Journal:Journal of Head Trauma Rehabilitation
Year, Volume, Issue, Page(s):14, 29, 6, 490-497
Study systematically reviewed the evidence on interventions for posttraumatic brain injury fatigue (PTBIF). Multiple databases were searched for peer-reviewed studies published in English through January 22, 2014, on interventions targeting PTBIF as a primary or secondary outcome. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies. The searches yielded 1,526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. The authors conclude that despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF. This study was conducted by the Sleep Wake Fatigue Special Interest Group of the Traumatic Brain Injury Model Systems and supported by National Institute for Disability and Rehabilitation Research (NIDRR).