Intervention Review

Interventions for apathy after traumatic brain injury

  1. Amanda Lane-Brown*,
  2. Robyn Tate

Editorial Group: Cochrane Injuries Group

Published Online: 15 APR 2009

Assessed as up-to-date: 30 JAN 2008

DOI: 10.1002/14651858.CD006341.pub2

How to Cite

Lane-Brown A, Tate R. Interventions for apathy after traumatic brain injury. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006341. DOI: 10.1002/14651858.CD006341.pub2.

Author Information

  1. University of Sydney and Royal Rehabilitation Centre Sydney, Rehabilitation Studies Unit, Ryde, New South Wales, Australia

*Amanda Lane-Brown, Rehabilitation Studies Unit, University of Sydney and Royal Rehabilitation Centre Sydney, P.O. Box 6, Ryde, New South Wales, 1680, Australia. amandal@med.usyd.edu.au.

Publication History

  1. Publication Status: New
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Apathy is a deficiency in overt behavioural, emotional and cognitive components of goal-directed behaviour. It is a common occurrence after traumatic brain injury (TBI), with widespread impact. We have systematically reviewed studies examining the effectiveness of interventions for apathy in the TBI population.

Objectives

To investigate the effectiveness of interventions for apathy in adults who have sustained a TBI. This was evaluated by changes in behavioural, cognitive and emotional measures of apathy.

Search methods

We searched the following databases up to January 2008: CENTRAL (The Cochrane Library 2008, Issue 1), Database of Abstracts of Reviews of Effects, ACP Journal Club, MEDLINE (1950 to Jan 2008), EMBASE (1980 to Jan 2008), PsycINFO (1806 to Jan 2008), CINAHL (1982 Jan 2008), PsycBITE, AMED (1985 to Jan 2008), www.controlled-trials.com, www.clinicaltrials.gov and www.actr.org.au.The Cochrane Injuries Group's Specialised Register was searched to Jan 2009. Additionally, we examined key conference proceedings and reference lists of included trials to identify further studies meeting the inclusion criteria.

Selection criteria

Randomised controlled trials (RCTs) of interventions specifically targeting apathy for people with TBI.

Data collection and analysis

Two authors (ALB and RLT) independently assessed studies for inclusion. We rated the methodological quality of included studies and extracted data.

Main results

We identified one trial that satisfied the inclusion criteria for this review. This trial (N = 21) showed that cranial electrotherapy stimulation (CES) decreased inertia, which is a component of apathy, while no changes were seen in the sham treatment or no treatment control groups. Given that no between-group analysis was reported, it was not possible to determine if the CES treatment group improved significantly more than the control group.

Authors' conclusions

No evidence was provided to support the use of CES treatment for inertia, a component of apathy. Between-group statistical analyses were not conducted and it was therefore not possible to determine the efficacy of the treatment relative to no treatment or sham treatment. Results regarding the effectiveness of treatment can only be inferred, and this evidence is based on only one trial with a small sample size. More randomised controlled trials evaluating different ways of treating apathy would be valuable. Trials should have larger sample sizes and use rigorous research designs and statistical analyses appropriate for examining between-group differences.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Treatment for apathy in people with traumatic brain injury

Many people who have a traumatic brain injury experience apathy. Apathy is a decrease in cognitive, behavioural and emotional components of goal-directed activity due to reduced motivation. It is characterised by lessened activity, initiative and concern about working towards and achieving goals. This problem impacts on rehabilitation outcome, independence, work and family burden.

The review authors searched the literature for treatment studies of apathy, or a component of apathy, in people who have had a traumatic brain injury. One randomised controlled trial was found which examined the use of cranial electrotherapy stimulation for inertia, which is a component of apathy. Evidence for the effectiveness of this treatment is particularly restricted by the small number of participants and the lack of statistical analyses to demonstrate that the cranial electrotherapy stimulation treatment was more successful than sham or no treatment. More methodologically rigorous studies need to be conducted to investigate different methods of effectively treating apathy in people with traumatic brain injury.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

介入措施用於治療外傷性腦傷後之神情呆滯

神情呆滯是一種缺陷,其表現在外顯行為,情感與認知所組成之目標導向行為上。它常見於腦外傷(TBI)發生後,並具廣泛的影響。我們有系統地回顧研究以評估介入措施對於腦外傷人口其神情呆滯之效果。

目標

調查介入措施對於腦外傷後神情呆滯成人的效果。這篇回顧是評估神情呆滯者其在行為、認知與情感上之改變。

搜尋策略

我們搜索了以下資料庫至2008年1月:CENTRAL (The Cochrane Library 2008, Issue 1), Database of Abstracts of Reviews of Effects, ACP Journal Club, MEDLINE (1950 to Jan 2008), EMBASE (1980 to Jan 2008), PsycINFO (1806 to Jan 2008), CINAHL (1982 Jan 2008), PsycBITE, AMED (1985 to Jan 2008), www.controlledtrials.com, www.clinicaltrials.gov and www.actr.org.au。檢索The Cochrane Injuries Group's Specialised Register至2009年1月。此外,我們評估重要的會議記錄及蒐集研究的參考文獻以確認研究符合納入標準。

選擇標準

介入措施專門針對腦外傷人口其神情呆滯的隨機對照試驗(Randomised controlled trials (RCTs))。

資料收集與分析

兩位作者(ALB和RLT)分別獨立評估研究以納入本篇回顧。我們評值納入研究的方法學品質並摘錄資料。

主要結論

我們確定了一項試驗,其符合本篇回顧的納入標準。這項試驗(N = 21)顯示,顱電刺激(cranial electrotherapy stimulation (CES))可以減少遲鈍,其為神情呆滯的組成部分,然而模擬治療或無治療之對照組則沒有變化。已知沒有進行組間分析的報告,因此不可能就此決定是否顱電刺激治療組較對照組有明顯的改善。

作者結論

沒有證據支持使用顱電刺激來治療遲鈍,其為神情呆滯的一個組成部分。沒有進行組間統計分析,因此無法確定治療相對於無治療或模擬治療的效益。結果有關治療的效果只能推斷,而且這項證據是基於僅一項研究之小樣本數。更多的隨機對照試驗其評估治療神情呆滯的不同方法將是很有價值的。試驗應該有更大的樣本數和使用嚴謹的研究設計和適當的統計分析以評估組間的差異。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

許多創傷性腦損傷的人有神情呆滯的經驗。神情呆滯是一種由於動機減少使目標導向活動在認知,行為和情緒上的減少。它的特點是減少活動,主動關心及努力實現目標。這個問題會影響復健結果,獨立,工作和家庭負擔。這篇回顧的作者檢索有關治療創傷性腦損傷人口其神情呆滯,或神情呆滯組成部分的文獻。找到一篇隨機對照試驗其評估使用顱電刺激治療遲鈍,其為神情呆滯的一個組成部分。這種治療效果的證據受限於小樣本的參與者及缺乏統計分析以證明顱電刺激治療較模擬或無治療成功。需要建立更多方法學上嚴謹的研究以調查不同方法其有效治療創傷性腦損傷人口之神情呆滯。