Predictors and moderators of outcomes on activities, participation, and quality of life following outpatient comprehensive neuropsychological rehabilitation for individuals with acquired brain injury: A systematic review

Acquired brain injury (ABI) often limits daily activities and participation. Comprehensive neuropsychological rehabilitation (CNR) aims to address these issues. This review examines research on predictors and moderators of improved activity, participation, and quality of life (QoL) after CNR, and updates its effectiveness. A comprehensive search of five databases (PubMed, MEDLINE, CINAHL, PsycINFO, CENTRAL) from 2002 to 2025 identified 12,174 studies. Ninety-five were screened, and 25 met the inclusion criteria. The included studies evaluated CNR for adults with ABI in outpatient or community settings, incorporating cognitive and psychological interventions with repeated assessments of activity, participation, and QoL. We found no clinical trials reporting predictors or moderators of CNR outcomes. However, four observational studies suggested that earlier admission to CNR may serve as a potential predictor of improved outcomes. Most controlled studies demonstrated that CNR significantly improved activity, participation, or QoL compared to control groups. These effects were substantiated by 13 observational studies, with improvements sustained in 89% of studies with follow-up beyond three months. Overall, while CNR improves levels of activity, participation, and QoL post-ABI, research on predictors and moderators of CNR effectiveness is still lacking. Future research should focus on identifying these factors to optimize CNR effectiveness for individual patients.