Clinically Meaningful Cognitive Interventions for People With Multiple Sclerosis: A Systematic Review With a Functional Perspective

PURPOSE: The aim of this study is to determine whether any cognitive rehabilitation (CR) interventions for persons with multiple sclerosis (MS) exist in the literature (2009–2014) that produce long-term (1-yr postintervention) effects contributing to improvement of everyday functioning and if they are supported by relevant outcome measures.

This study also examined whether any CR interventions focus on cognitive domains other than the two most commonly explored: learning and memory. Last, any recommendations regarding effective interventions for CR in persons with MS are also proposed.

RATIONALE: Cognitive impairment is observed in 40%–70% of persons with MS, yet few practice standards exist for CR with this population. This prevents occupational therapists from delivering evidence-based interventions. The current study reviews literature between 2009 and 2014 to determine the existence of new cognitive rehabilitation interventions for people with MS. Outcome measures that are long term and functional in nature will be prioritized. The purpose of this study is to determine whether any cognitive rehabilitation interventions result in prolonged improvement of global functioning in those with MS and whether any clinical practice guidelines can be recommended.

DESIGN: This study was an intervention-focused systematic review. We reviewed 22 articles focused on CR for persons with MS published 2009–2014.

METHOD: A literature review using the following databases: PubMed, PsycINFO, Medline, and CINAHLplus with full text (EBSCO). Excluded articles were those in which the study was not an intervention, it was a theoretic article, it was a review article, detail was lacking to fully evaluate the intervention, it was not specific to the MS population, it included a pediatric sample, it was a case report without empirical data to evaluate outcomes, it was not peer reviewed (also excludes book chapters), it was a pharmacologic intervention, and it was not available for review in English.

ANALYSIS: There were five reviewers. All articles were reviewed independently by at least two readers to characterize the important elements of each study, classify the level of evidence, and examine the risk of bias.

RESULTS: The domains of attention, processing speed, and executive functions were addressed in a total of 14 articles. All randomized controlled trials reported significant results in their respective domains of study. Fourteen of the total 22 studies utilized a computer-based intervention technique, and all of these yielded significant results. Only 3 of the 22 reviewed articles included long-term follow-up. Ten of the 22 reviewed articles included functional outcomes measures, and none of these measures include both a subjective and an objective component. Only 1 study included both functional and long-term outcome measures.

DISCUSSION: Results indicate that cognitive impairments such as memory, executive functions, and attention can be improved with certain CR interventions. However, there are still gaps in research that need to be addressed to recommend additional practice standards, as well as practice standards for cognitive domains other than memory. Future research in this area will allow for these standards to be made, and as a result clients may generalize gains made in therapy to their everyday lives, thereby increasing independence and quality of life.

IMPACT STATEMENT: The current study reviews literature between 2009 and 2014 to explore cognitive rehabilitation interventions for people with MS. Research in this area is needed to make practice standards, which will contribute to successful occupational performance for this population.