Cognitive strategy interventions for improving performance of activities of daily living in adults following stroke: a systematic review.
Swanton, R Gustaffson, L. Elspeth Froude, Tenelle Hodson, Michelle McInerney, Natasha Lannin
Background: People with stroke experience persistent difficulties performing important activities of daily living. In cognitive strategy training people learn to apply a structured problem-solving framework, whereby they identify barriers to performance, generate strategies and practice applying strategies to achieve activity goals. Several cognitive strategy training approaches have been described in the literature. However, little is known on the effect of cognitive strategy training for improving performance of activities of daily living for adults with neurological conditions. A systematic review with meta-analysis was conducted.
Method: Searches were conducted in MEDLINE, CINAHL, EMBASE, PsycINFO, PsycBite and Cochrane Database of Systematic Reviews. Primary outcome included any measure of performance of activities of daily living. Two reviewers independently screened abstracts and appraised methodological quality of studies. Validity of studies was systematically assessed, and a content analysis of methodologies was conducted.
Results: 34 studies were included in the content analysis. Of these, 21 studies (62%) compared cognitive strategy training with usual care (commonly task-specific-training) in people with stroke. Eleven were randomised controlled trials (n = 613) and were included in meta-analysis. PEDro scores ranged from 4 to 8. Studies were conducted across all phases of rehabilitation. Six different cognitive strategy training approaches were used. Overall, results indicated that cognitive strategy training was not superior to usual care interventions in improving activity performance with SMD 0.41, 95% CI 0.12 to 0.71 favouring control interventions.
Conclusion: There is currently insufficient high-quality evidence to support or refute the effectiveness of cognitive strategy training for adults following stroke.