Department of Occupational Therapy, New York University, New York, NY; Kessler Foundation, East Hanover, NJ.
Kessler Foundation, East Hanover, NJ; Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, Newark, NJ.
Arch Phys Med Rehabil. 2018 Feb;99(2):390-407. doi: 10.1016/j.apmr.2017.07.021. Epub 2017 Sep 25.
To update the clinical recommendations for cognitive rehabilitation of people with multiple sclerosis (MS), based on a systematic review of the literature from 2007 through 2016.
Searches of MEDLINE, PsycINFO, and CINAHL were conducted with a combination of the following terms: attention, awareness, cognition, cognitive, communication, executive, executive function, language, learning, memory, perception, problem solving, reasoning, rehabilitation, remediation, training, processing speed, and working memory. One hundred twenty-nine articles were identified and underwent initial screening.
Fifty-nine articles were selected for inclusion after initial screening. Nineteen studies were excluded after further detailed review. Forty studies were fully reviewed and evaluated.
Articles were assigned to 1 of 6 categories: attention, learning and memory, processing speed and working memory, executive functioning, metacognition, or nonspecified/combined cognitive domains. Articles were abstracted and levels of evidence were decided using specific criteria.
The current review yielded 6 class I studies, 10 class II studies, and 24 class III studies. One intervention in the area of verbal learning and memory received support for a practice standard, 2 computer programs received support as practice guidelines (in the area of attention and multicognitive domains), and several studies provided support for 5 practice options in the domains of attention and learning and memory.
Substantial progress has been made since our previous review regarding the identification of effective treatments for cognitive impairments in persons with MS. However, much work remains to be done to optimize rehabilitation potential by applying the most methodologically rigorous research designs to provide class I evidence in support of a given treatment strategy.
根据 2007 年至 2016 年的文献系统回顾，更新多发性硬化症（MS）患者认知康复的临床建议。
通过以下术语的组合，对 MEDLINE、PsycINFO 和 CINAHL 进行了搜索：注意力、意识、认知、认知、沟通、执行、执行功能、语言、学习、记忆、知觉、问题解决、推理、康复、补救、培训、处理速度和工作记忆。确定了 129 篇文章，并进行了初步筛选。
经过初步筛选，选择了 59 篇文章进行纳入。进一步详细审查后，排除了 19 项研究。对 40 项研究进行了全面审查和评估。
文章被分配到以下 6 个类别之一：注意力、学习和记忆、处理速度和工作记忆、执行功能、元认知或未指定/综合认知领域。对文章进行了摘要，并使用特定标准确定了证据水平。
本次审查产生了 6 项 I 类研究、10 项 II 类研究和 24 项 III 类研究。在言语学习和记忆领域的一项干预措施得到了实践标准的支持，2 个计算机程序在注意力和多认知领域得到了实践指南的支持，并且几项研究在注意力和学习和记忆领域为 5 种实践选择提供了支持。
自我们上次审查以来，在确定多发性硬化症患者认知障碍的有效治疗方法方面取得了重大进展。然而，为了通过应用最严格的方法学研究设计来提供支持特定治疗策略的 I 类证据，以优化康复潜力，还有很多工作要做。
