title: Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials.
abstract: BACKGROUND
  Computer-assisted cognitive remediation (CACR) has been demonstrated to enhance cognition of patients with severe mental illness (SMI). Patients with improved cognitive skills may find it easier to be employed, and the ability to maintain employment is an important sign of recovery.
  
  
  OBJECTIVE
  To assess whether CACR is an effective method to enhance work-related outcomes in patients with SMI.
  
  
  METHODS
  Prospective controlled trials evaluating CACR on productivity outcomes were systematically identified from the OVID databases. Employment rates, total days of work in a year, and total annual earnings were defined as the productivity outcomes.
  
  
  RESULTS
  Nine trials were published between 2005 and 2014 and were conducted in the United States, Germany, Italy, Singapore and Japan. A total of 740 patients with mean age of 36.4 years were included. The duration of CACR ranged from 2 months to 2 years, and the patients were followed-up from 1 year to 3 years. Patients receiving CACR showed 20% higher employment rate (95% CI = 5%-35%), worked 19.5 days longer in a year (95% CI = 2.5-36.6 days), and earned US$959 more in total annual earnings (95% CI = US$285 to US$1634) than those not receiving CACR.
  
  
  CONCLUSIONS
  CACR can enhance productivity outcomes for patients with SMI, including higher employment rate, longer duration of work and higher income. The economic benefit of CACR can enhance the quality of life for patients with SMI, and may reduce financial burden on the health and welfare system. Therefore, CACR can be recommended and incorporated into regular vocational rehabilitation programs.
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, China.
authors.forename: Joyce Y C
authors.initials: JY
authors.lastname: Chan
authors.affiliation: Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, China.
authors.forename: Hoyee W
authors.initials: HW
authors.lastname: Hirai
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, China; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, China. Electronic address: kelvintsoi@cuhk.edu.hk.
authors.forename: Kelvin K F
authors.initials: KK
authors.lastname: Tsoi
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000706:statistics & numerical data*; D018849:Controlled Clinical Trials as Topic / Q000706:statistics & numerical data*; D004651:Employment / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D011618:Psychotic Disorders / Q000534:rehabilitation*; D012050:Rehabilitation, Vocational / Q000379:methods / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000534:rehabilitation*; D013813:Therapy, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data*
keywords: Computer-assisted cognitive remediation; Employment rate; Productivity outcomes; Schizophrenia; Severe mental illness