title: Rehabilitation for post-stroke cognitive impairment: an overview of recommendations arising from systematic reviews of current evidence.
abstract: BACKGROUND
  Although cognitive impairments are common following stroke, there is considerable uncertainty about the types of interventions that can reduce activity restrictions and improve quality of life. Indeed, a recent project to identify priorities for research into life after stroke determined that the top priority for patients, carers and health professionals was how to improve cognitive impairments.
  
  
  OBJECTIVE
  To provide an overview of the evidence for the effectiveness of cognitive rehabilitation for patients with stroke and to determine the main gaps in the current evidence base.
  
  
  METHODS
  Evidence was synthesised for the six Cochrane reviews relating to rehabilitation for post-stroke cognitive impairment and any subsequently published randomized controlled trials to February 2012.
  
  
  RESULTS
  Data arising from 44 trials involving over 1500 patients was identified. Though there was support for the effectiveness of cognitive rehabilitation for some cognitive impairments, significant gaps were found in the current evidence base. All of the Cochrane reviews identified major limitations within the evidence they identified.
  
  
  CONCLUSIONS
  There is currently insufficient research evidence, or evidence of insufficient quality, to support clear recommendations for clinical practice. Recommendations are made as to the research required to strengthen the evidence base, and so facilitate the delivery of effective interventions to individuals with cognitive impairment after stroke.
authors.affiliation: Clinical Neuropsychology Service, Western General Hospital, Edinburgh, UK david.gillespie@nhslothian.scot.nhs.uk.
authors.forename: David C
authors.initials: DC
authors.lastname: Gillespie
authors.affiliation: Stroke Research, University of Manchester, Manchester, UK.
authors.forename: Audrey
authors.initials: A
authors.lastname: Bowen
authors.affiliation: Department of Occupational Therapy, NHS Fife, Fife, UK.
authors.forename: Charlie S
authors.initials: CS
authors.lastname: Chung
authors.affiliation: Retired, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Cockburn
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Knapp
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Pollock
mesh_terms: D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D017410:Practice Guidelines as Topic; D012196:Review Literature as Topic; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
keywords: Cognitive impairment; randomized controlled trial; rehabilitation; stroke; systematic review