Non-Pharmacological Complementary and Alternative Medicine Therapies in Randomized Controlled Trials of Moderate to Severe Traumatic Brain Injury

Purpose of the ReviewTo examine the current landscape of randomized controlled trials (RCTs) on non-pharmacological complementary and alternative medicine (CAM) therapies used for the management of moderate to severe traumatic brain injury (MSTBI).Recent FindingsA total of 25 RCTs published between 2005 and 2022 were included. 52% of included RCTs were conducted in the United Kingdom, Iran, Finland, and the United States. Among the 12 distinct non-pharmacologic CAM interventions studied, 89 unique outcome measures were used, and 8 interventions were studied in only one RCT. Music therapy, acupuncture, light therapy, and compassionate imagery were the most common CAM interventions studied. 56% of RCTs had high risk of bias (RoB), 36% had unclear RoB, and 8% had low RoB. Given the limited available evidence, its low quality, and its heterogeneity, drawing conclusions about which of these interventions, if any, should be recommended to patients and/or their care teams is difficult.SummaryThe majority of RCTs examining CAM interventions are poor in quality, as measured by the Cochrane RoB tool, and have generated mixed results. High quality RCTs with larger sample sizes are required to improve the strength of the evidence and inform high level evidence-based recommendations pertaining to CAM interventions in MSTBI.