1
|
Abdul Razak LH, Denis T, Murugiah Y, Yoong WK, Idris Z, Senik MH. The Effect of Traumatic Brain Injury on Memory. Malays J Med Sci 2024; 31:52-74. [PMID: 38984242 PMCID: PMC11229567 DOI: 10.21315/mjms2024.31.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/22/2023] [Indexed: 07/11/2024] Open
Abstract
Having a good memory is essential for carrying out daily tasks. People cannot study, plan, remember or navigate life effectively if they are memoryless. People may be at risk when mistakes made in the past will be repeated and lessons regarding danger cannot be learned. In the community, traumatic brain injury (TBI) is common and individuals with TBI frequently have memory problems. It is crucial to study how TBI affects memory to better understand the underlying mechanism and to tailor rehabilitation for patients with a range of pathologies and severity levels. Thus, this paper aimed to review studies related to TBI's effect on memory. This review examined recent studies to learn more regarding and comprehend the connection between TBI and memory, including short-term memory (STM), working memory (WM) and long-term memory (LTM). This will undoubtedly have a big impact on how memory problems that may arise after TBI will be addressed. Virtual reality and other technological advancements have given the medical community a new way to investigate rehabilitative therapy.
Collapse
Affiliation(s)
| | - Tedd Denis
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Yoghaanjaly Murugiah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Weng Kei Yoong
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Harizal Senik
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| |
Collapse
|
2
|
Brown J, Kaelin D, Mattingly E, Mello C, Miller ES, Mitchell G, Picon LM, Waldron-Perine B, Wolf TJ, Frymark T, Bowen R. American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2455-2526. [PMID: 36373898 DOI: 10.1044/2022_ajslp-21-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. PURPOSE The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. METHOD A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. RECOMMENDATIONS This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.
Collapse
Affiliation(s)
| | | | | | | | - E Sam Miller
- Maryland State Department of Education, Baltimore
| | | | | | | | | | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
| | - Rebecca Bowen
- American Speech-Language-Hearing Association, Rockville, MD
| |
Collapse
|
3
|
Ling X, Gabrio A, Mason A, Baio G. A Scoping Review of Item-Level Missing Data in Within-Trial Cost-Effectiveness Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1654-1662. [PMID: 35341690 DOI: 10.1016/j.jval.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Cost-effectiveness analysis (CEA) alongside randomized controlled trials often relies on self-reported multi-item questionnaires that are invariably prone to missing item-level data. The purpose of this study is to review how missing multi-item questionnaire data are handled in trial-based CEAs. METHODS We searched the National Institute for Health Research journals to identify within-trial CEAs published between January 2016 and April 2021 using multi-item instruments to collect costs and quality of life (QOL) data. Information on missing data handling and methods, with a focus on the level and type of imputation, was extracted. RESULTS A total of 87 trial-based CEAs were included in the review. Complete case analysis or available case analysis and multiple imputation (MI) were the most popular methods, selected by similar numbers of studies, to handle missing costs and QOL in base-case analysis. Nevertheless, complete case analysis or available case analysis dominated sensitivity analysis. Once imputation was chosen, missing costs were widely imputed at item-level via MI, whereas missing QOL was usually imputed at the more aggregated time point level during the follow-up via MI. CONCLUSIONS Missing costs and QOL tend to be imputed at different levels of missingness in current CEAs alongside randomized controlled trials. Given the limited information provided by included studies, the impact of applying different imputation methods at different levels of aggregation on CEA decision making remains unclear.
Collapse
Affiliation(s)
- Xiaoxiao Ling
- Department of Statistical Science, University College London, London, England, UK.
