We identified ten trials of good methodological quality and four of lower quality. Within the subgroup of predominantly mild brain injury, ’strong evidence’ suggested that most patients make a good recovery with provision of appropriate information, without additional specific intervention. For moderate to severe injury, there is ’strong evidence’ of benefit from formal intervention. For patients with moderate to severe ABI already in rehabilitation, there is strong evidence that more intensive programmes are associated with earlier functional gains, and ’moderate evidence’ that continued outpatient therapy can help to sustain gains made in early postacute rehabilitation. There is ’limited evidence’ that specialist in-patient rehabilitation and specialist multi-disciplinary community rehabilitation may provide additional functional gains, but the studies serve to highlight the particular practical and ethical restraints on randomisation of severely affected individuals for whom there are no realistic alternatives to specialist intervention.

Problems following ABI vary; different services are required to suit the needs of patients with different problems. Patients presenting acutely to hospital with moderate to severe brain injury should be routinely followed up to assess their need for rehabilitation. Intensive intervention appears to lead to earlier gains. The balance between intensity and cost-effectiveness has yet to be determined. Patients discharged from in-patient rehabilitation should have access to out-patient or community-based services appropriate to their needs. Those with milder brain injury benefit from follow-up, and appropriate information and advice. Not all questions in rehabilitation can be addressed by traditional research methodologies. There are important questions still to be answered and future research should employ the most appropriate methodology «Turner-Stokes L, Disler PB, Nair A ym. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 2005;3:CD004170 »1.

• Tutkimuksen laatu: tasokas
• Sovellettavuus suomalaiseen väestöön: kohtalainen

Yasuda ym. ei-systemaattisessa aivovammapotilaiden työhönpaluuta käsittelevässä katsauksessa siteerataan 87 tutkimusta vuosilta 1985– 999. Aivovamman jälkeiset työllisyysluvut vaihtelevat tutkimuksesta riippuen 10–70 % ja kirjoittavat kritisoivatkin tutkimusten metodologista heterogeenisyyttä (vamman vaikeusaste, työkyvyn operationaalinen määritelmä, pitkäaikaisseurantojen puute). Moniammatillisilla tuetun työllistämisen ohjelmilla sisältäen sekä psykososiaalisen että ammatillisen lähestymistavan on helpotettu työhönpaluuta on saatu lupaavia tuloksia «Yasuda S, Wehman P, Targett P ym. Return to work for persons with traumatic brain injury. Am J Phys Med Rehabil 2001;80:852-64 »2, «Johnstone B, Reid-Arndt S, Franklin KL ym. Vocational outcomes of state vocational rehabilitation clients with traumatic brain injury: a review of the Missouri Model Brain Injury System Studies. Neuro»3, «Johnstone B, Price T, Bounds T ym. Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI. NeuroRehabilitation 2003;18:197-203 »4, «Malec JF, Buffington AL, Moessner AM ym. A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes. Arch Phys Med Rehabil 2000;81:1007-15 »5 «Malec JF. Impact of comprehensive day treatment on societal participation for persons with acquired brain injury. Arch Phys Med Rehabil 2001;82:885-95 »6, «Malec JF, Moessner AM. Replicated positive results for the VCC model of vocational intervention after ABI within the social model of disability. Brain Inj 2006;20:227-36 »7. Myös erilaisilla intensiivisillä 'day-treatment' ohjelmilla, joissa moniammatillisesti kuntoutetaan kognitiivisia, emotionaalisia sekä käyttäytymisen säätelyn ongelmia on saatu parannettua työkykyä «Yasuda S, Wehman P, Targett P ym. Return to work for persons with traumatic brain injury. Am J Phys Med Rehabil 2001;80:852-64 »2 ja sekä psykososiaalista toimintakykyä «Sarajuuri JM, Kaipio ML, Koskinen SK ym. Outcome of a comprehensive neurorehabilitation program for patients with traumatic brain injury. Arch Phys Med Rehabil 2005;86:2296-302 »8.

• Tutkimuksen laatu: kelvollinen
• Sovellettavuus suomalaiseen väestöön: kohtalainen