Systematic review of rehabilitation intervention outcomes of adult and paediatric patients with infectious encephalitis

Abstract

Objective: Although a range of rehabilitation interventions have been applied to restore function after infectious encephalitis, there is a lack of literature summarising the benefits of these interventions. This systematic review aims to synthesise current scientific knowledge on outcome measures following rehabilitative interventions among children and adults with infectious encephalitis, with a specific focus on the influence of the age, sex, baseline status and intervention type.

Search strategy: Five scholarly databases (MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials), three sources of grey literature (Google, Google Scholar and Grey Matters) and reference lists of included publications were systematically searched. Literature published before 15 December 2017 and focused on patients with infectious encephalitis in any rehabilitation setting were included. Quality assessment was completed using the Downs and Black rating scale.

Results: Of the 12 737 reference titles screened, 20 studies were included in this review. All of the studies had sample sizes of less than 25 patients and received a score of less than 15 out of 31 points on the Downs and Black rating scale. Findings showed a variety of interventions has been applied to alleviate sequelae from infectious encephalitis, including using cognitive therapy (nine studies), behavioural therapy (five studies), physical therapy (two studies) or two or more therapies (four studies). There was inconclusive evidence on the effect of sex, age and baseline functional abilities on outcomes. Due to clinical and methodological heterogeneity between studies, meta-analyses were not performed.

Conclusion: Evidence suggests the potential for a beneficial effect of rehabilitation interventions in patients with infectious encephalitis. Future research is required to identify all effect modifiers and to determine the effect of time in the natural course of recovery. An enhanced set of known effect modifiers will support the process of future evaluation of a client-centred rehabilitation intervention.

Trial registration number: CRD42015029217.

Keywords: infectious encephalitis; intervention; non-traumatic brain injury; rehabilitation; rehabilitation outcome.

Figure 1

Our search yielded 12 737 citations, with an additional eight records identified from a grey literature database and two by hand-searching the reference lists of included studies. Figure 1 details our search and selection process. We selected reviews that, based on our inclusion criteria, had a full-text version available and examined a type of a rehabilitation intervention administered to patients with infectious encephalitis and excluded records that were (1) theoretical articles or review of treatment approaches; (2) studies describing pharmacological-based interventions not focused on rehabilitation as defined by the WHO; (3) studies not providing predata/postdata of intervention; and (4) studies not presenting results using patient outcome measure. We identified 20 studies that met both first and second screen criteria.