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Meta-Analysis
. 2013 May 31;2013(5):CD002842.
doi: 10.1002/14651858.CD002842.pub2.

Cognitive rehabilitation for attention deficits following stroke

Tobias Loetscher  1 , Nadina B Lincoln
Affiliations
Meta-Analysis

Cognitive rehabilitation for attention deficits following stroke

Tobias Loetscher et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Many survivors of stroke complain about attentional impairments, such as diminished concentration and mental slowness. However, the effectiveness of cognitive rehabilitation for improving these impairments is uncertain.

Objectives: To determine whether (1) people receiving attentional treatment show better outcomes in their attentional functions than those given no treatment or treatment as usual, and (2) people receiving attentional treatment techniques have a better functional recovery, in terms of independence in activities of daily living, mood and quality of life, than those given no treatment or treatment as usual.

Search methods: We searched the Cochrane Stroke Group Trials Register (October 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library October 2012), MEDLINE (1948 to October 2012), EMBASE (1947 to October 2012), CINAHL (1981 to October 2012), PsycINFO (1806 to October 2012), PsycBITE and REHABDATA (searched October 2012) and ongoing trials registers. We screened reference lists and tracked citations using Scopus.

Selection criteria: We included randomised controlled trials (RCTs) of cognitive rehabilitation for impairments of attention for people with stroke. The primary outcome was measures of global attentional functions, and secondary outcomes were measures of attention domains, functional abilities, mood and quality of life.

Data collection and analysis: Two review authors independently selected trials, extracted data and assessed trial quality.

Main results: We included six RCTs with 223 participants. All six RCTs compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no statistically significant effect of cognitive rehabilitation for persisting effects on global measures of attention (two studies, 99 participants; standardised mean difference (SMD) 0.16, 95% confidence interval (CI) -0.23 to 0.56; P value = 0.41), standardised attention assessments (two studies, 99 participants; P value ≥ 0.08) or functional outcomes (two studies, 99 participants; P value ≥ 0.15). In contrast, a statistically significant effect was found in favour of cognitive rehabilitation when compared with control for immediate effects on measures of divided attention (four studies, 165 participants; SMD 0.67, 95% CI 0.35 to 0.98; P value < 0.0001) but no significant effects on global attention (two studies, 53 participants; P value = 0.06), other attentional domains (six studies, 223 participants; P value ≥ 0.16) or functional outcomes (three studies, 109 participants; P value ≥ 0.21).Thus there was limited evidence that cognitive rehabilitation may improve some aspects of attention in the short term, but there was insufficient evidence to support or refute the persisting effects of cognitive rehabilitation on attention, or on functional outcomes in either the short or long term.

Authors' conclusions: The effectiveness of cognitive rehabilitation remains unconfirmed. The results suggest there may be a short-term effect on attentional abilities, but future studies need to assess the persisting effects and measure attentional skills in daily life. Trials also need to have higher methodological quality and better reporting.