| | - Andrea Gabrio
- Department of Methodology and Statistics, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Alexina Mason
- London School of Hygiene and Tropical Medicine, London, England, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, England, UK
| |
Collapse
|
4
|
Superior memory as a new perspective to tackle memory loss. Neurosci Biobehav Rev 2022; 141:104828. [PMID: 35970419 DOI: 10.1016/j.neubiorev.2022.104828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022]
|
5
|
Current practice in the measurement and interpretation of intervention adherence in randomised controlled trials: A systematic review. Contemp Clin Trials 2022; 118:106788. [PMID: 35562000 DOI: 10.1016/j.cct.2022.106788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ideally all participants in a randomised controlled trial (RCT) should fully receive their allocated intervention; however, this rarely occurs in practice. Intervention adherence affects Type II error so influences the interpretation of trial results and subsequent implementation. We aimed to describe current practice in the definition, measurement, and reporting of intervention adherence in non-pharmacological RCTs, and how this data is incorporated into a trial's interpretation and conclusions. METHODS We conducted a systematic review of phase III RCTs published between January 2018 and June 2020 in the National Institute for Health Research Journals Library for the Health Technology Assessment, Programme Grants for Applied Research, and Public Health Research funding streams. RESULTS Of 237 reports published, 76 met the eligibility criteria and were included. Most RCTs (n = 68, 89.5%) reported adherence, though use of terminology varied widely; nearly three quarters of these (n = 49, 72.1%) conducted a sensitivity analysis. Adherence measures varied between intervention types: behavioural change (n = 10, 43.5%), psychological therapy (n = 5, 83.3%) and physiotherapy/rehabilitation (n = 8, 66.7%) interventions predominately measured adherence based on session attendance. Whereas medical device and surgical interventions (n = 17, 73.9%) primarily record the number of participants receiving the allocated intervention, a third (n = 33, 67.3%) of studies reported a difference in findings between primary and sensitivity analyses. CONCLUSIONS Although most trials report elements of adherence, terminology was inconsistent, and there was no systematic approach to its measurement, analyses, interpretation, or reporting. Given the importance of adherence within clinical trials, there is a pressing need for a standardised approach or framework.
Collapse
|
6
|
Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial. BMC Health Serv Res 2022; 22:185. [PMID: 35151285 PMCID: PMC8840547 DOI: 10.1186/s12913-022-07585-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Traumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.
Methods
One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER).
Results
The mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU.
Conclusions
Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.
Trial registration
ClinicalTrails.gov NCT03092713.
Collapse
|
7
|
Lincoln NB, Bradshaw LE, Constantinescu CS, Day F, Drummond AE, Fitzsimmons D, Harris S, Montgomery AA, das Nair R. Group cognitive rehabilitation to reduce the psychological impact of multiple sclerosis on quality of life: the CRAMMS RCT. Health Technol Assess 2021; 24:1-182. [PMID: 31934845 DOI: 10.3310/hta24040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND People with multiple sclerosis have problems with memory and attention. The effectiveness of cognitive rehabilitation has not been established. OBJECTIVES The objectives were to assess the clinical effectiveness and cost-effectiveness of a cognitive rehabilitation programme for people with multiple sclerosis. DESIGN This was a multicentre, randomised controlled trial in which participants were randomised in a ratio of 6 : 5 to receive cognitive rehabilitation plus usual care or usual care alone. Participants were assessed at 6 and 12 months after randomisation. SETTING The trial was set in hospital neurology clinics and community services. PARTICIPANTS Participants were people with multiple sclerosis who had cognitive problems, were aged 18-69 years, could travel to attend group sessions and gave informed consent. INTERVENTION The intervention was a group cognitive rehabilitation programme delivered weekly by an assistant psychologist to between four and six participants for 10 weeks. MAIN OUTCOME MEASURES The primary outcome was the Multiple Sclerosis Impact Scale - Psychological subscale at 12 months. Secondary outcomes included results from the Everyday Memory Questionnaire, the 30-Item General Health Questionnaire, the EuroQol-5 Dimensions, five-level version and a service use questionnaire from participants, and the Everyday Memory Questionnaire - relative version and the Modified Carer Strain Index from a relative or friend of the participant. RESULTS Of the 449 participants randomised, 245 were allocated to cognitive rehabilitation (intervention group) and 204 were allocated to usual care (control group). Of these, 214 in the intervention group and 173 in the control group were included in the primary analysis. There was no clinically important difference in the Multiple Sclerosis Impact Scale - Psychological subscale score between the two groups at the 12-month follow-up (adjusted difference in means -0.6, 95% confidence interval -1.5 to 0.3; p = 0.20). There were no important differences between the groups in relation to cognitive abilities, fatigue, employment, or carer strain at follow-up. However, there were differences, although small, between the groups in the Multiple Sclerosis Impact Scale - Psychological subscale score at 6 months (adjusted difference in means -0.9, 95% confidence interval -1.7 to -0.1; p = 0.03) and in everyday memory on the Everyday Memory Questionnaire as reported by participants at 6 (adjusted difference in means -5.3, 95% confidence interval -8.7 to -1.9) and 12 months (adjusted difference in means -4.4, 95% confidence interval -7.8 to -0.9) and by relatives at 6 (adjusted difference in means -5.4, 95% confidence interval -9.1 to -1.7) and 12 months (adjusted difference in means -5.5, 95% confidence interval -9.6 to -1.5) in favour of the cognitive rehabilitation group. There were also differences in mood on the 30-Item General Health Questionnaire at 6 (adjusted difference in means -3.4, 95% confidence interval -5.9 to -0.8) and 12 months (adjusted difference in means -3.4, 95% confidence interval -6.2 to -0.6) in favour of the cognitive rehabilitation group. A qualitative analysis indicated perceived benefits of the intervention. There was no evidence of a difference in costs (adjusted difference in means -£574.93, 95% confidence interval -£1878.93 to £729.07) or quality-adjusted life-year gain (adjusted difference in means 0.00, 95% confidence interval -0.02 to 0.02). No safety concerns were raised and no deaths were reported. LIMITATIONS The trial included a sample of participants who had relatively severe cognitive problems in daily life. The trial was not powered to perform subgroup analyses. Participants could not be blinded to treatment allocation. CONCLUSIONS This cognitive rehabilitation programme had no long-term benefits on quality of life for people with multiple sclerosis. FUTURE WORK Future research should evaluate the selection of those who may benefit from cognitive rehabilitation. TRIAL REGISTRATION Current Controlled Trials ISRCTN09697576. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 4. See the National Institute for Health Research Journals Library website for further project information.
