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Cognitive and motor therapy after stroke is not superior to motor and cognitive therapy alone to improve cognitive and motor outcomes : New insights from a meta-analysis
Embrechts, Elissa McGuckian, Thomas B. Rogers, Jeffrey M. Dijkerman, Chris H. Steenbergen, Bert Wilson, Peter H. Nijboer, Tanja C. W.
Embrechts, Elissa
McGuckian, Thomas B.
Rogers, Jeffrey M.
Dijkerman, Chris H.
Steenbergen, Bert
Wilson, Peter H.
Nijboer, Tanja C. W.
Abstract
Objective
To evaluate whether cognitive and motor therapy (CMT) is more effective than no therapy, motor therapy, or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting and which CMT approach is most effective.
Data Sources
AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October 2022.
Study Selection
Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010 that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive, or cognitive-motor outcome. Two CMT approaches exist: CMT dual-task (“classical” dual-task where the secondary cognitive task has a distinct goal) and CMT integrated (where cognitive components of the task are integrated into the motor task).
Data Extraction
Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multilevel random effects meta-analysis was conducted.
Data Synthesis
CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49; 95% confidence interval [CI], 0.10, 0.88) and cognitive-motor outcomes (g=0.29; 95% CI, 0.03, 0.54). CMT showed no significant effects compared with motor therapy on motor, cognitive, and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18; 95% CI, 0.01, 0.36) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07; 95% CI, −0.04, 0.18). Comparison of CMT dual-task and integrated revealed no significant difference for motor (F1,141=0.80; P=.371) or cognitive outcomes (F1,72=0.61, P=.439).
Conclusions
CMT was not superior to monotherapies in improved outcomes after stroke. CMT approaches were equally effective, suggesting that training that enlists a cognitive load per se may benefit outcomes.
Keywords
cognition, cognitive-motor therapy, motor, rehabilitation, stroke
Date
2023
Type
Journal article
Journal
Archives of Physical Medicine and Rehabilitation
Book
Volume
104
Issue
10
Page Range
1720-1734
Article Number
ACU Department
School of Behavioural and Health Sciences
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled
Notes
© 2023 by the American Congress of Rehabilitation Medicine.