databases: Medline, EMBase, PsycInfo, Education Resources Information Center (ERIC), and Cochrane (e.g., Cochrane DB of Systematic Reviews, Database of Reviews of Effects [DARE] and Cochrane Central Register of Controlled Trials). Key terms and Medical Subject Headings (keywords for Medline) focused on subject areas related to brain injury and CRT. Strategy parameters limited searches to human subjects, the English language, and results published between January 1991 and April 2011. The time period was chosen to include articles prior to Operation Desert Storm, which began in 1991. Setting time parameters allowed for the evaluation of the most recent research of relevance, acknowledging that more recent studies build on the evidence base created by older literature. Furthermore, because TBI has occurred more frequently among service members in recent conflicts, beginning with Operation Desert Storm, research in the field of TBI and CRT has greatly expanded since that time. To ensure it captured all relevant studies, the committee conducted a secondary search to identify articles not found during the electronic search. This practice is common when conducting a literature review. To complete the secondary search, the committee extensively examined the bibliographies of previously published systematic reviews on cognitive rehabilitation therapy for TBI, reading all full-text articles contained in those reference lists that had not been identified in the primary search. The committee determined it would include studies from these reference lists that met inclusion criteria (as described in Box 6-1), regardless of publishing date. The committee reviewed many excellent studies during this process; however, not all studies met inclusion criteria. The secondary search identified 12 additional articles, 2 of which were published prior to 1991. No other study published prior to 1991, that the committee reviewed, met inclusion criteria.
The committee focused on studies that used one or several forms of CRT to ameliorate the effects of traumatic brain injury. Per its charge, the committee considered CRT for TBI across all severities of injury (mild and moderate-severe) and across all stages of recovery (acute, subacute, and chronic). For the purposes of this review, the committee defined the time periods for acute, subacute, and chronic phases of recovery following TBI (see Table 6-1). The searches limited the scope of terms to traumatic brain injury, and did not consider other forms of acquired brain injury, such as those due to stroke, ischemia, infection, or malignancy. Similarly, the committee did not review literature on the effects of CRT for non-TBI cognitive conditions, such as schizophrenia, dementia, or learning disabilities.
The initial electronic search identified 856 studies. Upon review of titles and abstracts, 121 studies were selected for more detailed review. At least two committee members reviewed each full text article to determine relevancy, based on the committee’s inclusion and exclusion criteria, shown in Box 6-1. Upon full-text review, 43 studies were excluded. An additional