**1. Introduction**

The World Health Organization (WHO) has described an unmet global need for the delivery of rehabilitation interventions in health systems, which is amplified in low- and middle- income countries with limited availability of resources [1–3]. The 'WHO Rehabilitation 2030 Call for Action' [2] was therefore launched. One of the main actions considered is the development of a Package of Interventions for Rehabilitation (PIR) [3,4]. The PIR aims at promoting favorable outcomes, accessibility, and the integration of multidisciplinary/interdisciplinary rehabilitation services into healthcare systems worldwide [3,4]. The WHO identified 20 major noncommunicable diseases to be investigated to develop the PIR; among these is traumatic brain injury (TBI) [4].

TBI is defined as 'any alteration in brain function or other evidence of brain pathology caused by an external force' [5] and it is estimated to affect 69,000 individuals worldwide annually [6]. Alterations in brain function may include any of the following: loss of (or decrease in) consciousness; loss of memory of events immediately preceding or following

**Citation:** Young, V.M.; Hill, J.R.; Patrini, M.; Negrini, S.; Arienti, C. Overview of Cochrane Systematic Reviews of Rehabilitation Interventions for Persons with Traumatic Brain Injury: A Mapping Synthesis. *J. Clin. Med.* **2022**, *11*, 2691. https://doi.org/10.3390/jcm11102691

Academic Editors: Nada Andelic, Cecilie Røe, Eirik Helseth, Emilie Isager Howe, Marit Vindal Forslund and Torgeir Hellstrom

Received: 14 April 2022 Accepted: 6 May 2022 Published: 10 May 2022

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the injury; neurologic deficits (e.g., loss of balance or vision); or altered mental status, such as disorientation or confusion at the time of the injury [5]. TBI can be categorized into three possible diagnostic levels (mild, moderate, or severe), typically after evaluation using the Glasgow Outcome Scale or Glasgow Outcome Scale Extended [7,8] or by assessing structural imaging, loss of consciousness, altered consciousness, or post-traumatic amnesia.

Research has identified falls and road injuries as the two main causes of TBI worldwide [9,10], although causes of TBI have been found to differ across countries, depending on income, geographical region, and political circumstances [9,11]. Other common causes include sports-related concussions, assault, interpersonal violence, and blast injuries [12]. The direct consequences of a single TBI or repetitive insults include many possible longterm sequelae that vary according to age, sex, and the nature of the injury [13,14]. Common secondary pathophysiological conditions include seizures, sleep disorders, neurodegenerative diseases, neuroendocrine dysregulation, and psychiatric issues, each of which may persist throughout the long-term recovery process following moderate-to-severe TBI [15]. Due to these numerous clinical and demographic variables, TBI patients often experience nonlinear recovery trends, and those with moderate and severe cases are reported to show deteriorating Glasgow Outcome Scale Extended scores over time [16]. These unfavorable outcomes can hinder functioning, quality of life, and employment, and may worsen preexisting conditions [17], further highlighting the chronic health issues associated with TBI as well as the need for complex rehabilitative programs and long-term services to support this group of patients [16].

A major step to the development of the PIR encompasses the "Best Evidence for Rehabilitation" (be4rehab) approach, which is applied to this work. Be4rehab supports the gathering of best evidence on the effectiveness and quality of pharmacological and non-pharmacological rehabilitation interventions for individuals with TBI and the delivery of this overview of Cochrane systematic reviews (CSRs) [4]. Overviews of systematics reviews are a methodological approach proposed by Cochrane to compile and synthesize data from multiple systematic reviews into one single, accessible document. All overviews requested by the WHO are restricted to CSRs to preserve the coherence and quality of the gathered evidence.

Supplemented by evidence mapping to aid in the synthesis of available evidence, this work aims at identifying the broad quality and the quantity of evidence, published in CSRs, on the effectiveness of rehabilitation interventions in person with TBI.
