A randomized control trial of the effects of home-based online attention training and working memory training on cognition and everyday function in a community stroke sample

Figures & data

Figure 1. CONSORT diagram showing flow of patients through the study.

Table 1. Comparison of the three groups on background measures and self-reported symptom severity at baseline.

Measure	Intervention group	Mean (±S.D)	F-test (p value)
Background Measures
	SAT	58 (15.4)
Age (yrs)	WMT	62 (12.2)	0.89 (.42)
	WL	61 (13.8)
	SAT	23.45 (6.92)
Visual Acuity (value/20)	WMT	25.03 (7.16)	1.31 (.27)
	WL	26.67(10.21)
	SAT	34.61 (7.27)
NART (no.correct)	WMT	32.35 (8.69)	1.63 (.20)
	WL	30.64 (8.66)
	SAT	27.61 (5.84)
Cattell (no. correct)	WMT	25.86 (6.51)	1.66 (.20)
	WL	24.88 (6.14)
Symptom Severity
	SAT	1.60 (0.31)
EBIQ core (patient)	WMT	1.65 (0.44)	0.38 (.68)
	WL	1.58 (0.28)
Time since stroke onset
	SAT	2.33 (3.56)
Time since injury (years)	WMT	3.85 (5.92)	0.97 (.39)
	WL	3.10 (4.35)

Table 2. Participant performance on baseline measures of cognitive function.

Measure	Mean (±S.D)	% Patients >2 SD below population mean	% patients >1.28 SD below population mean
Cattell (scaled IQ score)	91 (14.4)	8%	23%
TVA Absolute Bias	0.09 (0.09)	35%	53%
TVA VSTM capacity (K)	3.30 (0.95)	43%	65%
OCS-BRIDGE Spatial Bias on the Hearts Cancellation Test	0.063 (0.13)	18%	52%
OCS-BRIDGE Forward Digit Span	6.05 (1.19)	8%	25%
OCS-BRIDGE Backwards Digit Span	4.33 (1.31)	2%	49%
OCS-BRIDGE Sustained and Lateralized Attention Test (SALT). Spatial bias (omissions)	0.09 (0.15)	41%	64%
OCS-BRIDGE SALT Lateralized bias in reaction times	0.11 (0.24)	28%	43%
OCS-BRIDGE SALT Sustained Attention	2.85 (1.02)	8%	33%

Note: Here, mean and standard deviations of performance are provided together with the percentage of the sample performing more than 2 standard deviations below the general population mean (i.e., approximately below the 5th percentile), a level often taken as operationalizing an “impairment.” The percentage of the sample in the less conservative lower 10% range (i.e., below 1.28 standard deviations of the general population mean that may be characterized as “probable impairment”) is also presented.

Figure 2. Mean daily performance on the training tasks over the 20 training sessions. (A) shows average performance of the SAT patients (collapsed across the five training tasks which made up each session) whilst (B) shows the avarage performance of the WMT patients (collapsed across the 4 training tasks they completed at each session).

Figure 3. Mean (±S.E) ratings of (A) the helpfulness and (B) the enjoyableness of SAT and WMT over the 4 weeks of training.

Table 3. The results of the regression analyses of the secondary end-points.

Measure	R²	F-test (p value)	Β (p value)
Attention Measures
OCS-BRIDGE Visual Extinction (Absolute bias)	0.75	93.47 (<.001)	Pre-int’ 0.87 (<.001)
OCS-BRIDGE Hearts Cancellation (Absolute bias)	0.79	119.60 (<.001)	Pre-int’ 0.87 (<.001)
OCS-BRIDGE SALT Reaction Time (Absolute bias)	0.36	16.27 (<.001)	Pre-int’ 0.60 (<.001)
OCS-BRIDGE SALT Count errors	0.16	5.75 (<.001)	Pre-int’ 0.40 (<.001)
ANT (Incong RT- ((CongRT + NeutRT)/2))	0.26	13.32 (<.001)	Pre-int’ 0.54 (<.001)
CRT (RT)	0.69	73.10 (<.001)	Pre-int’ 0.83 (<.001)
CRT (variability)	0.21	8.67 (<.001)	Pre-int’ 0.46 (<.001)
TVA VSTM capacity (K)	0.70	77.39 (<.001)	Pre-int’ 0.84 (<.001)
TVA K variability	0.70	82.77 (<.001)	Pre-int’ 0.85 (<.001)
Memory Measures
OCS-BRIDGE FINS Forward Span	0.15	4.44 (.01)	Pre-int’ 0.36 (=.001)
OCS-BRIDGE FINS Backward Span	0.34	13.03 (<.001)	Pre-int’ 0.58 (<.001)
AWMA Dot Matrix	0.56	41.98 (<.001)	Pre-int’ 0.76(<.001)
AWMA Spatial Recall (memory)	0.62	52.77 (<.001)	Pre-int’ 0.79(<.001)
AWMA Spatial Recall (processing)	0.48	30.37 (<.001)	Pre-int’ 0.70(<.001)
Symptom Severity
EBIQ core (patient)	0.75	98.63 (<.001)	Pre-int’ 0.86 (<.001)
EBIQ core (carer)	0.77	81.57(<.001)	Pre-int’ 0.87 (<.001)
Cognitive Failures Questionnaire	0.73	86.93(<.001)	Pre-int’ 0.83 (<.001)
Subjective Neglect Questionnaire	0.77	84.56 (<.001)	Pre-int’ 0.89 (<.001)

