외상성 뇌손상 환자의 관리기능 중재에 관한 체계적 고찰
A Systematic Review of Executive Function Interventions for Patients with Traumatic Brain Injury
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본 연구는 체계적 고찰을 통해 외상성 뇌손상 환자의 관리기능 중재에 대한 특성과 효과를 분석하고자 시행되었다. 한국보건의료연구원 지침에 따라 체계적 고찰을 시행하였고, 검색 데이터베이스는 PubMed, Embase, 한국학술정보, 한국교육학술정보원, 누리미디어를 사용하였으며 2010년 1월부터 2019년 5월까지 출간된 연구를 분석하였다. 총 1,345편의 연구가 검색되었으며, 선정기준에 따라 8편의 연구가 최종 분석에 포함되었다. 문헌의 질 평가는 코크란의 RoB(risk of bias) 도구를 사용하였다. 분석된 연구는 모두 무작위 대조군 실험연구로써 근거수준은 Ⅰ에 해당한다. 관리기능 평가도구는 8편의 연구에서 17개가 사용되었으며, 그 중 D-KEFS(Delis–Kaplan Executive Functioning System), TMT(Trail Making Test)가 주로 사용되었다. 관리기능 중재는 한국형 전산화인지재활프로그램(CoTras), 상호작용식 메트로놈, 웹기반 인지훈련용 재활게임(CogniFit), 가상현실 슈퍼마켓(Virtual Mall), 작업기반 전략훈련, SMART, CogSMART, STEP 프로그램이 적용되었다. CogniFit을 제외한 대부분의 중재방법이 관리기능 혹은 일상생활 참여 향상에 효과적이었다. 본 연구는 외상성 뇌손상 환자에 대한 관리기능 중재의 종류, 적용방법 및 효과성을 체계적으로 보고하여 임상적 근거를 제시하였다. 따라서 인지재활전문가인 작업치료사가 근거기반 실행을 통해 효과적인 중재접근을 클라이언트에게 적용하기를 기대한다.
Abstract
The purpose of this study was reviewing the literature to analysis the characteristics and effects of executive function intervention for patients with traumatic brain injury. A systematic review was executed according to the NECA's guidance. Literature search was performed using PubMed, Embase, Kiss, RISS, DBpia, and we searched studies published from January 2010 to May 2019. A total 1,345 studies were found and included 8 studies matching the selection criteria in the final analysis. Methodological quality was assessment with the Cochrane’s RoB(risk of bias) tool for randomized studies. All studies were randomized control trials. In the evidence level, all studies were included in level Ⅰ. There were a total of 17 assessment tool used in 8 studies with D-KEFS and TMT mainly used. Executive function intervention were CoTras, Interactive Metronome, CogniFit, Virtual Mall, Occupation-based strategies training, SMART, CogSMART and STEP program. Most of the intervention except CogniFit were effective in improving executive function or participation in everyday life. This study provided clinical evidence about type, method, effect of executive function intervention. Therefore, We expect a cognitive rehabilitation specialist, occupational therapist, to apply an effective intervention approach to clients through evidence-based practice.
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