Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

Klein, Olga A.; Drummond, Avril; Mhizha-Murira, Jacqueline R; Mansford, Laura; dasNair, Roshan

doi:10.1080/09602011.2017.1309323

Cited by 30 publications

(21 citation statements)

References 52 publications

(67 reference statements)

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“…[123][124][125][126] Therefore, some of those recruited may have reported memory problems associated with low mood and, therefore, would be unlikely to benefit from memory rehabilitation. However, despite some previous studies demonstrating better mood in those who had cognitive rehabilitation than in those who did not, 127,128 and previous meta-syntheses of qualitative studies demonstrating this, 106,113 our quantitative data suggested no significant differences between the memory rehabilitation arm and the usual-care arm at the 6-or 12-month follow-up in relation to mood. Interestingly, our qualitative study (see Effects of the group in Chapter 5) found mixed results, with some people finding benefits in relation to mood as a consequence of attending the group sessions, but others finding the groups distressing.…”

Section: Severity Of Memory Impairmentcontrasting

confidence: 96%

“…The aspects that they felt had improved as a result of the intervention have also been reported in previous studies. 24,106,113 Improvements related to learning new strategies, reinforcing the use of existing strategies and increased use of external strategies, all related to improved memory. Furthermore, participants also felt that they understood how memory worked.…”

Section: Discussionmentioning

confidence: 99%

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A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT

Nair

Bradshaw

Carpenter

et al. 2019

Health Technol Assess

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Background People with traumatic brain injuries (TBIs) commonly report memory impairments. These are persistent, debilitating and reduce quality of life, but patients do not routinely receive memory rehabilitation after discharge from hospital. Objective To assess the clinical effectiveness and cost-effectiveness of a group memory rehabilitation programme for people with TBI. Design Multicentre, pragmatic, cluster randomised controlled trial. Qualitative and health economic evaluations were also undertaken. Setting Community settings in nine sites in England. Participants Participants were aged 18–69 years, had undergone a TBI > 3 months prior to recruitment, reported memory problems, were able to travel to a site to attend group sessions, could communicate in English and gave informed consent. Randomisation and blinding Clusters of four to six participants were randomised to the memory rehabilitation arm or the usual-care arm on a 1 : 1 ratio. Randomisation was based on a computer-generated pseudo-random code using random permuted blocks of randomly varying size, stratified by study site. Participants and therapists were aware of the treatment allocation whereas outcome assessors were blinded. Interventions In the memory rehabilitation arm 10 weekly sessions of a manualised memory rehabilitation programme were provided in addition to usual care. Participants were taught restitution strategies to retrain impaired memory functions and compensation strategies to enable them to cope with memory problems. The usual-care arm received usual care only. Main outcome measures Outcomes were assessed at 6 and 12 months after randomisation. Primary outcome: patient-completed Everyday Memory Questionnaire – patient version (EMQ-p) at 6 months’ follow-up. Secondary outcomes: Rivermead Behavioural Memory Test – third edition (RBMT-3), General Health Questionnaire 30-item version, European Brain Injury Questionnaire, Everyday Memory Questionnaire – relative version and individual goal attainment. Costs (based on a UK NHS and Personal Social Services perspective) were collected using a service use questionnaire, with the EuroQol-5 Dimensions, five-level version, used to derive quality-adjusted life-years (QALYs). A Markov model was developed to explore cost-effectiveness at 5 and 10 years, with a 3.5% discount applied. Results We randomised 328 participants (memory rehabilitation, n = 171; usual care, n = 157), with 129 in the memory rehabilitation arm and 122 in the usual-care arm included in the primary analysis. We found no clinically important difference on the EMQ-p between the two arms at 6 months’ follow-up (adjusted difference in mean scores –2.1, 95% confidence interval –6.7 to 2.5; p = 0.37). For secondary outcomes, differences favouring the memory rehabilitation arm were observed at 6 months’ follow-up for the RBMT-3 and goal attainment, but remained only for goal attainment at 12 months’ follow-up. There were no differences between arms in mood or quality of life. The qualitative results suggested positive experiences of participating in the trial and of attending the groups. Participants reported that memory rehabilitation was not routinely accessible in usual care. The primary health economics outcome at 12 months found memory rehabilitation to be £26.89 cheaper than usual care but less effective, with an incremental QALY loss of 0.007. Differences in costs and effects were not statistically significant and non-parametric bootstrapping demonstrated considerable uncertainty in these findings. No safety concerns were raised and no deaths were reported. Limitations As a pragmatic trial, we had broad inclusion criteria and, therefore, there was considerable heterogeneity within the sample. The study was not powered to perform further subgroup analyses. Participants and therapists could not be blinded to treatment allocation. Conclusions The group memory rehabilitation delivered in this trial is very unlikely to lead to clinical benefits or to be a cost-effective treatment for people with TBI in the community. Future studies should examine the selection of participants who may benefit most from memory rehabilitation. Trial registration Current Controlled Trials ISRCTN65792154. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 16. See the NIHR Journals Library website for further project information.

