Interventions Injury type Study, year Key findings Level of evidence Acupuncture TBI Wong et al., 2013 [46] Insufficient evidence for effectiveness and safety of acupuncture in the acute treatment and/or rehabilitation of TBI. I Physical therapy TBI Bland et al., 2011 [47] Limited evidence to support the effectiveness of PT in improving balance and gait in functionally mild-to-moderate individuals with TBI. I TBI Hassett et al., 2008 (edited 2009) [48] Insufficient evidence to support the effectiveness of fitness training in improving cardio-respiratory fitness in persons with TBI. I Psychological interventions TBI Lane-Brown and Tate, 2009 [49] No evidence for use of interventions for apathy such as cranial electrotherapy stimulation in persons with TBI. I TBI Soo and Tate, 2007 (edited 2009) [30] Moderate evidence for effectiveness of CBT for treatment of acute stress disorder following mild TBI; and combination of CBT and neurorehabilitation for treatment of general anxiety symptoms for mild to moderate TBI. I TBI Snell et al., 2009 [50] Limited evidence to support the selection of active treatments for mild TBI, although patient education approaches may be beneficial in the early stages. I Traumatic physical injuries: fracture/crush injuries De Silva et al., 2009 [51] Insufficient evidence for psychological interventions for prevention of disability following traumatic physical injury. I TBI Rohling et al., 2009 [27] Strong evidence for effectiveness of attention training after TBI, and for language and visuospatial training for aphasia and neglect syndromes after stroke. I TBI Fann et al., 2009 [52] Insufficient evidence to support practice recommendations regarding any of the psychotherapeutic or rehabilitation interventions for depression following TBI. I TBI Kennedy et al., 2008 [53] Strong evidence that meta cognitive strategy instruction should be used in adults with TBI. Insufficient evidence for trained verbal reasoning and multi-tasking in improved function. I Hyperbaric oxygen therapy (HBOT) TBI Bennett et al., 2012 [29] Strong evidence for HBOT as adjunctive therapy in reduction of risk of death in TBI, but insufficient evidence that HBOT improves outcomes (QoL) in survivors. I Hyperventilation therapy TBI Roberts and Schierhout, 1997 (updated 2009) [54] Limited evidence for any potential benefits or harm that might result from hyperventilation therapy in improving patient outcomes in persons with TBI. I Sensory stimulation programmes Head injury Lombardi et al., 2002 (edited 2009) [55] Limited evidence to support, or refute the effectiveness of multisensory programmes in patients with coma and vegetative state. I Hypothermia therapy TBI Georgiou and  Manara, 2013 [56] No evidence of benefit of primary therapeutic hypothermia on mortality or neurological morbidity. Hypothermia was associated with cerebrovascular disturbances on rewarming and possibly with pneumonia in adult patients. I TBI/stroke Harris et al., 2012 [57] Insufficient evidence non-invasive head cooling may be beneficial for improving functional outcomes. I TBI Sadaka and  Veremakis, 2012 [58] Therapeutic hypothermia (32–34°C) is shown to have beneficial effect in controlling intracranial hypertension in patients with severe TBI. I TBI Sydenham et al., 2009 [59] No evidence that hypothermia is beneficial in the treatment of head injury. I TBI Saxena et al., 2008 [60] No evidence to support the use of moderate cooling (35°C-37.5°) therapies after TBI in improving patient outcomes. I Nutritional support TBI Wang et al., 2013 [28] Early initiation of nutrition showed significant reduction in the rate of mortality, poor outcome, and infectious complications. It appears that parenteral nutrition is superior to enteral nutrition in improving outcomes. I Head injury Perel et al., 2008 [61] Strong evidence that early nutritional support associated with fewer infections and a trend towards better outcomes in terms of survival and disability. I Vocational rehabilitation TBI Fadyl and McPherson, 2009 [62] Limited evidence to suggest what should be considered the best practice approach to vocational rehabilitation in people with TBI I Educational intervention ATLS training for ambulance crews Jayaraman and Sethi, 2010 [63] No evidence that ATLS for ambulance crews cuts death rates or decreases disability in injured people. I ATLS for hospital staff Jayaraman and Sethi, 2009 [64] Insufficient evidence that ATLS programmes improve knowledge of hospital staff, and no evidence that ALTS for hospital staff reduces death and disability of injured patients. I Speech and language therapy TBI/stroke Sellars et al., 2005 (edited 2009) [65] No evidence that speech and language therapy in improving dysarthria following non-progressive brain injury (TBI/stroke). I Abbreviations: ATLS: Advanced Trauma Life Support; CBT: Cognitive Behavioural Therapy; HBOT: Hyperbaric Oxygen Therapy; PT: Physical Therapy; QoL: Quality of Life; TBI: Traumatic Brain Injury. Reference:National Health and Medical Research Council (NHMRC) (2009) NHMRC Levels of Evidence and Grades for Recommendations for Developers of Guidelines. Accessed in October 2013, from http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf.

Table 3: Summary of the systematic reviews in the Cochrane Central Register for the treatment of traumatic brain injury (TBI).