Rehabilitation interventions for oculomotor deficits in adults with mild traumatic brain injury: A systematic review and meta-analysis

Objective(s): Mild traumatic brain injury (mTBI) can cause persistent oculomotor symptoms which can be treated with restitutive interventions as reported on in several studies. The primary objective of this systematic review was to summarize and critically appraise available evidence on the effectiveness of oculomotor interventions, in adults with mTBI using a sex and gender lens.

Data Sources: Medline, EMBASE, PsychInfo, CINAHL, Scopus, clinical trials registries, Google Scholar and reference lists of related research were searched using the PRISMA guidelines. The search strategy used text and index terms to capture the concepts ‘oculomotor’, ‘rehabilitation’ and ‘mild traumatic brain injury.’ Experts in the field were contacted. Searches were limited to English language and human studies.

Study Selection: The screening and selection of studies was completed independently by two review authors. First all the titles and abstracts were screened to identify relevant citations of experimental studies of oculomotor rehabilitation in adults with mTBI. Consensus was met and there was no need to consult a senior author. Conference abstracts, thesis and studies of mixed TBI severity were excluded.

Data Extraction: Data items were extracted using standardized tables independently by two review authors and included: 1) Participants: Age, sex, mechanism of injury, time since injury, inclusion and exclusion criteria, 2) Intervention and 3) Comparison: details, frequency, and duration of intervention and professional delivering the intervention, 4) Outcomes: key findings, significance and adverse events.

Data Synthesis: Twelve studies of low quality with N=418 (43% male) were included in the review. A meta-analysis was completed for outcomes reported on in two or more studies and showed a trend of improvement in convergence, reading rate and visual search and attention. Heterogeneity (I2) was moderate to high between studies. Sex and gender were not addressed in any of the studies.

Conclusions: There is benefit of oculomotor-based rehabilitation in mTBI, however, there remains low certainty in the evidence overall, due to inconsistency, reporting bias and publication bias. Future research should include a published protocol and comparison group.

Author(s) Disclosures: There are no conflicts of interest to report.