Is NeuroBITE unique?

NeuroBITE is similar to three existing databases, all developed in Australia: the Physiotherapy Evidence Database (PEDro, launched on 1st September, 1999), the Occupational Therapy Systematic Evaluation of Evidence (OTseeker, launched on 17th March, 2003) and speechBITE (Speech Pathology database for Best Interventions and Treatment Efficacy), launched on 2 May 2008. NeuroBITE, OTseeker and speechBITE were modelled on PEDro, a database of systematic reviews, evidence-based guidelines, and randomised controlled trials (RCTs) in physiotherapy which is available on the internet free of charge. NeuroBITE differs from PEDro and OTseeker in three important ways:

1. Multidisciplinary  
NeuroBITE is not exclusive to a single discipline, but rather encompasses a range of disciplines including neurology, nursing, occupational therapy, physiotherapy, psychiatry, psychogeriatrics, rehabilitation medicine, social work, speech pathology and obviously, psychology.

2. Broad range of levels of evidence
PEDro and OTseeker are restricted to higher levels of evidence (systematic reviews, evidence-based guidelines, and RCTs). By contrast, NeuroBITE includes trials with a broader range of levels of evidence: systematic reviews (SR), randomised and non-randomised controlled trials (RCTs and non-RCTs) , case series (CS) and single-case designs (SCDs) — you can find detailed information on specific designs under Research Design and Rating. The report must, however, contain empirical data about treatment efficacy (usually pre- and post-treatment test results). For this reason reports without such data (e.g., editorials, narrative reviews, case descriptions) are not included on NeuroBITE. The selection criteria are explained further below.

3. Specific to acquired brain impairment
PEDro, OTseeker and speechBITE encompass all medical conditions, whereas NeuroBITE is restricted to acquired brain impairment (ABI). 

NeuroBITE and research methodology

The reasons why NeuroBITE takes a different approach to the other databases are interlinked. The small number of systematic reviews of various therapies for psychological issues after ABI have all yielded very few RCTs. This is largely because of the difficulties in conducting RCTs in this area. Generally there are not sufficient numbers of people presenting with the target problem for treatment at the same point in time. Moreover, the clear majority of published treatments have lesser levels of evidence, but we consider that their inclusion on NeuroBITE is warranted. Often, for example, such studies are a source of ideas for treatments that can be applied in the context of a single-case design (SCD). We therefore consider that inclusion of as many pertinent trials as possible will increase the relevance of the database for practicing clinicians and researchers. Our decision to adopt an inclusive approach for trials to be entered on NeuroBITE has been done at the expense of breadth of aetiology. Our team's clinical and research interests lie in the field of ABI and the trials on NeuroBITE reflect this orientation. There is a multitude of therapies for psychological issues arising from other medical conditions, but at present these are not included on NeuroBITE.

Which trials are accepted on NeuroBITE?

There are five selection criteria which must be met in order to include an article on NeuroBITE:
  1. The report is published as a full-length paper in a peer-reviewed scientific journal,
  2. The population treated is human, with brain impairment of acquired aetiology that involves structural/morphological changes,
  3. The population is older than 5 years of age,
  4. Treatment comprises at least one intervention that is psychologically-based and/or targets at least one psychological consequence of ABI, and
  5. The report provides empirical data regarding treatment efficacy.
As mentioned, a multidisciplinary approach is taken in the inclusion of research papers on ABI.

How are studies identified?

Seven databases are searched for potentially relevant studies: In addition, the reference lists of relevant review articles are also searched. These databases are set up to conduct automated searches and alerts which are based on 85 search terms addressing five domains [selection criteria]:
  1. Target areas (i.e., area targeted for treatment, such as memory, social skills, anxiety, pain)
  2. Intervention (e.g., communication therapy, education, sexuality counselling, cognitive-behaviour therapy)
  3. Neurological group (e.g., Alzheimer's disease, stroke, traumatic brain injury)
  4. Age group (the broad categories of child, adolescent and adult)
  5. Study design (e.g., systematic review, RCT).
Before trials are entered on NeuroBITE they are examined to ensure they meet the selection criteria (referred to as the identification process). Those papers to be included are then indexed, using the indexing terms as you find them on the search page. The indexing terms were developed from the 85 search terms and address the following: target area, intervention, neurological group, age group and study design.

How reliable is NeuroBITE?

Inter-rater reliability studies of the identification process and indexing procedure have been conducted (for details, see Tate et al., 2004). Inter-rater agreement on the identification process of 2,000 reports was very high (Kappa coefficient 0.92). For the indexing procedure using 52 reports, overall agreement on the indexing terms was 98% (agreement on 254/260 data points).