Qualitative exploration of the benefits of group-based memory rehabilitation for people with neurological disabilities: implications for rehabilitation delivery and evaluation

Objective: To identify patient-perceived benefits of memory rehabilitation and draw transferrable lessons for the delivery and evaluation of similar interventions for people with neurological disabilities. Methods: A qualitative study was conducted as part of a pragmatic randomised controlled trial comparing 2 memory rehabilitation approaches with a self-help control group. Postintervention interviews were conducted with 20 participants with a diagnosis of traumatic brain injury, multiple sclerosis or stroke. Data were analysed using a qualitative content analysis approach. Results: Participants receiving memory rehabilitation reported that the sessions responded to previously unmet needs for information on brain injury and memory function and developed their insight along with a sense of self-efficacy and control over the management of their memory problems. Although they did not experience major improvements in their memory function per se, they reported that rehabilitation gave them the skills to effectively cope with the residual deficits. Respondents in the control groups did not report similar benefits. The opportunities for interaction offered by the group setting were greatly valued by all respondents. Mixed aetiology groups were received positively; however, marked differences in cognitive performance were frustrating for some participants. Conclusions: The study highlighted important patient-perceived outcomes that should be considered by researchers and rehabilitation professionals when evaluating the effects of memory rehabilitation. The use of domain-specific outcome measures which reflect these areas is recommended. Qualitative changes in the use of memory aids may be achieved which cannot be captured by frequency indices alone. The benefits of the group-based rehabilitation approach were stressed by participants, suggesting that a combination of group and individual sessions might be a good practice

Outcome measurement in cognitive neurorehabilitation

Introduction: The aim of this chapter is to consider the criteria for selecting outcome measures for evaluating the effects of cognitive neurorehabilitation. The International Classification of Function, Disability and Health (ICF) (World Health Organization, 2001) is used as a framework for deciding what to measure. The properties of the ideal outcome measure are discussed. Examples of outcome measures commonly used in clinical studies are provided and their strengths and limitations considered. The focus is on self-report measures rather than neuropsychological tests as these reflect the effect of cognitive rehabilitation on daily life

Cognitive rehabilitation for memory deficits following stroke

Background: Memory problems are a common cognitive complaint following stroke. Memory rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them. Objectives: To determine the effectiveness of cognitive rehabilitation for memory problems following stroke. Search methods: We searched the Cochrane Stroke Group Trials Register (last searched September 2006). In addition, we searched the following electronic databases; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), CINAHL (1982 to June 2005), PsycINFO (1980 to July 2006), AMED (1985 to June 2005), British Nursing Index (1985 to June 2005), CAB Abstracts (1973 to May 2005) and the National Research Register (June 2006). We handsearched relevant journals and searched reference lists. Selection criteria: We selected controlled trials of memory retraining in stroke. We excluded studies with mixed aetiology groups unless 75% or more of the participants had a stroke or separate data were available for the stroke patients. Data collection and analysis: Two review authors selected trials for inclusion, assessed quality, and extracted data. Main results: Two trials, involving 18 participants, were included. One study compared the effectiveness of a mnemonic strategy treatment group with a 'drill and practice' control, while the other compared the effectiveness of an imagery mnemonics programme with a 'pragmatic' memory rehabilitation control programme. Formal meta‐analyses could not be performed due to a paucity of studies and lack of commonly‐employed outcome measures. The results do not show any significant effect of memory rehabilitation on performance of objective memory tests, and no significant effects of treatment on subjective and observer‐rated measures of memory. Authors' conclusions: There was no evidence to support or refute the effectiveness of memory rehabilitation on functional outcomes, and objective, subjective, and observer‐rated memory measures. There is a need for more robust, well‐designed and better‐reported trials of memory rehabilitation using common standardised outcome measures

The effectiveness of memory rehabilitation following neurological disabilities: a qualitative inquiry of patient perspectives

The evidence for the effectiveness of memory rehabilitation following neurological conditions, mainly studied through quantitative methodologies, has been equivocal. This study aimed to examine feedback from participants who had been through a randomised controlled trial (RCT) comparing two types of memory rehabilitation with a self-help control. It was envisaged that this information would offer a detailed understanding of patient experience of going through a trial and the perceived effects of having attended group sessions. Through 31 in-depth interviews, data collected were thematically analysed. The seven themes identified highlighted improvements in insight and awareness of memory problems and their neurological conditions, knowledge and skills about using memory aids; and as a consequence, improvements in cognitive functions, mood, and confidence, assertiveness and control over their condition. Participants also reported an altered perspective of life that helped them deal with their problems, and the therapeutic effects of attending group sessions. While these improvements were mainly reported in the intervention groups, even those in the control group reported some benefits. This study highlights that it is both feasible and advantageous to embed qualitative research within the traditional RCT methodology to arrive at a more nuanced understanding of patient experiences and intervention outcomes