Collapse
Affiliation(s)
- Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | | | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
8
|
ABCA1-Labeled Exosomes in Serum Contain Higher MicroRNA-193b Levels in Alzheimer's Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5450397. [PMID: 33763470 PMCID: PMC7963893 DOI: 10.1155/2021/5450397] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
Objective We aimed to establish a method to determine whether microRNA-193b (miR-193b) levels in ABCA1-labeled serum exosomes might serve as a marker for the diagnosis of Alzheimer's disease. Methods We used immunocapture methods to determine the levels of ABCA1-labeled exosomal miR-193b in cultures of white blood cells (WBCs), red blood cells (RBCs), mouse hippocampal neuron HT-22 cells, and primary mouse neuronal cells. ABCA1-labeled exosomal miR-193b levels were also evaluated in the cerebrospinal fluid (CSF) and serum of APP/PS1 double-transgenic mice, as well as control subjects (n = 60) and study participants with subjective cognitive decline (SCD, n = 89), stage and mild cognitive impairment (MCI, n = 92), and dementia of the Alzheimer type (DAT, n = 92). Results ABCA1 levels of exosomes harvested from the medium of HT-22 cells and neurons were significantly higher than those of RBCs and WBCs (P < 0.05). Exosomal ABCA1 from the CSF of APP/PS1 mice were transmitted to the serum of wild-type mice after injection, and high miR-193b levels were observed in both the serum and CSF after injection. The ABCA1-labeled exosomal miR-193b levels were higher in the CSF of MCI and DAT patients compared with the CSF of the control group (P < 0.05). The ABCA1-labeled exosomal miR-193b were also slightly higher (P > 0.05) in the serum of SCD patients and significantly higher in the serum of MCI and DAT patients compared with the serum of the control group (P < 0.05). Conclusion This study provides a method to capture specific exosomes. Detection of serum exosomes labeled with ABCA1 may facilitate the early diagnosis of AD.
Collapse
|
9
|
Trigg E, Clarke S, Wong D, Nair R. Therapist competence and clinical outcome in the rehabilitation of memory following traumatic brain injury trial. Brain Inj 2021; 35:395-403. [PMID: 33593156 DOI: 10.1080/02699052.2021.1877817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Therapist competencies when delivering an intervention can impact clinical outcomes. However, the relationship between competence and outcome in the context of memory rehabilitation has not previously been investigated. We aimed to evaluate whether therapist competencies in delivering a group-based memory rehabilitation intervention, as part of a randomized-controlled trial, was associated with changes in clinical outcome in the participants with traumatic brain injury.Method: Outcome data on the Everyday Memory Questionnaire (EMQ) and Goal Attainment Scaling (GAS) were obtained for 24 participants of the memory rehabilitation trial. Video recordings of intervention sessions delivered by six therapists were coded using a checklist designed to evaluate therapist competence in group facilitation.Results: Therapists demonstrated consistently high levels of competency in facilitating the memory group. Correlational analyses showed that there was a non-significant weak association between EMQ and therapist competence (r = .28, p = .18), and between GAS and therapist competence for short- and long-term goals (r = -.33, p = .12 and r = -.24, p = .25, respectively).Conclusions: We found no significant association between competence and outcome in this memory rehabilitation trial. This may reflect insufficient variability in therapist competence and/or the nature of the clinical outcome measures used. Further research is needed to understand competence-outcome relationships in cognitive rehabilitation.
