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Titre : | 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 (2023) |
Auteurs : | Elissa Embrechts ; Thomas B. McGuckian ; Jeffrey M. Rogers ; Chris H. Dijkerman ; Bert Steenbergen ; Peter H. Wilson ; Tanja C.W. Nijboer |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 104, n° 10, 2023) |
Article en page(s) : | p. 1720-1734 |
Note générale : | https://doi.org/10.1016/j.apmr.2023.05.010 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Accident vasculaire cérébral (AVC) ; Cognition ; Réadaptation ; Thérapie cognitive ; Troubles moteurs |
Résumé : | 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. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S000399932300343X |