Structured Abstract
Brain Injury Structured Abstract - BI #10
A coma arousal program is no more effective than conventional treatment
CITATION: Pierce, J. P., Lyle, D. M., Quine, S., Evans, N. J., Morris, J., & Fearnside, M. R. (1990). The effectiveness of coma arousal intervention. Brain Injury, 4(2), 191-197.
LEVEL OF EVIDENCE: IIA3c
This single case design study, sample size ranged above 20 in each condition (n = 31, n = 135) with low internal validity and low external validity provided a IIA level of evidence.
RESEARCH OBJECTIVE/QUESTION
To examine the effects of a coma arousal program and a conventional treatment on levels of consciousness.
DESIGN
| |
RCT |
|
Single Case |
X |
Case Control |
| |
Cohort |
|
Before-After |
|
Cross-Sectional |
This study is also known as a retrospective study or a case comparison study. A case control study is generally performed to view in retrospect to see how a certain issue affected a group of clients involved in the study. Therefore, one can find out what makes these clients different from each other. The group of clients exposed to the issue in question is compared to a similar control group that was not exposed to the issue. Outcomes were compared with a reference group chosen from the literature.
SAMPLING PROCEDURE
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Random |
X |
Consecutive |
| |
Controlled |
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Convenience |
Individuals involved in the study were selected consecutively as they entered a certain program or clinic where the study is being conducted. All patients arrived at the hospital during a 15-month period were assessed by a study nurse.
SAMPLE
|
N = 31 |
M age = 24 |
Male = 21 |
Ethnicity = NR |
Female = 10 |
NR = Not reported
Consecutive sampling, participants had a Glasgow Coma Scale score of less then 6, all intubated and ventilated. Compared intervention with historical reference group chosen from the literature consisting of 135 similarly classified clients.
PARTICIPANT CHARACTERISTICS
Severe traumatic brain injury clients
MEDICAL DIAGNOSIS/CLINICAL DISORDER
Traumatic brain injury
OT TREATMENT DIAGNOSIS
Physical substrates: Cognitive substrate
OUTCOMES
Eye response
Body movements
|
Measures |
Reliability |
Validity |
|
1. Glasgow Coma Scale time taken to obey a simple command on 2 consecutive occasions 24 hours apart |
NR |
NR |
|
2. Score on Glasgow Outcome Scale |
NR |
NR |
NR = Not Reported
Outcome - OT terminology
Performance Component
1. Cognitive Component - Arousal
2. Motor Control
Outcome - ICIDH-2 terminology
Body structure
INTERVENTION
Coma Arousal Program
- Intervention Group
- Historical Reference Group - Report from Italy
n = 135
Description
A sequence of vigorous multisensory stimulation
- Visual
- Vestibular
- Auditory
- Cutaneous
- ROM
Who delivered
- Nurse - Assessment
- Neurologist
- Epidemiologist
- Social psychologist
Setting
Hospital, Sydney, Australia
Frequency
8 Hours a day
Duration
7 Days (1 week)
Reference Group
4 - 8 Weeks
RESULTS
- No significant improvement was noted in either the time to obey a simple command (p > 0.2) or in the Glasgow Outcome Scale (p > .25)
- Chi-Square statistics = 3.24, 4 df, p. 0.5
- A statistically significant difference in the management of clients in the intensive care unit (intubation and ventilation) was identified as a significant discrepancy between the groups
CONCLUSIONS
Biases
| |
Attention |
X |
Masking/blinding |
|
Drop outs |
| |
Contamination |
|
Co-intervention |
|
This study was unable to provide any evidence that coma arousal program had a better outcome compared with conventional treatment.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice - Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Beatriz C. Abreu, PhD, OTR, FAOTA, and colleagues. For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
