Head injury and family carers: a critical appraisal of case management programmes in the community.

The objective of this review was to identify the available support systems for family carers of head-injured people within the community. The following databases were searched: MEDLINE, EMBASE PSYCHIATRY, CINAHL and PSYCHLIT (years 1987-1999). Only seven papers were identified. Programmes varied from behavioural to cognitive interventions to help carers adjust to particular problem behaviours in their injured relatives. All programmes were professionally led. Most of the data presented was on primary caregivers related to the head-injured person. Only one study used standard assessment tools. The remainder used a variety of methods including self-report measures and interviews. All interventions were reported as beneficial to carers. Overall these studies were found to be limited by biased sampling, nonstandardized outcome measures using subjective methodologies and a lack of control samples. Most studies did not reveal pertinent information regarding the degree and type of head injury or rehabilitation history. There is an outstanding requirement for large randomized controlled studies using standardized methodologies to identify efficacious carer programmes.