Brain injury rehabilitation: what works for whom and when?

Primary objective: This paper reviewed the available evidence that patient characteristics may determine the type of intervention that works best in brain injury rehabilitation. Reasoning behind literature selection: A broad search strategy was used to identify papers which enabled conclusions to be drawn about patient characteristics which determined rehabilitation effectiveness. Six main areas were considered: severity of the brain injury, presenting problem, complicating factors, rehabilitation readiness, demographic, and socio-geographic variables. Critical analysis of literature: A levels of evidence analysis Was used to evaluate the studies. Main outcomes and results: Very few studies on rehabilitation effectiveness were found which attempted to define the patient characteristics which predict a good response to rehabilitation. The best evidence relates to injury severity; more intense programmes may be unnecessary for those with less severe injuries. There is some evidence that dysexecutive problems, i.e. difficulties with organization and control of behaviour and emotion, interfere with rehabilitation. Conclusions: Patient characteristics may well determine individual benefits from particular rehabilitation programmes. However, few studies have attempted to provide evidence about this. As health provision focuses on needs-led services, it becomes paramount to investigate effectiveness from the client's perspective.