Rasch analysis of the Nottingham Extended Activities of Daily Living Scale

Background and purpose: The Nottingham Extended Activities of Daily Living (EADL) Scale is frequently used in clinical practice and research in rehabilitation to assess patients’ independence in activities of daily living. Summative scores are used for this purpose, but this is problematic because the EADL is an ordinal level measurement scale. Objective: To examine the fit of data to the Rasch model and to determine how the fit could be improved by making changes to the scale. The appropriateness of using total and subscale (Mobility, Kitchen, Domestic and Leisure) scores in determining change over time was evaluated. Methods: EADL data (n = 210 stroke patients, 55% male, age range 27–93 years) from a randomized trial of a Stroke family support organiser service were analysed using the Partial Credit model. Results: Rasch analysis did not support the total scale as a unidimensional measure of activities of daily living. However, the subscales exhibited reasonable fit to the Rasch model following re-scoring and removal of items. Item 16 exhibited differential item functioning for age and item 22 differential item functioning for gender. Conclusion: The results endorse the use and psychometric properties of the 4 EADL subscales, but not the total scale. Further work to corroborate these findings would be usefu

Examining the relationship between fatigue and cognition after stroke: a systematic review

Many stroke survivors experience fatigue, which is associated with a variety of factors including cognitive impairment. A few studies have examined the relationship between fatigue and cognition and have obtained conflicting results. The aim of the current study was to review the literature on the relationship between fatigue and cognition post-stroke. The following databases were searched: EMBASE (1980–February, 2014), PsycInfo (1806–February, 2014), CINAHL (1937–February, 2014), MEDLINE (1946–February, 2014), Ethos (1600–February, 2014) and DART (1999–February, 2014). Reference lists of relevant papers were screened and the citation indices of the included papers were searched using Web of Science. Studies were considered if they were on adult stroke patients and assessed the following: fatigue with quantitative measurements (≥ 3 response categories), cognition using objective measurements, and the relationship between fatigue and cognition. Overall, 413 papers were identified, of which 11 were included. Four studies found significant correlations between fatigue and memory, attention, speed of information processing and reading speed (r = −.36 to .46) whereas seven studies did not. Most studies had limitations; quality scores ranged from 9 to 14 on the Critical Appraisal Skills Programme Checklists. There was insufficient evidence to support or refute a relationship between fatigue and cognition post-stroke. More robust studies are needed

Dysexecutive symptoms and carer strain following acquired brain injury: Changes measured before and after holistic neuropsychological rehabilitation.

BACKGROUND: Following acquired brain injury (ABI), deficits in executive functioning (EF) are common. As a result many brain-injured patients encounter problems in every-day functioning, and their families experience significant strain. Previous research has documented the benefits of cognitive rehabilitation for executive dysfunction, and rehabilitation programmes designed to ameliorate functional problems associated with ABI. OBJECTIVES: This study primarily aims to evaluate whether a neuropsychological rehabilitation programme reduces reported symptoms of everyday dysexecutive behaviour and carer strain. METHODS: In this study 66 ABI outpatients attended comprehensive holistic neuropsychological rehabilitation programme. A repeated-measures design was employed to determine the effect of rehabilitation on EF and carer strain, as part of a service evaluation. Outcome measures comprised the dysexecutive questionnaire (DEX/DEX-I) and carer strain index (CSI), applied pre- and post-rehabilitation. RESULTS: Results indicate rehabilitation benefited clients and carers in 5 of 6 DEX/DEX-I subscales, and 2 of 3 CSI subscales, (p < 0.05). An effect of aetiology on rehabilitation was found on the metacognitive scale of the DEX-I. CONCLUSIONS: Therefore, this study supports a comprehensive holistic neuropsychological rehabilitation programme as effective in reducing reported symptoms of dysexecutive behaviour and carer strain following ABI.Andrew Bateman is supported by National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust.This is the author accepted manuscript. The final version is available from IOS Press at http://dx.doi.org/10.3233/NRE-161338

Cognitive rehabilitation for memory deficits after stroke

Memory problems are common after a stroke, leading to difficulties in everyday life. Memory rehabilitation aims to help retrain lost functions or to teach patients strategies to compensate for them. Although some studies have reported positive outcomes after memory rehabilitation, reviews have provided inconclusive evidence for effectiveness. This is an update of a Cochrane review first published in 2000 and subsequently updated in 200

External memory aids for memory problems in people with multiple sclerosis: a systematic review

Approximately 40-60% of people with multiple sclerosis (MS) have memory problems, which adversely impact on their everyday functioning. Evidence supports the use of external memory aids in people with stroke and brain injury, and suggests they may reduce everyday memory problems in people with MS. Previous reviews of people with MS have only evaluated randomised trials; therefore this review included other methodologies. The aim was to assess the efficacy of external memory aids for people with MS for improving memory functioning, mood, quality of life, and coping strategies. Seven databases were systematically searched. Intervention studies that involved training in the use of external memory aids, e.g., personal digital assistants, with at least 75% of people with MS, were included. Based on study design, quality was rated with the SCED or PEDro scale. Nine studies involving 540 participants were included. One single case experimental design (mean of 8 on SCED scale) and eight group studies (mean of 5 on PEDro scale) were included. One study reported a significant treatment effect on subjective memory functioning, two on mood, and two on coping strategies. There is insufficient evidence to support or refute the effectiveness of external memory aids for improving memory function in people with MS