Cognitive strategy on upper extremity function for stroke: A randomized controlled trials

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

“…Low: Has 1 or fewer criteria listed in ‘a’. Internal validity concern: * Selection bias: Risk of bias in allocation to interventions due to inadequate generation of randomisation sequence or inadequate concealment. § Performance bias: Risk of bias due to knowledge of the allocated interventions by participants and personnel during the study. † Detection bias: Risk of bias due to knowledge of allocated interventions by outcome assessors. ‡ Attrition bias: Risk of bias due to the amount, nature or handling of incomplete data. ⁑ Selective reporting: Risk of bias due to selective outcome reporting or outcomes of interest reported incompletely. ҂ Other bias: Threat of maturation or baseline imbalance. ** Design does not control for threats to bias. External validity concern: *** Treatment may not represent current practice. §§§ Treatment does not have strong theoretical support or insufficient information presented to make an assessment. ††† Participants may not be representative of population. ⁑⁑⁑ Study not conducted in natural setting or insufficient information presented to make an assessment. summarise the method of each study and the methodological quality and level of evidence ratings. Twenty studies provided level II evidence (good quality RCTs) (Ahn, 2019; Ahn et al., 2017; Bertens et al., 2015; Bertilsson et al., 2014; Donkervoort et al., 2001; Geusgens et al., 2006; Goverover et al., 2007; Guidetti and Ytterberg, 2011; Guidetti and colleagues, 2010, 2015; Kessler et al., 2017; Liu and Chan, 2014; Liu et al., 2004a; McEwen et al., 2015; Ownsworth et al., 2008; Polatajko et al., 2012; Skidmore et al., 2015; Song et al., 2019; Spikman et al., 2010; Winkens et al., 2009), two studies provided level III-1 evidence (quasi-RCTs) (Dawson et al., 2013; Poulin et al., 2017). Of the remaining studies, two studies pr...…”

“…Most studies compared cognitive strategy training with a comparable control intervention (Table 3). Comparative interventions included ‘standard’ or ‘usual’ occupational therapy (Ahn et al., 2017; Bertilsson et al., 2014; Donkervoort et al., 2001; Liu and Chan, 2014; Liu et al., 2004a; Polatajko et al., 2012), attention control in addition to usual care (Skidmore et al., 2015), usual care without (no) occupational therapy (Kessler et al., 2017), action focusing intervention (Ahn, 2019), task-specific retraining (Song et al., 2019), conventional task practice or functional retraining (Goverover et al., 2007), conventional cognitive rehabilitation (Winkens et al., 2009) and computer-based cognitive retraining (Poulin et al., 2017; Spikman et al., 2010). Only one study used a no intervention control group (Dawson et al., 2013).…”

“…The immediate effect of cognitive strategy training compared to any other comparative intervention or no intervention was examined using a random effects model from 16 studies, involving 833 participants with non-progressive brain injury (Ahn, 2019; Ahn et al., 2017; Bertilsson et al., 2014; Dawson et al., 2013; Donkervoort et al., 2001; Goverover et al., 2007; Kessler et al., 2017; Liu and Chan, 2014; Liu et al., 2004a; McEwen et al., 2015; Polatajko et al., 2012; Poulin et al., 2017; Skidmore et al., 2015; Song et al., 2019; Spikman et al., 2010; Winkens et al., 2009). Cognitive strategy training improved activity performance outcomes for participants immediately after the intervention period (SMD 0.79, 95% CI 0.49–1.09) (Figure 2

Figure 2. Standard mean difference (SMD) (95% confidence interval (CI)) of the effect of cognitive strategy training compared with any comparative intervention or no intervention on activity performance outcomes immediately after intervention for people with non-progressive brain injury.

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“…The effect of cognitive strategy training for people diagnosed with stroke was examined by pooling post-intervention data from 13 studies, with 725 participants. Of these, five trials were conducted in early stage rehabilitation (less than 3 months since onset) (Bertilsson et al., 2014; Liu and Chan, 2014; Liu et al., 2004a; McEwen et al., 2015; Skidmore et al., 2015), seven were conducted in the chronic phase of rehabilitation (greater than 3 months following stroke) in outpatient or community rehabilitation settings (Ahn, 2019; Ahn et al., 2017; Kessler et al., 2017; Polatajko et al., 2012; Poulin et al., 2017; Song et al., 2019; Winkens et al., 2009) and one study offered the intervention to participants within 2 years of stroke onset in either inpatient rehabilitation or a nursing home setting (Donkervoort et al., 2001). Cognitive strategy training improved activity performance in stroke participants compared to usual or standard care (SMD 0.75, 95% CI 0.41–1.10) (Figure 4

Figure 4. Standard mean difference (SMD) (95% confidence interval (CI)) of the effect of cognitive strategy training compared with any comparative intervention on activity performance outcomes immediately after intervention for people with stroke.

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“…Of the 22 RCTs and quasi-RCTs, 16 were included in the meta-analysis (Ahn, 2019;Ahn et al, 2017;Bertilsson et al, 2014;Dawson et al, 2013;Donkervoort et al, 2001;Goverover et al, 2007;Kessler et al, 2017;Liu and Chan, 2014;Liu et al, 2004a;McEwen et al, 2015;Polatajko et al, 2012;Poulin et al, 2017;Skidmore et al, 2015;Song et al, 2019;Spikman et al, 2010;Winkens et al, 2009). Six studies were not included for the following reasons: Guidetti et al (2010) reported median and interquartile range and subsequently data could not be pooled in the meta-analysis.…”