The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness: systematic review and meta-analysis

Poster B20, Tuesday, October 9, 11:30 am - 1:00 pm, Essex Ballroom

Daniëlle van Duin1,2, Lars de Winter, Matthijs Oud, Hans Kroon, Wim Veling, Jaap van Weeghel; 1Phrenos Centre of Expertise, 2Trimbos Institute, 3Tilburg School of Social and Behavioral Sciences, 4University of Groningen, 5University Medical Center Groningen

OBJECTIVE: 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 domains of functioning. METHOD: A meta-analysis of randomized controlled trials of CR combined with PR 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 1,819 patients. The combination of CR and PR had beneficial effects on employment outcomes (e.g. employment rate: SMD=0.41, 95% CI 0.10-0.72), and social skills (SMD=0.25, 95% CI 0.14-0.37). No beneficial effects were found on relationships and outcomes of community functioning. Effects on employment 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 the same is true for the effect of the combined intervention, compared to a stand-alone CR intervention.

Topic Area: Neurocognition

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