Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets

Abstract

BackgroundLimited access to Cognitive Training (CT) for people with schizophrenia (SZ) prevents widespread adoption of this intervention. Delivering CT remotely via tablets may increase accessibility, improve scheduling flexibility, and diminish patient burden.MethodsIn this reanalysis of data from a larger trial of CT, we compared two samples of individuals with SZ who chose to complete 40 h of CT either on desktop computers in the laboratory (N = 33) or remotely via iPads (N = 41). We examined attrition rates and adherence to training, and investigated whether remote iPad-based CT and in-person desktop-based CT induced significantly different improvements in cognitive and real-world functioning.ResultsThe attrition rate was 36.6%. On average, participants completed 3.06 h of CT per week. There were no significant between-group differences in attrition and adherence to CT requirements. Participants who completed iPad-based CT were significantly younger and had lower symptoms at baseline compared to participants who completed CT on the lab desktops. Controlling for age and symptom severity, rANCOVA showed that iPad-based and desktop-based CT similarly and significantly improved verbal learning and problem solving. Main effects of time, at trend level significance, were evident in global cognition, verbal memory, quality of life, and social functioning. All group by time interactions were non-significant except for verbal memory, where iPad users showed greater gains. Within-group effect sizes for changes in outcomes were in the small range.ConclusionAlthough underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples.

mHealth for schizophrenia spectrum disorders management: A systematic review

“…To support users’ engagement and acceptance of technology while solving cognitive exercises, two of them use an applied behavioral economics’ gamification method: Bias Blaster, a bubble-shooting game that uses the Cognitive Bias Modification Interpretation (CBM-I) method (Steel et al, 2010) for training patients to interpret ambiguous social situations in a positive way (Wartena & van Dijk, 2013), and Challenging Our Minds (Mariano et al, 2015), an online cognitive remediation program, provides gaming tasks to improve attention, executive function, memory, visual-spatial abilities, problem-solving and communication. In the third program, Brain HQ (Biagianti et al, 2017), auditory processing training and social cognition exercises aim to improve working memory, processing speed and brain plasticity.…”

“…BrainHQ (Biagianti et al, 2017) Cognitive training Auditory processing training and social cognition exercises A study with seven participants with schizophrenia + − Users, researchers Significant effects of time on verbal learning (p = .02) and problem-solving (p = .05) on the omnibus test.…”

Cognitive remediation in large systems of psychiatric care

“…While laboratory-based developments aim to enhance cognitive learning, ongoing work in the field aims to enhance the treatment's accessibility and its individuallevel effectiveness in improving both cognition and recovery outcomes. 31,32 Indeed, there is increasing enthusiasm for implementing theoretically and empirically grounded CR approaches in large systems of psychiatric care. However, there is a lack of clarity about a number of factors that impact how CR can be feasibly implemented in clinical settings.…”

ThinkRx cognitive training for adults over age 50: Clinician–caregiver partners in delivery as effective as clinician-only delivery.

“…The partnership model has the potential to reduce the overall cost of training and can be more flexible in terms of scheduling-making the program accessible to more people who need it. This is particularly important, since prior research has revealed scheduling and commuting to multiple cognitive training appointments each week can be burdensome when juggling work, school, and other medical appointments (Biagianti et al, 2017). Encouragingly, a home-based model has been successfully implemented in neurofeedback training programs to reduce costs and improve access to treatment (Kober et al, 2016).…”