South Eastern Sydney Local Health District, Sydney, NSW, Australia.
Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2031, Australia.
Neuropsychol Rev. 2018 Sep;28(3):285-309. doi: 10.1007/s11065-018-9378-4. Epub 2018 Jul 13.
Cognitive remediation (CR) has been shown to improve cognitive abilities following a stroke. However, an updated quantitative literature review is needed to synthesize recent research and build understanding of factors that may optimize training parameters and treatment effects. Randomized controlled trials of CR were retrieved from seven electronic databases. Studies specific to adult stroke populations were included. Treatment effects were estimated using a random effects model, with immediate and longer-term follow-up outcomes, and moderator effects, examined for both overall and domain-specific functioning. Twenty-two studies were identified yielding 1098 patients (583 in CR groups). CR produced a small overall effect (g = 0.48, 95% CI 0.35-0.60, p < 0.01) compared with control conditions. This effect was moderated by recovery stage (p < 0.01), study quality (p = 0.04), and dose (p = 0.04), but not CR approach (p = 0.63). Significant small to medium (g = 0.25-0.75) post-intervention gains were evident within each individual outcome domain examined. A small overall effect (g = 0.27, 95% CI 0.04-0.51, p = 0.02) of CR persisted at follow-up (range 2-52 weeks). CR is effective and efficient at improving cognitive performance after stroke. The degree of efficacy varies across cognitive domains, and further high-quality research is required to enhance and sustain the immediate effects. Increased emphasis on early intervention approaches, brain-behavior relationships, and evaluation of activity and participation outcomes is also recommended.
认知康复（CR）已被证明可改善中风后的认知能力。然而，需要进行更新的定量文献综述，以综合最近的研究成果，并了解可能优化训练参数和治疗效果的因素。从七个电子数据库中检索到 CR 的随机对照试验。纳入专门针对成人中风人群的研究。使用随机效应模型估计治疗效果，包括即时和长期随访结果，以及整体和特定领域功能的调节效应。确定了 22 项研究，共纳入 1098 名患者（CR 组 583 名）。CR 与对照组相比，总体效果较小（g=0.48，95%CI 0.35-0.60，p<0.01）。该效果受恢复阶段（p<0.01）、研究质量（p=0.04）和剂量（p=0.04）的调节，但不受 CR 方法（p=0.63）的调节。在所检查的每个单独的结果领域中，都有明显的小到中等（g=0.25-0.75）的干预后收益。在随访（2-52 周）时，CR 仍具有较小的总体效果（g=0.27，95%CI 0.04-0.51，p=0.02）。CR 在中风后改善认知表现是有效的和高效的。疗效在不同认知领域有所不同，需要进一步进行高质量的研究以增强和维持即时效果。还建议更加强调早期干预方法、大脑-行为关系以及活动和参与结果的评估。
