Sandroff Brian M, DeLuca John
Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
Kessler Foundation, West Orange, NJ, USA; Department of Physical Medicine and Rehabilitation, Rutgers Medical School, Newark, NJ, USA.
Int J Psychophysiol. 2020 Aug;154:67-79. doi: 10.1016/j.ijpsycho.2019.02.010. Epub 2019 Feb 28.
Cognitive impairment is common and debilitating in persons with multiple sclerosis (MS), and further is poorly-managed by pharmacotherapy. Cognitive rehabilitation and exercise training have been identified as promising behavioral approaches for managing MS-related cognitive impairment based on systematic reviews and meta-analyses. However, each body of literature is associated with similar sets of methodological shortcomings, as has been identified by periodic systematic reviews and meta-analyses. Thus, there is little generalizability or transportability research supporting either behavioral approach for managing cognitive dysfunction in this population under real-world conditions (i.e., as a standard-of-care). To that end, this paper aims to catalyze the advancement of cognitive rehabilitation and exercise training research in MS, respectively, towards the successful implementation of generalizability/transportability trials. This first involves critical examinations of the respective cognitive rehabilitation and exercise training literatures in MS from a chronological perspective, with particular emphasis on how the fields have each evolved in response to systematic reviews and meta-analyses. Accordingly, the current paper then provides a roadmap for harmonizing research in those areas to systematically and efficiently inform the development of generalizability/transportability trials for behavioral approaches to manage MS-related cognitive dysfunction. This involves the recognition of overlapping facilitators and impediments for progress in each field, including considerations for the implementation of neuroimaging. Ultimately, the provision of such a framework aims to shorten the timeline for research to influence clinical practice and improve the lives of cognitively-impaired persons with MS.
认知障碍在多发性硬化症（MS）患者中很常见且使人衰弱，并且药物治疗对此的管理效果不佳。基于系统评价和荟萃分析，认知康复和运动训练已被确定为管理与MS相关的认知障碍的有前景的行为方法。然而，正如定期的系统评价和荟萃分析所指出的那样，每一组文献都存在类似的方法学缺陷。因此，在现实世界条件下（即作为标准治疗），几乎没有支持这两种行为方法来管理该人群认知功能障碍的可推广性或可转移性研究。为此，本文旨在分别推动MS认知康复和运动训练研究的进展，以成功实施可推广性/可转移性试验。这首先需要从时间顺序的角度对MS中各自的认知康复和运动训练文献进行批判性审视，特别强调这些领域如何因应系统评价和荟萃分析而各自发展。因此，本文随后提供了一个路线图来协调这些领域的研究，以便系统而有效地为管理与MS相关的认知功能障碍的行为方法的可推广性/可转移性试验的发展提供信息。这涉及识别每个领域进展的重叠促进因素和障碍，包括对神经影像学实施的考虑。最终，提供这样一个框架旨在缩短研究影响临床实践的时间线，并改善MS认知障碍患者的生活。
