Cognitive strategy training for adults with neurological conditions: a systematic review and meta-analysis exploring effect on occupational performance

Abstract

Introduction The objective of this systematic review was to synthesise the evidence for cognitive strategy training to determine its effectiveness to improve performance of activities of daily living in an adult neurological population. Method Medline, CINAHL, EMBASE, PSYCInfo, PsycBITE and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched until August 2019. Studies examining the effect of cognitive strategy training on functional performance were included. Population criteria included adults with non-progressive neurological conditions. External and internal validity of included studies was systematically evaluated using an appropriate methodological quality assessment for each study design. A content analysis was conducted of the methodologies used. Findings Forty-one studies met the inclusion criteria and were appraised for content, 16 randomised or quasi-randomised trials were meta-analysed. Trial quality was generally ‘good’, Physiotherapy Evidence Database scale scores ranged from 3 to 8 (out of 10). For activity performance outcomes post-intervention, there was a significant benefit of cognitive strategy training over usual care (standardised mean difference 0.79, 95% confidence interval 0.49–1.09; P < 0.00001). Conclusion More high-quality research is needed to strengthen the evidence base for cognitive strategy interventions to improve activity performance outcomes for adults with non-progressive neurological conditions. Systematic review registration PROSPERO CRD42016033728

Effect of the cognitive strategy training protocol on task mastery and cognitive performance during the instrumental activity of daily living in stroke patients

“…The duration time of intervention ranged from 1 to 16 weeks, and the frequency was between 1 and 5 days per week. 34 This study provided a duration time of about 60 minutes per day, 3 times a week for 4 consecutive weeks. The duration and frequency of this study might not be sufficient and intense enough for patients with severe cognitive impairment or those having low levels of education to show a cognitive change.…”

Digital support for people with cognitive impairment : An intervention to increase the occupational performance in everyday life

“…When training a single ability such as prospective memory using a computer program, it can be difficult to generalize the individual ability into everyday life (Strobach & Karbach, 2020). Therefore, it is an advantage if the rehabilitation of cognitive impairments is incorporated into and based on people's everyday life occupations in their natural environment (Guidetti, Eriksson, von Koch, Johansson, & Tham, 2020;Swanton et al, 2020). This appears to be most effective in terms of improving cognitive abilities (Strobach & Karbach, 2020) together with coping strategies (Langhorne et al, 2011;Stephens et al, 2015).…”

“…This appears to be most effective in terms of improving cognitive abilities (Strobach & Karbach, 2020) together with coping strategies (Langhorne et al, 2011;Stephens et al, 2015). Interventions that compensate for lost cognitive ability often include using assistive technology for cognition (ATC) (Brandt, Jensen, Søberg, Andersen, & Sund, 2020;Gillespie et al, 2012;O'Neill & Gillespie, 2015) or finding strategies to use from everyday life (Swanton et al, 2020). The Archives of Physical Medicin and Rehabilitation (ACRM) (Cicerone et al, 2019) emphasise that rehabilitation interventions for people with cognitive impairment derive from and support them in their everyday life.…”

Occupational therapy practice to support executive function impairment after acquired brain injury: A UK clinical survey

“…These approaches use meaningful occupation and activities therapeutically to achieve client goals and outcomes (Che Daud et al, 2015), while applying a framework to support application of metacognitive strategy use (Toglia et al, 2020). However, the optimal treatment approach and intervention components including dose and timing for individuals with neurological cognitive impairment is unclear (Swanton et al, 2020), with more robust evidence required to establish intervention efficacy and guide practice (Chung et al, 2013;Skidmore et al, 2023) The need for knowledge translation to implement evidence-based interventions into clinical practice has also been increasingly recommended (Downing et al, 2019;Nott et al, 2020). For example, Tang et al (2017) completed qualitative interviews with primary and secondary care workers to establish views on support received by service users with memory difficulties after stroke.…”

“…These approaches use meaningful occupation and activities therapeutically to achieve client goals and outcomes (Che Daud et al, 2015), while applying a framework to support application of metacognitive strategy use (Toglia et al, 2020). However, the optimal treatment approach and intervention components including dose and timing for individuals with neurological cognitive impairment is unclear (Swanton et al, 2020), with more robust evidence required to establish intervention efficacy and guide practice (Chung et al, 2013; Skidmore et al, 2023)…”