Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis.
Objective:To quantitatively aggregate effects of cognitive training (CT) on cognitive and functional outcome measures in patients with traumatic brain injury (TBI) more than 12-months post-injury.Design:We systematically searched six databases for non-randomized and randomized controlled trials of CT in TBI patients at least 12-months post-injury reporting cognitive and/or functional outcomes.Main Measures:Efficacy was measured as standardized mean difference (Hedges'g) of post-training change. We investigated heterogeneity across studies using subgroup analyses and meta-regressions.Results:Fourteen studies encompassing 575 patients were included. The effect of CT on overall cognition was small and statistically significant (g= 0.22, 95%CI 0.05 to 0.38;p= 0.01), with low heterogeneity (I2= 11.71%) and no evidence of publication bias. A moderate effect size was found for overall functional outcomes (g= 0.32, 95%CI 0.08 to 0.57,p= 0.01) with low heterogeneity (I2= 14.27%) and possible publication bias. Statistically significant effects were also found only for executive function (g= 0.20, 95%CI 0.02 to 0.39,p= 0.03) and verbal memory (g= 0.32, 95%CI 0.14 to 0.50,p< 0.01).Conclusion:Despite limited studies in this field, this meta-analysis indicates that CT is modestly effective in improving cognitive and functional outcomes in patients with post-acute TBI and should therefore play a more significant role in TBI rehabilitation.
Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia.
Harry
H
Hallock
Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia.
Daniel
D
Collins
Regenerative Neuroscience Group, Brain and Mind Centre, University of SydneySydney, NSW, Australia; School of Psychology, University of SydneySydney, NSW, Australia.
Amit
A
Lampit
Sydney Medical School, University of Sydney Sydney, NSW, Australia.
Kiran
K
Deol
School of Health and Rehabilitation Sciences, University of QueenslandBrisbane, QLD, Australia; Occupational Therapy Department, Princess Alexandra HospitalBrisbane, QLD, Australia; Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, QLD, Australia.
Jennifer
J
Fleming
Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia.
Michael
M
Valenzuela
TBI; closed head injury; cognitive outcome; cognitive training; neuropsychological outcome; rehabilitation; traumatic brain injury