The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness

Systematic review and meta-analysis

D. van Duin, L. de Winter, M. Oud, H. Kroon, W. Veling

Research output: Contribution to journalReview articleScientificpeer-review

Abstract

Background:
Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning.

Method:
A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects.

Results:
The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator.

Conclusions:
Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.
Original languageEnglish
Pages (from-to)1414-1425
JournalPsychological medicine: A journal for research in psychiatry and the allied sciences
Volume49
Issue number9
DOIs
Publication statusPublished - 2019

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Cognitive Remediation
Education
Cognitive Dysfunction
Social Skills

Keywords

  • Cognitive skills training
  • NEUROCOGNITIVE ENHANCEMENT THERAPY
  • PEOPLE
  • PRODUCTIVITY OUTCOMES
  • PSYCHIATRIC REHABILITATION
  • RANDOMIZED CONTROLLED-TRIAL
  • SCHIZOPHRENIA
  • SKILLS
  • SOCIAL COGNITION
  • SUPPORTED EMPLOYMENT
  • WORK THERAPY
  • psychiatric rehabilitation
  • psychotic disorders
  • real-life functioning
  • severe mental illness

Cite this

@article{bfb1b9b3065d4fb99d2b34d325127fd3,
title = "The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness: Systematic review and meta-analysis",
abstract = "Background: Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning.Method: A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects.Results: The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator.Conclusions: Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.",
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author = "{van Duin}, D. and {de Winter}, L. and M. Oud and H. Kroon and W. Veling",
year = "2019",
doi = "10.1017/S003329171800418X",
language = "English",
volume = "49",
pages = "1414--1425",
journal = "Psychological Medicine",
issn = "0033-2917",
publisher = "CAMBRIDGE UNIV PRESS",
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}

The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness : Systematic review and meta-analysis. / van Duin, D.; de Winter, L.; Oud, M.; Kroon, H.; Veling, W.

In: Psychological medicine: A journal for research in psychiatry and the allied sciences, Vol. 49, No. 9, 2019, p. 1414-1425.

Research output: Contribution to journalReview articleScientificpeer-review

TY - JOUR

T1 - The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness

T2 - Systematic review and meta-analysis

AU - van Duin, D.

AU - de Winter, L.

AU - Oud, M.

AU - Kroon, H.

AU - Veling, W.

PY - 2019

Y1 - 2019

N2 - Background: Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning.Method: A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects.Results: The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator.Conclusions: Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.

AB - Background: Psychiatric rehabilitation (PR) can improve functioning in people with severe mental illness (SMI), but outcomes are still suboptimal. Cognitive impairments have severe implications for functioning and might reduce the effects of PR. It has been demonstrated that performance in cognitive tests can be improved by cognitive remediation (CR). However, there is no consistent evidence that CR as a stand-alone intervention leads to improvements in real-life functioning. The present study investigated whether a combination of PR and CR enhances the effect of a stand-alone PR or CR intervention on separate domains of functioning.Method: A meta-analysis of randomized controlled trials of PR combined with CR in people with SMI was conducted, reporting on functioning outcomes. A multivariate meta-regression analysis was carried out to evaluate moderator effects.Results: The meta-analysis included 23 studies with 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational outcomes were moderated by years of education, intensity of the intervention, type of CR approach and integration of treatment goals for PR and CR. Type of PR was no significant moderator.Conclusions: Augmenting PR by adding cognitive training can improve vocational and social functioning in patients with SMI more than a stand-alone PR intervention. First indications exist that a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.

KW - Cognitive skills training

KW - NEUROCOGNITIVE ENHANCEMENT THERAPY

KW - PEOPLE

KW - PRODUCTIVITY OUTCOMES

KW - PSYCHIATRIC REHABILITATION

KW - RANDOMIZED CONTROLLED-TRIAL

KW - SCHIZOPHRENIA

KW - SKILLS

KW - SOCIAL COGNITION

KW - SUPPORTED EMPLOYMENT

KW - WORK THERAPY

KW - psychiatric rehabilitation

KW - psychotic disorders

KW - real-life functioning

KW - severe mental illness

U2 - 10.1017/S003329171800418X

DO - 10.1017/S003329171800418X

M3 - Review article

VL - 49

SP - 1414

EP - 1425

JO - Psychological Medicine

JF - Psychological Medicine

SN - 0033-2917

IS - 9

ER -