Nonpharmaceutical Interventions and Neurodevelopmental Outcomes in School-Age Preterm Children and Adolescents: A Systematic Review.
Russia Ha-Vinh Leuchter, Vanessa Siffredi
PMID 39671172WHAT IT FOUND
The most rigorously tested interventions (Cogmed, BrainGame Brian, physiotherapy) showed no significant benefit on their primary outcomes in preterm school-age children.
Smaller, less rigorous studies reported gains, but effects were often short-lived or limited to trained tasks.
Key findings
01The largest and lowest-bias trial (IMPRINT, n = 91) found no significant improvement in working memory, attention, or academic skills from Cogmed training at 2 weeks, 12 months, or 24 months, and neuroimaging studies found no specific structural or functional brain changes.
02The BrainGame Brian RCT found no beneficial effect in any outcome (academic, executive, attentional, or behavioral), and the physiotherapy RCT in 4-year-old extremely preterm children found no specific effect on gross motor or behavioral outcomes beyond standard care, at immediate and 1-year follow-up.
03Smaller studies reported short-term gains: XtraMath improved academic performance immediately but not at 12 months; two memory training programs improved trained and some nontrained tasks; and a mindfulness-based intervention improved executive, behavioral, and socio-emotional competencies. However, 39% of included studies had fewer than 30 participants, and 26.1% carried a serious risk of bias.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
No meta-analysis was performed; the narrative synthesis limits the ability to draw firm conclusions across studies. 39% of included studies had fewer than 30 participants, and the review notes low participation and high dropout rates (for example, 15 of 120 invited children agreed to participate in one Cogmed study, and only 12 completed all sessions). 26.1% of studies carried a serious risk of bias (ROBIN-I), and 7.1% of RCTs had a high risk of bias (RoB 2). No studies included adolescents beyond 15 years, leaving a gap for the older end of the target age range. Only nonpharmaceutical interventions were included; pharmaceutical options for attention difficulties in preterm children were not considered. Several studies failed to blind participants, families, or outcome assessors, which the authors note is an important source of bias.
Declared interests
The authors declare no conflict of interest.
The easy way to misread this
Do not read the positive findings from smaller Cogmed or BrainGame Brian studies as evidence these programs work for preterm children. The largest and lowest-bias trial (IMPRINT, n = 91) found no significant improvement in working memory, attention, or academic skills, and the BrainGame Brian RCT found no beneficial effect in any outcome. The gains reported in smaller studies were often limited to trained tasks or not sustained at follow-up.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →