title: Brain training improves recovery after stroke but waiting list improves equally: A multicenter randomized controlled trial of a computer-based cognitive flexibility training.
abstract: BACKGROUND
  Brain training is currently widely used in an attempt to improve cognitive functioning. Computer-based training can be performed at home and could therefore be an effective add-on to available rehabilitation programs aimed at improving cognitive functioning. Several studies have reported cognitive improvements after computer training, but most lacked proper active and passive control conditions.
  
  
  OBJECTIVE
  Our aim was to investigate whether computer-based cognitive flexibility training improves executive functioning after stroke. We also conducted within-group analyses similar to those used in previous studies, to assess inferences about transfer effects when comparisons to proper control groups are missing.
  
  
  METHODS
  We conducted a randomized controlled, double blind trial. Adults (30-80 years old) who had suffered a stroke within the last 5 years were assigned to either an intervention group (n = 38), active control group (i.e., mock training; n = 35), or waiting list control group (n = 24). The intervention and mock training consisted of 58 half-hour sessions within a 12-week period. Cognitive functioning was assessed using several paper-and-pencil and computerized neuropsychological tasks before the training, immediately after training, and 4 weeks after training completion.
  
  
  CONCLUSIONS
  Both training groups improved on training tasks, and all groups improved on several transfer tasks (three executive functioning tasks, attention, reasoning, and psychomotor speed). Improvements remained 4 weeks after training completion. However, the amount of improvement in executive and general cognitive functioning in the intervention group was similar to that of both control groups (active control and waiting list). Therefore, this improvement was likely due to training-unspecific effects. Our results stress the importance to include both active and passive control conditions in the study design and analyses. Results from studies without proper control conditions should be interpreted with care.
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Renate M
authors.identifier: http://orcid.org/0000-0002-9422-3787
authors.initials: RM
authors.lastname: van de Ven
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jessika I V
authors.initials: JI
authors.lastname: Buitenweg
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.|Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Schmand
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Dick J
authors.initials: DJ
authors.lastname: Veltman
authors.affiliation: Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.
authors.forename: Justine A
authors.initials: JA
authors.lastname: Aaronson
authors.affiliation: Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.|Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.
authors.forename: Tanja C W
authors.initials: TC
authors.lastname: Nijboer
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
authors.forename: Suzanne J C
authors.initials: SJ
authors.lastname: Kruiper-Doesborgh
authors.affiliation: Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.
authors.forename: Coen A M
authors.initials: CA
authors.lastname: van Bennekom
authors.affiliation: Adelante-Zorggroep, Maastricht University, Caphri, Rehabilitation Medicine, Maastricht, The Netherlands.
authors.forename: Sascha M C
authors.initials: SM
authors.lastname: Rasquin
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.|Amsterdam Brain & Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: K Richard
authors.initials: KR
authors.lastname: Ridderinkhof
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jaap M J
authors.initials: JM
authors.lastname: Murre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D001921:Brain / Q000503:physiopathology; D003071:Cognition; D004311:Double-Blind Method; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation / Q000379:methods*; D014163:Transfer, Psychology; D014850:Waiting Lists