Meta-analysis of Cognitive Rehabilitation Interventions in Veterans and Service Members With Traumatic Brain Injuries.
Tara A Austin, Cooper B Hodges, Michael L Thomas and 5 others
PMID 38270528WHAT IT FOUND
Cognitive rehabilitation produced a small improvement on memory and executive function tests for veterans with mild TBI, but no significant gain in everyday functioning.
Strategy-based approaches showed benefit; drill-and-practice did not.
Key findings
01Across all 8 trials, cognitive rehabilitation produced a small but statistically significant improvement in objective neuropsychological performance (d = 0.22, 95% CI 0.01 to 0.43, p = 0.04), while the effect on performance-based functional capacity was small and not significant (d = 0.16, 95% CI −0.48 to 0.81, p = 0.62).
02Strategy-based interventions showed a significant effect on neuropsychological performance (d = 0.37, p = 0.01) and a moderate-to-large effect on functional capacity (d = 0.72, p < 0.01, based on 2 studies). Drill-and-practice interventions showed no significant effect on either outcome (neuropsychological d = 0.10, p = 0.59; functional capacity d = −0.45, p = 0.32, with the small non-significant difference actually favouring the control group).
03In the 4 studies that included follow-up, treatment effects on overall neuropsychological performance at 10- or 12-week follow-up (d = 0.45, 95% CI 0.01 to 0.90, p = 0.04) were similar to immediate post-treatment effects (d = 0.40, 95% CI 0.33 to 0.77, p = 0.03).
STILL TO COME
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What it does not show
Only 8 trials with small samples (median n = 40.5), and one additional null study would make the primary neuropsychological finding non-significant. 97% of participants had mild TBI, so findings may not apply to moderate or severe TBI. Average participant age was 35.6 years, well below the 49.9-year average for Veterans reporting TBI, so results may not generalise to older veterans. The strategy-based functional capacity effect (d = 0.72) is based on only 2 studies. Included studies used different neuropsychological batteries, limiting domain-level analysis. Comorbid conditions (PTSD, depression, anxiety) were inconsistently measured across the primary studies. Only 2 of 8 studies reported previous cognitive rehabilitation or mood treatment, making it unclear how prior treatment affected results. Meta-regression was underpowered with 8 studies, and the restricted age and education range in the primary studies may have masked true moderating effects.
Declared interests
The authors declare no competing interests. Funding was provided by non-U.S. government and U.S. government non-PHS sources.
The easy way to misread this
Do not read this as evidence that cognitive rehabilitation broadly improves daily functioning for veterans with TBI. The functional capacity outcome was not significant (p = 0.62), the neuropsychological effect was small (d = 0.22) and would become non-significant with one additional null study, and the strategy-based functional benefit rests on only two trials.
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