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Section: Severity Of Memory Impairmentcontrasting

confidence: 96%

Section: Discussionmentioning

confidence: 99%

A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT

Nair

Bradshaw

Carpenter

et al. 2019

Health Technol Assess

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“…Focusing on the cognitive functions most affected in those with multiple sclerosis (Chiaravalloti & DeLuca, ), the qualitative meta‐synthesis by Klein et al . () assesses perspectives of memory, attention and executive function interventions, and subsequent self‐perceived cognitive performance. The authors note that previous research employing objective measures of cognitive performance has indicated minimal interventional impact; however despite this, participants reported perceived improvements in function.…”

Section: Commentarymentioning

confidence: 99%

People with multiple sclerosis report cognitive rehabilitation is effective in increasing strategy use and quality of life but they recommend more caregiver involvement and personal feedback to enhance outcomes

George

Rampling

2018

Aus Occup Therapy J

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“…Subsequent qualitative research on COB-MS revealed that the COB-MS intervention was perceived as useful and feasible; specifically, people with MS reported that the programme was a validating intervention, and occupational therapists noted its client-centred nature [22]. Similarly, a recent metasynthesis of qualitative studies, examining the perspectives of people with MS towards cognitive rehabilitation, found that participation in such rehabilitation facilitated reflection and awareness of cognitive deficits; enhanced understanding of MS; provided emotional and social improvements; increased cognitive strategy use; and enhanced confidence, perseverance and optimism [23]. However, to date, there remains a paucity of evidence, as few methodologically rigorous research programmes have been developed to reduce impairment in cognition, decrease the detrimental effects of impairment and support patients by helping them to function well in everyday life [24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the feasibility and preliminary efficacy of a Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS): protocol for a feasibility cluster-randomised controlled trial

Dwyer

Alvarez‐Iglesias

Joyce

et al. 2020

Trials

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Background: Cognitive difficulties experienced by people with multiple sclerosis (MS) impact their quality of life and daily functioning, from childcare and work, to social and self-care activities. Despite the high prevalence of cognitive difficulties seen in MS, there is a lack of developed programmes that target cognition, while also supporting patients by helping them to function well in everyday life. The Cognitive Occupation-Based programme for people with MS (COB-MS) was developed as a holistic, individualised cognitive rehabilitation intervention. It addresses the wide-ranging symptoms and functional difficulties that present in MS, including the ability to maintain employment, social activities, home management and self-care. The aim of the current research is to evaluate the feasibility and preliminary efficacy of COB-MS for people with MS. The focus is on feasibility outcomes as well as functioning associated with cognitive difficulty and secondary outcomes related to cognition, fatigue and quality of life. Methods: One hundred and twenty people with MS will be assigned to participate in either the COB-MS programme or a treatment as usual, wait-list control group as part of this single-blind, cluster-randomised controlled feasibility and preliminary efficacy trial of the COB-MS programme. The COB-MS group will participate in an eight-session occupational-based cognitive rehabilitation programme over 9 weeks. The primary outcome measure is the goal attainment scaling at 12 weeks. Participants will be assessed pre-intervention, post-intervention and at 12 weeks post-intervention and 6 months post-intervention. Qualitative evaluations of participants' perspectives will also be examined as part of the feasibility study. Discussion: Results will provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy. In the event that results indicate efficacy, study findings will suggest that COB-MS requires consideration as a means of enhancing cognitive and daily functioning in people living with MS.

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Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

Cited by 30 publications

References 52 publications

A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT

A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT

People with multiple sclerosis report cognitive rehabilitation is effective in increasing strategy use and quality of life but they recommend more caregiver involvement and personal feedback to enhance outcomes

Evaluating the feasibility and preliminary efficacy of a Cognitive Occupation-Based programme for people with Multiple Sclerosis (COB-MS): protocol for a feasibility cluster-randomised controlled trial

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