Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches.

OBJECTIVE To assimilate the published evidence for the effectiveness of multidisciplinary rehabilitation following acquired brain injury in adults of working age. DESIGN The evidence derived from 2 contrasting approaches to systematic evaluation of the published literature is compared. METHODS A synthesis of best evidence compiled from a Cochrane Review of randomized controlled trials is compared with literature assembled for the UK National Service Framework for long-term neurological conditions, using a new typology based on evaluation of research quality irrespective of study design. RESULTS The trial-based studies provided "strong evidence" that more intensive programmes are associated with more rapid functional gains, and "moderate evidence" that continued outpatient therapy can help to sustain gains made in early post-acute rehabilitation. However, they failed to address the impact of early or late rehabilitation, the effect of specialist programmes (e.g. vocational or neuro-behavioural rehabilitation), or cost-effectiveness. In contrast, the non- nottrial-based studies provided strong evidence in all these areas, as well as evidence for the cost-benefits of rehabilitation. CONCLUSION There is now a substantial body of high-quality research evidence for the effectiveness, and indeed the cost-effectiveness, of rehabilitation. This review highlights the importance of looking beyond the somewhat restrictive set of trial-based evidence.