http://stroke.ahajournals.org/content/48/2/e28?etoc=
Introduction
Memory
problems are common after a stroke, leading to difficulties in everyday
life. Memory rehabilitation aims to help retrain lost functions or to
teach patients strategies to compensate for them. Although some studies
have reported positive outcomes after memory rehabilitation, reviews
have provided inconclusive evidence for effectiveness.
This is an update of a Cochrane review first published in 2000 and subsequently updated in 2007.
Objectives
The objective of this review1
was to determine whether participants who have received cognitive
rehabilitation for memory problems after a stroke had better outcomes in
relation to memory function, functional ability, mood, and quality of
life, than those given no treatment or a placebo control.
Search Methods
For
this update, we used a comprehensive electronic search strategy to
identify studies in 16 databases, including the Cochrane Stroke Group
Trials Register (last searched May 19, 2016), Cochrane Central Register
of Controlled Trials (CENTRAL: 2016, Issue 5), and MEDLINE (2005 to
March 7, 2016), in conjunction with handsearches of primary studies
included.
Selection Criteria
We
selected randomized controlled trials where cognitive rehabilitation
was compared with a control condition. Studies with stroke patients were
included, along with mixed etiology studies where separate stroke data
were available.
Data Collection and Analysis
Two
reviewers (H.C. and E.W.) selected trials, extracted data, and assessed
trial quality, confirmed through group discussion. Authors of studies
were contacted to obtain further information where required. Where there
were sufficient numbers of similar outcomes, we performed
meta-analyses.
Main Results
This
review included 13 trials involving 514 participants. There was a
significant effect of treatment on subjective reports of memory in the
short term (standard mean difference, 0.36; 95% confidence interval,
0.08–0.64; P=0.01, moderate quality of evidence), with small-to-moderate effect size (Figure).
No significant effects of treatment were found in subjective reports in
the long term or on performance on objective memory measures, mood,
functional abilities, or quality of life.
Figure.
Memory
rehabilitation vs control (treatment as usual or placebo) and standard
mean difference of subjective memory measures (short term) outcome are
shown. CI indicates confidence interval.
Conclusions
Benefits
were reported in the short term on subjective measures of memory;
however, these did not persist in the long term. In addition, no
benefits were reported in objective memory measures, mood, or daily
functioning. There was insufficient evidence to support or refute the
effectiveness of memory rehabilitation after stroke. This may be because
of poor methodological quality of the included studies, inconsistencies
in the choice of outcome measures, and small sample sizes. Furthermore,
more robust trials of memory rehabilitation that use standardized
activity or participatory level outcome measures are required.
Implications for Practice and Research
Because
of the high prevalence of memory problems after a stroke and the
diversity of interventions available to address these, it is important
to understand the effectiveness of available interventions. Studies
included in this review highlighted the broad range of interventions
used in stroke care and the variety of measures used to evaluate their
effectiveness. The results of this review indicated that there are some
improvements to subjective reports of memory functioning in the short
term but with unclear effects in the long term.
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