Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and the Maudsley NHS Trust, UK.
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
Schizophr Res. 2024 May;267:367-372. doi: 10.1016/j.schres.2024.04.001. Epub 2024 Apr 17.
Cognitive Remediation (CR) is an evidence-based therapy targeting cognitive difficulties in people with psychosis to promote functional recovery, but it is rarely implemented routinely. To reach more individuals, CR is beginning to be delivered remotely, but there is limited evidence to support the acceptability of this method.
To evaluate the acceptability and feasibility of remote therapist-supported CR in people with psychosis and estimate its cost and potential benefits.
A case-series with all participants assessed before and after therapy with measures of personal goal attainment (main outcome), cognition, functioning and symptoms. Acceptability was assessed with post-therapy interviews. Feasibility was assessed using proportions and confidence intervals on pre-specified parameters. Indication of benefits was assessed with exploratory analyses comparing baseline and post-therapy scores on the pre-specified outcomes. The cost of providing remote CR was assessed from both healthcare and societal perspectives.
Twenty-nine participants started therapy with two dropping out; on average participants attended 25.5 sessions. Interviews suggested that remote CR had good acceptability and led to perceived benefits. Significant and large improvements were observed on goal attainment. Cost analyses suggest that remote CR has the same health care cost as face-to-face therapy but a lower societal cost.
Our results support the use of remote CR in psychosis services as an alternative delivery modality. This method may improve adherence, attendance and be more convenient for service users. Possible barriers such as poor digital literacy or appropriate device ownership should be addressed before starting therapy.
认知康复（CR）是一种针对精神分裂症患者认知困难的循证疗法，旨在促进功能恢复，但该疗法很少常规实施。为了让更多的人受益，CR 开始远程实施，但目前支持这种方法的接受度的证据有限。
评估远程治疗师支持的 CR 在精神分裂症患者中的接受度和可行性，并评估其成本和潜在效益。
本病例系列研究纳入所有参与者，在治疗前后均使用个人目标达成（主要结局）、认知、功能和症状的测量指标进行评估。采用治疗后访谈评估接受度。通过对预设参数的比例和置信区间评估可行性。通过对预设结局的基线和治疗后评分进行探索性分析，评估获益的迹象。从医疗保健和社会角度评估远程 CR 的成本。
29 名参与者开始接受治疗，其中 2 名退出；平均参与者接受了 25.5 次治疗。访谈表明，远程 CR 的接受度良好，并带来了感知到的益处。在目标达成方面观察到显著且较大的改善。成本分析表明，远程 CR 的医疗保健成本与面对面治疗相同，但社会成本更低。
我们的研究结果支持在精神分裂症服务中使用远程 CR 作为替代的提供模式。这种方法可能会提高依从性、出勤率，并为服务使用者提供便利。在开始治疗之前，应解决数字素养较差或适当设备拥有率等可能存在的障碍。
