Combined Cognitive and Psychological Interventions Improve Meaningful Outcomes after Acquired Brain Injury: A Systematic Review and Meta-Analysis.

IF 5.4 2区 心理学 Q1 NEUROSCIENCES
Alexandra Davies, Jeffrey M Rogers, Katharine Baker, Lily Li, Joshua Llerena, Roshan das Nair, Dana Wong
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引用次数: 1

Abstract

Interventions addressing cognitive and emotional difficulties after acquired brain injury (ABI) often focus on specific impairments in cognition or mood. These interventions can be effective at addressing their specific target, but do not routinely translate to improved activity and participation outcomes. Approaches that combine cognitive and psychological rehabilitation are increasingly popular; however, to date, there have been no systematic evaluations of their efficacy. We conducted a systematic review of five databases, searching for randomised controlled trials of adults with diagnoses of non-progressive ABI at least 1-month post injury, in receipt of interventions that combined cognitive and psychological components compared to any control. Screening and data extraction were evaluated by two independent reviewers using a standardised protocol. Effect sizes were calculated using Hedge's g and estimated using a random-effects model. Risk of bias was assessed using the PEDro-P rating system, and quality of evidence evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) approach. Thirteen studies were included in the meta-analysis (n = 684). There was an overall small-to-medium effect (g = 0.42) for combined interventions compared with controls, with gains maintained at 6-month follow-up. Improvements were observed at the level of impairment, activity, participation and quality of life. GRADE ratings and analyses investigating sensitivity, heterogeneity and publication bias indicated that these effects were robust. No a priori variables moderated these effects. Overall, this review provides strong evidence that combined cognitive and psychological interventions create meaningful change in the lives of people with ABI.

Abstract Image

认知和心理联合干预可改善获得性脑损伤后的有效预后:一项系统回顾和荟萃分析。
对获得性脑损伤(ABI)后认知和情绪障碍的干预通常侧重于特定的认知或情绪障碍。这些干预措施可以有效地解决其具体目标,但通常不能转化为改善活动和参与的结果。结合认知和心理康复的方法越来越受欢迎;然而,到目前为止,还没有对它们的功效进行系统的评价。我们对5个数据库进行了系统回顾,寻找在受伤后至少1个月诊断为非进行性ABI的成年人的随机对照试验,与任何对照相比,这些成年人接受了结合认知和心理成分的干预。筛选和数据提取由两名独立审稿人使用标准化方案进行评估。效应大小使用Hedge's g计算,并使用随机效应模型进行估计。偏倚风险采用pedrop分级系统评估,证据质量采用推荐、评估、发展和评价(GRADE)分级方法评估。meta分析纳入13项研究(n = 684)。与对照组相比,联合干预的总体效果为中小型(g = 0.42),在6个月的随访中仍保持增益。在损伤、活动、参与和生活质量方面观察到改善。GRADE评分和调查敏感性、异质性和发表偏倚的分析表明,这些影响是稳健的。没有先验变量调节这些影响。总的来说,这篇综述提供了强有力的证据,表明认知和心理干预相结合可以为ABI患者的生活带来有意义的改变。
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来源期刊
Neuropsychology Review
Neuropsychology Review 医学-神经科学
CiteScore
11.00
自引率
1.70%
发文量
36
期刊介绍: Neuropsychology Review is a quarterly, refereed publication devoted to integrative review papers on substantive content areas in neuropsychology, with particular focus on populations with endogenous or acquired conditions affecting brain and function and on translational research providing a mechanistic understanding of clinical problems. Publication of new data is not the purview of the journal. Articles are written by international specialists in the field, discussing such complex issues as distinctive functional features of central nervous system disease and injury; challenges in early diagnosis; the impact of genes and environment on function; risk factors for functional impairment; treatment efficacy of neuropsychological rehabilitation; the role of neuroimaging, neuroelectrophysiology, and other neurometric modalities in explicating function; clinical trial design; neuropsychological function and its substrates characteristic of normal development and aging; and neuropsychological dysfunction and its substrates in neurological, psychiatric, and medical conditions. The journal''s broad perspective is supported by an outstanding, multidisciplinary editorial review board guided by the aim to provide students and professionals, clinicians and researchers with scholarly articles that critically and objectively summarize and synthesize the strengths and weaknesses in the literature and propose novel hypotheses, methods of analysis, and links to other fields.
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