Integrative group-based cognitive rehabilitation efficacy in multiple sclerosis: a randomized clinical trial

Abstract

Purpose: This study aimed to determine the efficacy of the integrative group-based cognitive rehabilitation programme, REHACOP, on improving cognitive functions in multiple sclerosis (MS).

Methods: Fourty-two MS patients were randomized to the treatment programme REHACOP (n = 21) or waiting list control condition (n = 21). The REHACOP group received cognitive rehabilitation in group format for three months focused on attention, processing speed, learning and memory, language, executive functioning, and social cognition. Patients completed a neuropsychological assessment at baseline and follow-up, which included tests of attention, processing speed, working memory, verbal memory, verbal fluency, and executive functioning. Repeated measures multivariate analysis of covariance (MANCOVA) was used to determine the efficacy of the cognitive rehabilitation programme.

Results: Group × Time interactions revealed significant improvements in the REHACOP group as compared with the control group for processing speed (p = 0.011, n_p² = 0.16), working memory (p = 0.014, n_p² = 0.15), verbal memory (p = 0.025, n_p² = 0.13), and executive functioning (p = 0.024, n_p² = 0.13), showing medium–large effect sizes.

Conclusions: Patients receiving REHACOP showed improvements in several cognitive domains. This preliminary study thus provides evidence supporting the efficacy of this integrative group-based cognitive rehabilitation intervention in MS. Future research should confirm these findings, examine the impact of the treatment on everyday life functioning and explore the presence of brain changes associated with cognitive rehabilitation.

Implications for rehabilitation

• This study provides initial evidence for integrative group-based cognitive rehabilitation efficacy in MS patients through the implementation of the REHACOP cognitive rehabilitation programme.

• Patients received cognitive rehabilitation for three months (3 one-hour-sessions per week) focused on training attention, learning and memory, language, executive functioning, and social cognition.

• Patients attending REHACOP sessions showed medium to large and statistically significant improvements in processing speed, working memory, verbal memory, and executive functioning.

Keywords:

• REHACOP
• neuropsychological rehabilitation
• cognition
• neurodegenerative diseases
• multiple sclerosis

Acknowledgements

The authors would like to thank ADEMBI and all the patients involved in the study.

Disclosure statement

N.O. and J.P. are coauthors and copyright holders of the REHACOP cognitive rehabilitation programme, published by Parima Digital, S.L. (Bilbao, Spain). J.D.L has received grant funding from Biogen IDEC. He also has served on an advisory board for Biogen IDEC, and a speaker for EMD Serono. O.R., A.R.A., M.M.B., A.G.G, N.C. and N.I.B. have no conflicts of interest to report.

Additional information

Funding

This work was supported by the Spanish Ministry of Economy and Competitiveness [grant number PSI2012-32441 to N.I.B.].