Note: The table provides the variance (R²) in post-intervention scores that can be predicted by pre-intervention performance score and intervention group, the F-test and p value, as well as the standardized β coefficients (and p-values) of significant predictors. Statistically significant results (P <−.05) are in bold. Int’ = intervention.

Figure 4. Mean ± S.E. Patient rating of change in symptoms compared to the previous week across 8 key areas, for (A) SAT, (B) WMT and (C) WL.

Table 4. The results of the regression analyses at 3 months post training.

Measure	R²	F-test (p value)	Β (p value)
Attention Measures
TVA absolute bias	0.63	42.36 (<.001)	Pre-int’ 0.78 (<.001)
OCS-bridge Visual Extinction (Absolute bias)	0.87	159.52 (<.001)	Pre-int’ 0.92 (<.001)
OCS-bridge Hearts Cancellation (Absolute bias)	0.84	127.14 (<.001)	Pre-int’ 0.92 (<.001)
OCS-bridge SALT Reaction Time (Absolute bias)	0.43	16.33 (<.001)	Pre-int’ 0.66 (<.001)
OCS-bridge SALT Count errors	0.14	3.72 (=.02)	Pre-int’ 0.35 (=.003)
ANT (Incong RT- ((CongRT + NeutRT)/2))	0.49	24.71 (<.001)	Pre-int’ 0.69 (<.001)
CRT (RT)	0.61	38.13 (<.001)	Pre-int’ 0.77 (<.001)
CRT (variability)	0.17	5.06 (=.003)	Pre-int’ 0.39 (<.001)
TVA VSTM capacity (K)	0.70	58.30 (<.001)	Pre-int’ 0.85 (<.001)
TVA K variability	0.55	30.57 (<.001)	Pre-int’ 0.74 (<.001)
Memory Measures
OCS-bridge FINS Forward Span	0.22	5.66 (=.002)	Pre-int’ 0.47 (<.001)
OCS-bridge FINS Backward Span	0.14	3.12 (=.03)	Pre-int’ 0.32 (=.012)
AWMA Dot Matrix	0.58	35.13 (<.001)	Pre-int’ 0.76 (<.001)
AWMA Spatial Recall (memory)	0.59	35.19 (<.001)	Pre-int’ 0.76 (<.001)
AWMA Spatial Recall (processing)	0.48	23.06 (<.001)	Pre-int’ 0.69(<.001)
Symptom Severity
EBIQ core (patient)	0.69	56.62 (<.001)	Pre-int’ 0.82 (<.001)
EBIQ core (carer)	0.65	34.83(<.001)	Pre-int’ 0.82 (<.001)
Cognitive Failures Questionnaire	0.68	53.21(<.001)	Pre-int’ 0.81 (<.001)
Subjective Neglect Questionnaire	0.67	37.19 (<.001)	Pre-int’ 0.81 (<.001)

Note: The table provides the variance (R²) in post-intervention scores that can be predicted by pre-intervention performance score and intervention group, the F-test and p value, as well as the standardized β coefficients (and p-values) of significant predictors. Statistically significant results (P < −.05) are in bold. Int’ = intervention

Data availability statement

The data are freely available at https://doi.org/10.17863/CAM.66310.