Collapse
Affiliation(s)
- Emma Trigg
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Sara Clarke
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Dana Wong
- School of Psychology & Public Health, La Trobe University, Melbourne, Australia.,School of Psychological Sciences, Monash University, Clayton, Australia
| | - Roshan Nair
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.,School of Psychology & Public Health, La Trobe University, Melbourne, Australia.,Institute of Mental Health, Nottingham, UK
| |
Collapse
|
10
|
Lincoln NB, Bradshaw LE, Constantinescu CS, Day F, Drummond AER, Fitzsimmons D, Harris S, Montgomery AA, das Nair R, Morgan M, Scott J, Evans S, McKeown S, Bharadia T, Moore P, Young C, Sharrack B, Isaac C, Griffths D, Fixter V, Hanley L, Evans S, Palmer L, Tyrell T, Gaughan S, Elliot G, Keogh S, Oldknow H, Edwards C, Schofield N, Clarke S, Crossley K, Griffiths H, Knight C, Martin K, Cunliffe A, Pollard C, Wilson J, Trigg E, Vanzan S, Dalton J, Pegnall S, Carpenter H, Cogger H, Harnell R, Klein O, Mhizha-Murira J, Powers K, Squires L, Sprange K, Evans A, Hobbs J, Wakefield N, Barnes B, Crone M, Foster M, Rumsey C, Erven A, Moss-Morris R, Bowen A, O’Connor R, Freeman J, Taylor R, Rose A. Cognitive rehabilitation for attention and memory in people with multiple sclerosis: a randomized controlled trial (CRAMMS). Clin Rehabil 2019; 34:229-241. [DOI: 10.1177/0269215519890378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the clinical and cost-effectiveness of cognitive rehabilitation for attention and memory problems in people with multiple sclerosis. Design: Multicentre, pragmatic, randomized controlled trial. Setting: Community Participants: People with multiple sclerosis aged 18–69 years, who reported cognitive problems in daily life and had cognitive problems on standardized assessment. Interventions: A group cognitive rehabilitation programme delivered in 10 weekly sessions in comparison with usual care. Main measures: The primary outcome was the Multiple Sclerosis Impact Scale Psychological subscale at 12 months after randomization. Secondary outcomes included measures of everyday memory problems, mood, fatigue, cognitive abilities and employment at 6 and 12 months after randomization. Results: In all, 245 participants were allocated to cognitive rehabilitation and 204 to usual care. Mean Multiple Sclerosis Impact Scale Psychological at 12 months was 22.2 (SD = 6.1) for cognitive rehabilitation and 23.4 (SD = 6.0) for usual care group; adjusted difference −0.6, 95% confidence interval (CI) = −1.5 to 0.3, P = 0.20. No differences were observed in cognitive abilities, fatigue or employment. There were small differences in favour of cognitive rehabilitation for the Multiple Sclerosis Impact Scale Psychological at 6 months and everyday memory and mood at 6 and 12 months. There was no evidence of an effect on costs (−£808; 95% CI = −£2248 to £632) or on quality-adjusted life year gain (0.00; 95% CI = −0.01 to 0.02). Conclusion: This rehabilitation programme had no long-term benefits on the impact of multiple sclerosis on quality of life, but there was some evidence of an effect on everyday memory problems and mood.
Collapse
Affiliation(s)
- Nadina B Lincoln
- Division of Rehabilitation and Ageing, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Florence Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | | | - Shaun Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottingham, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
das Nair R, Bradshaw LE, Day FEC, Drummond A, Harris SRS, Fitzsimmons D, Montgomery AA, Newby G, Sackley C, Lincoln NB. Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial. Clin Rehabil 2019; 33:1171-1184. [PMID: 30977398 PMCID: PMC6585159 DOI: 10.1177/0269215519840069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury. DESIGN Multicentre, pragmatic, observer-blinded, randomized controlled trial in England. SETTING Community. PARTICIPANTS People with memory problems following traumatic brain injury, aged 18-69 years, able to travel to group sessions, communicate in English, and give consent. INTERVENTIONS A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control). MAIN MEASURES The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization. RESULTS We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: -2.1, 95% confidence interval (CI): -6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient's everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised. CONCLUSION This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions.
Collapse
Affiliation(s)
- Roshan das Nair
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Florence EC Day
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Shaun RS Harris
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | | | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Gavin Newby
- Newby Psychological Services Ltd, Northwich, UK
| | - Catherine Sackley
- School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Nadina B Lincoln
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| |
Collapse
|