Twenty studies (n=2,147) were included in the review: 8 RCTs, 1 CCT and 11 pre-test post-test studies.
Four studies were graded 'strong' in the validity assessment, four were considered 'moderate' and twelve were 'weak'.
Pharmacotherapy (8 studies including 1 RCT).
The single small RCT (n=17) assessed the effect of desmopressin acetate versus placebo on mental performance and reported a minor improvement in information processing rate and immediate recall (p<0.05 in each case). Other studies found mixed results for amitriptyline or sertraline on a variety of outcomes. A single study evaluated dihydroergotamine and found positive results on memory, sleep and dizziness.
Cognitive rehabilitation (3 studies).
Three pre-test, post-test studies reported positive outcomes of cognitive rehabilitation programmes for a variety of neuropsychological and functional outcomes.
Patient education (7 studies including 6 RCTs).
Two studies assessed minimal versus intensive education programmes. One found no difference at follow-up on symptomatology and functioning between patients in the single session group and those given a longer intervention course (improvements, p<0.001 for all patients). The second study found that CBT with an educational component was superior to education-based supportive counselling in patients with post-traumatic stress disorder (p<0.05). Five studies assessed an education intervention compared with normal hospital care, of which four (including 3 RCTs) found results statistically significantly in favour of the educational intervention on a variety of outcomes; the fifth study found no difference between the groups. A range of outcomes were assessed, however, and there were conflicting results with respect to the impact on symptoms, social and functional ability, and PCS.
Other interventions (2 studies including 1 RCT).
The RCT found evidence of short-term effectiveness for manual therapy compared with cold packs on post-traumatic headache (p<0.05) at 5 weeks. A pre-test-post-test study found beneficial effects of an outdoor challenge experience course on the patients' psychosocial functioning.