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Addressing cognitive impairment following stroke: systematic review and meta-analysis of non-randomised controlled studies of psychological interventions
  1. Niamh A Merriman1,
  2. Eithne Sexton1,
  3. Grainne McCabe2,
  4. Mary E Walsh1,3,
  5. Daniela Rohde1,
  6. Ashleigh Gorman1,
  7. Isabelle Jeffares1,
  8. Nora-Ann Donnelly4,
  9. Niall Pender5,
  10. David J Williams6,7,
  11. Frances Horgan3,
  12. Frank Doyle1,
  13. Maev-Ann Wren4,
  14. Kathleen E Bennett1,
  15. Anne Hickey1
  1. 1 Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  2. 2 Library, Royal College of Surgeons in Ireland, Dublin, Ireland
  3. 3 School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
  4. 4 Social Research Division, Economic and Social Research Institute, Dublin, Ireland
  5. 5 Department of Psychology, Beaumont Hospital, Dublin, Ireland
  6. 6 Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
  7. 7 Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Dr Niamh A Merriman; niamhmerriman{at}rcsi.ie

Abstract

Objective Cognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy.

Design Systematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment.

Data sources Electronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017.

Eligibility criteria All non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life.

Methods The current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre–post studies.

Results Results indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre–post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions.

Conclusions This review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored.

PROSPERO registration number CRD42017069714.

  • stroke
  • cognitive impairment
  • cognitive rehabilitation
  • systematic review
  • meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-024429

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    Footnotes

    • Contributors NAM, ES, N-AD, GMC, NP, DR, IJ, AG, MEW, DW, FD, FH, M-AW, KEB and AH contributed to the conception and design of the study, the development of the search strategy, the establishment of the inclusion and exclusion criteria, data extraction criteria, analyses and interpretation. NAM, DR, IJ, AG and MEW performed the study search, screening and extraction of data. NAM drafted the manuscript, and AH, KEB, DW, NP, FH and FD provided critical revision of the paper. All authors read and approved the final manuscript.

    • Funding This research was funded by the Health Research Board of Ireland Interdisciplinary Capacity Enhancement (ICE) award (2016-19): The StrokeCog study: modelling and modifying the consequences of stroke-related cognitive impairment through intervention (Grant code: ICE-2015-1048).

    • Competing interests None declared.

    • Ethics approval We did not seek formal ethical approval for this study as primary data were not collected.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We, authors, agree that, should the article be accepted, the BMJ Open shall take over the authors’ rights relating to this article, which shall become the property of the journal.

    • Patient consent for publication Not required.