Underrepresentation of Participants From Marginalized Racial and Ethnic Groups: A Secondary Analysis of the Cognitive Rehabilitation Literature

Objective: To examine the inclusion of people with brain injury from racially and ethnically marginalized groups in cognitive rehabilitation clinical trials. Data Sources: We conducted a secondary analysis of the Cicerone et al (2019) cognitive rehabilitation review. Study Selection: Of the originally included studies, we excluded those not conducted in the United States, along with case studies and case series studies. Data Extraction: We extracted data on the racial and ethnic demographics of the study samples, along with eligibility criteria and recruitment and sampling strategies. We examined demographic data descriptively (frequencies and percentages) and examined other study methods thematically. Data Synthesis: Sixty-five studies met criteria for inclusion in this secondary analysis. Of these, only 27 reported on the racial and ethnic demographics of the study samples. In all but 8, White non-Hispanic participants were overrepresented. We identified several frequently employed recruitment strategies and eligibility criteria that may disproportionately exclude participants from minoritized racial and ethnic groups, including English language, literacy, and baseline education requirements, exclusion based on comorbid conditions, and recruitment of participants from existing clinic patient pools. Conclusions: We found notable underrepresentation of people with traumatic brain injury (TBI) from racially and ethnically marginalized groups in cognitive rehabilitation clinical trials, which have been used to guide practice and research. This underrepresentation likely exacerbates disparities in rehabilitation access and outcomes among marginalized groups. Further research should seek to comprehensively understand current recruitment and sampling strategies that contribute to this problem and identify opportunities to improve inclusivity in TBI rehabilitation research.