General and Domain-Specific Effectiveness of Cognitive Remediation after Stroke: Systematic Literature Review and Meta-Analysis

I'm not looking to improve cognitive abilities post stroke I'm looking to get back to my previous abilities.  Why is everyone in stroke so fucking afraid to tackle the BHAG(Big Hairy Audacious Goal) of 100% recovery for all survivors! 
Small overall effect means these were complete failures. 
The fact they had to do a meta-analysis means that more wasted time occurred because our fucking failures of stroke associations have not set up a publicly available database of updated stroke research and stroke protocols.  

General and Domain-Specific Effectiveness of Cognitive Remediation after Stroke: Systematic Literature Review and Meta-Analysis

• Authors
• Authors and affiliations

• Jeffrey M. RogersEmail author
• Rachael Foord
• Renerus J. Stolwyk
• Dana Wong
• Peter H. Wilson

• Jeffrey M. Rogers
  • 1
  • 2
  Email authorView author's OrcID profile
• Rachael Foord
  • 3
• Renerus J. Stolwyk
  • 4
  • 5
• Dana Wong
  • 4
  • 5
  • 6
• Peter H. Wilson
  • 3
  • 7

1. 1.South Eastern Sydney Local Health DistrictSydneyAustralia
2. 2.Faculty of Health SciencesUniversity of SydneySydneyAustralia
3. 3.School of PsychologyAustralian Catholic UniversityMelbourneAustralia
4. 4.Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological SciencesMonash UniversityMelbourneAustralia
5. 5.Monash-Epworth Rehabilitation Research CentreMelbourneAustralia
6. 6.School of Psychology and Public HealthLa Trobe UniversityBundooraAustralia
7. 7.Centre for Disability and Development ResearchAustralian Catholic UniversityMelbourneAustralia

Review

First Online: 13 July 2018

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Abstract

Cognitive remediation (CR) has been shown to improve cognitive abilities following a stroke. However, an updated quantitative literature review is needed to synthesize recent research and build understanding of factors that may optimize training parameters and treatment effects. Randomized controlled trials of CR were retrieved from seven electronic databases. Studies specific to adult stroke populations were included. Treatment effects were estimated using a random effects model, with immediate and longer-term follow-up outcomes, and moderator effects, examined for both overall and domain-specific functioning. Twenty-two studies were identified yielding 1098 patients (583 in CR groups). CR produced a small overall effect (g = 0.48, 95% CI 0.35–0.60, p < 0.01) compared with control conditions. This effect was moderated by recovery stage (p < 0.01), study quality (p = 0.04), and dose (p = 0.04), but not CR approach (p = 0.63). Significant small to medium (g = 0.25–0.75) post-intervention gains were evident within each individual outcome domain examined. A small overall effect (g = 0.27, 95% CI 0.04–0.51, p = 0.02) of CR persisted at follow-up (range 2–52 weeks). CR is effective and efficient at improving cognitive performance after stroke. The degree of efficacy varies across cognitive domains, and further high-quality research is required to enhance and sustain the immediate effects. Increased emphasis on early intervention approaches, brain-behavior relationships, and evaluation of activity and participation outcomes is also recommended.

Keywords

Cognitive disorders Cognitive remediation Cognitive rehabilitation Meta-analysis Stroke Systematic review 

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