O'Brien Amanda R, Chiaravalloti Nancy, Goverover Yael, Deluca John
Neuropsychology and Neuroscience Laboratory, Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ 07052, USA.
Arch Phys Med Rehabil. 2008 Apr;89(4):761-9. doi: 10.1016/j.apmr.2007.10.019.
To conduct evidence-based review of cognitive rehabilitation intervention research conducted in persons with multiple sclerosis (MS), to classify level of evidence, and to generate recommendations for interventions in this area.
An open (no year limits set) search of Medline, PsychInfo, and CINAHL (eliminating repetitions) using combinations of the following terms: attention, awareness, cognition, cognitive, communication, executive, executive function, language, learning, memory, perception, problem solving, reasoning, rehabilitation, remediation, training, and working memory. Reference sections of articles found through the sites were also searched.
Studies were chosen based on criteria from previous evidence-based reviews such that articles are excluded from the review if (1) the study was not an intervention, (2) it was a theoretic article, (3) it was a review article, (4) detail was lacking to fully evaluate the intervention, (5) it was not MS-specific, (6) it included a pediatric sample, (7) it was a case report without empirical data to evaluate outcomes, (8) it was not peer-reviewed (also excludes book chapters), (9) it was a pharmacologic intervention, or (10) it was not available for review in English.
Articles were categorized into interventions for attention, learning and memory, executive functioning, or nonspecified/combined cognitive domains. There were 4 reviewers in the current study. All articles were reviewed independently by at least 2 persons and abstracted according to predetermined criteria. There was a final total of 16 articles, which underwent a full review and classification of a level of evidence based on previously published peer-reviewed methodology used for evidence-based reviews.
The current review yielded 16 studies of cognitive rehabilitation for persons with MS, including 4 class I studies, 5 class II studies, 2 class III studies, and 5 class IV studies. Two intervention methodologies in the area of verbal learning and memory received support for a practice guideline and practice option, respectively.
Cognitive rehabilitation in MS is in its relative infancy. More methodologically rigorous research is needed to determine the effectiveness and efficacy of various cognitive rehabilitation interventions. Specific recommendations for future research are given.
对针对多发性硬化症（MS）患者开展的认知康复干预研究进行循证综述，对证据水平进行分类，并针对该领域的干预措施提出建议。
使用以下术语组合对Medline、PsychInfo和CINAHL进行开放式检索（不设年份限制），以消除重复：注意力、意识、认知、认知的、沟通、执行、执行功能、语言、学习、记忆、感知、问题解决、推理、康复、补救、训练和工作记忆。还对通过这些数据库找到的文章的参考文献部分进行了检索。
根据以往循证综述的标准选择研究，若文章符合以下条件则被排除在综述之外：（1）该研究不是干预性研究；（2）是理论性文章；（3）是综述文章；（4）缺乏充分评估干预措施的细节；（5）不是针对MS患者的特定研究；（6）包含儿科样本；（7）是没有实证数据来评估结果的病例报告；（8）未经同行评审（也排除书籍章节）；（9）是药物干预；或（10）无法获取英文版本以供综述。
文章被分类为针对注意力、学习和记忆、执行功能或未明确指定/综合认知领域的干预措施。本研究有4名评审员。所有文章至少由2人独立评审，并根据预先确定的标准进行摘要。最终共有16篇文章，根据先前发表的用于循证综述的同行评审方法对其进行了全面评审和证据水平分类。
本次综述产生了16项针对MS患者的认知康复研究，包括4项I类研究、5项II类研究、2项III类研究和5项IV类研究。言语学习和记忆领域的两种干预方法分别获得了实践指南和实践选项的支持。
MS的认知康复尚处于相对初期阶段。需要开展更多方法学上更严谨的研究，以确定各种认知康复干预措施的有效性和疗效。给出了未来研究的具体建议。
