Archives of Physical Medicine and Rehabilitation
Special communicationMethodological Issues and Research Recommendations for Prognosis After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis
Section snippets
Definition of MTBI
The WHO Task Force report tabled 38 definitions from studies included in their best evidence synthesis.1 Although many definitions had overlapping criteria, they also exhibited considerable differences and used varying terms for the condition including MTBI, concussion, and minor head injury. Most definitions (62%) included Glasgow Coma Scale (GCS) scores as one or the only criterion, but not all applied the same GCS spectrum to define MTBI. Others (38%) used varying criteria for loss of
Quality of Existing Research
We found important biases and methodological flaws in the design and conduct of MTBI prognosis studies (table 2). The most common reasons for nonacceptance or exclusion in the ICoMP review are highlighted in this section.
Methodological issues
Even among accepted studies, nonfatal methodological issues existed. Table 3 summarizes some of the main issues and highlights practical recommendations to assist clinical researchers in addressing them.
Research Priorities
According to the findings of the ICoMP, the field of MTBI prognosis research has advanced slowly. In 2004, the WHO Task Force listed 5 research priority areas: (1) the use of confirmatory designs; (2) the influence of pain, psychological distress, and alcohol or drug abuse on recovery; (3) studies in the elderly; (4) exploration of the role of compensation/litigation issues; and (5) further examination of the long-term consequences of MTBI in very young children.1 Most of these are still
Conclusions
Future research on MTBI prognosis needs to address the issues highlighted in this review. Standard criteria for defining MTBI would improve the comparability of studies, but since this currently does not exist, authors need to clearly describe their MTBI criteria. Potential biases, including issues of confounding, information, and selection bias, should be considered in the design phase of a research study. Research designs should be selected as appropriate for the research question, and
Acknowledgments
We thank the other members of ICoMP: Jean-Luc af Geijerstam, MD, PhD; Eleanor Boyle, PhD; Victor G. Coronado, MD, MPH; Pierre Côté, DC, PhD; Cesar A. Hincapié, DC, MHSc; Ryan Hung, MD, MSc; Michelle Keightley, PhD; Alvin Li, BHSc; Connie Marras, MD, PhD; Peter Rumney, MD; and Britt-Marie Stålnacke, MD, PhD; Panos Lambiris, MSc, Information Scientist, University Health Network, for assisting in developing, testing, and updating the search strategies; and Meijia Zhou, BSc, for assistance with
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Supported by the Ontario Neurotrauma Foundation (grant no. 2010-ABI-MTBIWHO-871). The funder was not involved in the design or preparation of the study protocol, or in the management of the project, analysis or interpretation of data, or the preparation of the final article.
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.
The findings and conclusions in this research are those of the authors alone and do not necessarily represent the official views or policies of the Centers for Disease Control and Prevention or any agency of the United States government. Inclusion of individuals, programs, or organizations in this article does not constitute endorsement by the United States government.