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Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Analysis 1.1
Analysis 1.1
Comparison 1 Attention training versus control ‐ impact on global measures of attention deficits at post‐treatment assessment, Outcome 1 Subjective measures.
Analysis 2.1
Analysis 2.1
Comparison 2 Attention training versus control ‐ impact on global measures of attention deficits at follow‐up  , Outcome 1 Subjective measures at follow‐up.
Analysis 3.1
Analysis 3.1
Comparison 3 Attention training versus control ‐ impact on attentional domains at post‐treatment assessment, Outcome 1 Alertness.
Analysis 3.2
Analysis 3.2
Comparison 3 Attention training versus control ‐ impact on attentional domains at post‐treatment assessment, Outcome 2 Selective attention.
Analysis 3.3
Analysis 3.3
Comparison 3 Attention training versus control ‐ impact on attentional domains at post‐treatment assessment, Outcome 3 Sustained attention.
Analysis 3.4
Analysis 3.4
Comparison 3 Attention training versus control ‐ impact on attentional domains at post‐treatment assessment, Outcome 4 Divided attention.
Analysis 4.1
Analysis 4.1
Comparison 4 Attention training versus control ‐ impact on functional abilities in daily living, mood and quality of life at post‐treatment assessment:, Outcome 1 Functional abilities.
Analysis 4.2
Analysis 4.2
Comparison 4 Attention training versus control ‐ impact on functional abilities in daily living, mood and quality of life at post‐treatment assessment:, Outcome 2 Mood.
Analysis 4.3
Analysis 4.3
Comparison 4 Attention training versus control ‐ impact on functional abilities in daily living, mood and quality of life at post‐treatment assessment:, Outcome 3 Quality of life.
Analysis 5.1
Analysis 5.1
Comparison 5 Attention training versus control ‐ impact on attentional domains at follow‐up , Outcome 1 Alertness at follow‐up.
Analysis 5.2
Analysis 5.2
Comparison 5 Attention training versus control ‐ impact on attentional domains at follow‐up , Outcome 2 Selective attention at follow‐up.
Analysis 5.3
Analysis 5.3
Comparison 5 Attention training versus control ‐ impact on attentional domains at follow‐up , Outcome 3 Sustained attention at follow‐up.
Analysis 5.4
Analysis 5.4
Comparison 5 Attention training versus control ‐ impact on attentional domains at follow‐up , Outcome 4 Divided attention at follow‐up.
Analysis 6.1
Analysis 6.1
Comparison 6 Attention training versus control ‐ impact on functional abilities in daily living, mood, and quality of life at follow‐up, Outcome 1 Functional abilities at follow‐up.
Analysis 6.2
Analysis 6.2
Comparison 6 Attention training versus control ‐ impact on functional abilities in daily living, mood, and quality of life at follow‐up, Outcome 2 Mood at follow‐up.
Analysis 6.3
Analysis 6.3
Comparison 6 Attention training versus control ‐ impact on functional abilities in daily living, mood, and quality of life at follow‐up, Outcome 3 Quality of life at follow‐up.
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Update of

References

References to studies included in this review

    1. Barker‐Collo SL, Feigin VL, Lawes CM, Parag V, Senior H, Rodgers A. Reducing attention deficits after stroke using attention process training: a randomized controlled trial. Stroke 2009;40:3293‐8. - PubMed
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References to studies excluded from this review

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References to studies awaiting assessment

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References to ongoing studies

    1. Frommelt P. Neuropsychological rehabilitation: Modular cognitive retraining versus compensatory skills training. ISRCTN Register (ISRCTN45171788) (accessed October 2012).

Additional references

    1. Barker‐Collo S, Feigin V. The impact of neuropsychological deficits on functional stroke outcomes. Neuropsychology Review 2006;16:53‐64. - PubMed
    1. Barker‐Collo S, Feigin VL, Parag V, Lawes CMM, Senior H. Auckland Stroke Outcomes Study Part 2: cognition and functional outcomes 5 years poststroke. Neurology 2010;75:1608‐18. - PubMed
    1. Bowen A, Lincoln NB. Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database of Systematic Reviews 2007, Issue 8. [DOI: 10.1002/14651858.CD003586.pub2] - DOI - PubMed
    1. Broadbent DE, Cooper PF, FitzGerald P, Parkes KR. The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology 1982;21:1‐16. - PubMed
    1. Cappa SF, Benke T, Clarke S, Rossi B, Stemmer B, Heugten CM. EFNS guidelines on cognitive rehabilitation: report of an EFNS task force. European Journal of Neurology 2005;12:665‐80. - PubMed

References to other published versions of this review

    1. Lincoln NB, Majid MJ, Weyman N. Cognitive rehabilitation for attention deficits following stroke. Cochrane Database of Systematic Reviews 2000, Issue 4. [DOI: 10.1002/14651858.CD002842] - DOI - PubMed

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