Cognitive rehabilitation after out-of-hospital cardiac arrest: combining metacognitive strategy and direct training to improve daily cognitive functioning.

Objective: Approximately half of out-of-hospital cardiac arrest (OHCA) survivors have enduring cognitive impairment. This study investigated the effectiveness of a combined cognitive rehabilitation approach, combining metacognitive strategy training with direct computerized-training, to improve cognitive functioning in daily life after OHCA.

Method: A single-case experimental design with a non-concurrent multiple baseline was used including five participants. The intervention (6-10 weeks) entailed therapist-guided metacognitive and direct training, with a randomized starting date.  Participants completed daily visual analog scales on personal problems and subjective cognition (memory, attention, executive functioning). Cognitive tests and questionnaires on cognition, memory failures, societal participation, and quality of life were administered pre- and post-intervention. Statistical analysis included visual analysis, (weighted) TAU-U tests, and multilevel regression.

Results: Visual analysis showed improvements in personal daily problems for all adherent participants (n=4). Weighted TAU-U scores were small but significant for the personal problems (TAU-U=.19, p<.01) and attention (TAU-U=.18, p=.02). Three participants showed a significant decrease in personal problem severity during and after treatment. Descriptive cognitive test scores suggested an improvement. Participants reportedfewer memory failures and greater societal participation, but no statistical analyses were conducted. Subjective cognitive changes were mixed, life satisfaction remained stable.

Conclusions: The combined treatment improved daily cognitive functioning after OHCA.