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Fatigue After Traumatic Brain Injury: A Systematic Review
Arshad Ali1, Jussely Morfin, Judith Mills
1Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California (Messrs Ali and Dirlikov, Ms Morfin, and Dr Pasipanodya); Medical Library, Santa Clara Valley Medical Center, San Jose, California (Ms Mills); SeneCure, GGZ-Breburg, Tilburg, the Netherlands (Ms Maas); Physical Medicine and Rehabilitation Department, Santa Clara Valley Medical Center, San Jose, California (Drs Huang and Englander); Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, California (Dr Englander); and Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands (Dr Zedlitz).
This review found that methylphenidate, melatonin, and creatine show promise for reducing posttraumatic brain injury fatigue. Exercise interventions like walking and water aerobics were also effective, but more research is needed for PTBIF treatments.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Clinical Psychology
Background:
- Fatigue is a common and persistent symptom following traumatic brain injury (TBI).
- Posttraumatic brain injury fatigue (PTBIF) significantly impacts patient quality of life and recovery.
- Existing interventions for PTBIF lack a comprehensive, evidence-based synthesis.
Purpose of the Study:
- To systematically review and synthesize published interventions for posttraumatic brain injury fatigue (PTBIF).
- To identify effective pharmacological, psychological, and exercise-based treatments for PTBIF.
- To assess the risk of bias in studies investigating PTBIF interventions.
Main Methods:
- Systematic literature search of PubMed and OneSearch (1989-2019).
- Inclusion criteria: interventions for TBI patients reporting fatigue outcomes, available in specified languages.
- Risk of bias assessment conducted on all included studies.
Main Results:
- 37 studies met inclusion criteria, with 21 published after 2014.
- Pharmacological: Methylphenidate and melatonin reduced fatigue in RCTs; creatine effective in children.
- Exercise: Walking and water aerobics showed effectiveness; one multimodal intervention improved fatigue and postconcussion symptoms in children.
Conclusions:
- Methylphenidate, melatonin, and creatine show potential for PTBIF management.
- Exercise-based interventions like walking and water aerobics are promising.
- Further research is essential to develop and validate effective treatments for PTBIF.
