; Cochrane Collaboration; American Speech-Language-Hearing Association Compendium; Psychological Database for Brain Impairment Treatment Efficacy) and identified 19 reviews that met eligibility criteria (adults with TBI; behavioural treatments for EF impairments; no pharmacologic treatments). Two reviewers independently and reliably rated each paper using two appraisal tools (Critical Appraisal of Systematic Review or Meta-Analysis and Evidence in Augmentative and Alternative Communication systematic review scale).

Five MAs received highest ratings. Four SRs also addressed the majority of SR criteria. Reviews were better at addressing SR criteria as outcome measures across studies varied considerably, posing a challenge to quantitatively synthesize TBI outcomes. The strongest research evidence favours compensatory treatments that train individuals with TBI to use strategies to circumvent EF impairments in daily activities. Smaller effects are reported for direct training approaches.

Researchers need to identify core outcome measures to facilitate future rigorous MAs of the EF rehabilitation literature. SRs/MAs need to be conducted with thorough methods that are reported with detail.