Acceptability of cognitive remediation for schizophrenia: a systematic review and meta-analysis of randomized controlled trials.

Antonio Vita,Gabriele Nibbio,Til Wykes,Giacomo Deste,Stefano Barlati,Anna Ceraso

doi:10.1017/s0033291722000319

Abstract

Acceptability is an important factor for predicting intervention use and potential treatment outcomes in psychosocial interventions. Cognitive remediation (CR) improves cognition and functioning in people with a diagnosis of schizophrenia, but its acceptability, and the impact of participants and treatment characteristics, remain to be investigated. Few studies provide a direct measure of acceptability, but treatment drop-out rates are often available and represent a valid surrogate. The systematic search conducted for the most comprehensive CR outcomes database for schizophrenia was updated in December 2020. Eligible studies were randomized clinical trials comparing CR with any other control condition in patients diagnosed with schizophrenia spectrum disorders and that also reported drop-out in treatment and control arms separately. Acceptability was measured as odd-ratios (OR) of drop-out. Of 2119 identified reports, 151 studies, reporting 169 comparisons between CR and control interventions with 10 477 participants were included in the analyses. The overall rate of drop-out was 16.58% for CR programs and 15.21% for control conditions. In the meta-analysis, no difference emerged between CR interventions and controls [OR 1.10, 95% confidence interval (CI) 0.96-1.25, p = 0.177]. Factors improving acceptability were: inpatient only recruitment, participants with fewer years of education and lower premorbid IQ, the presence of all CR core elements, and the presence of techniques to transfer cognitive gains into real-world functioning. CR for people diagnosed with schizophrenia is effective and has a good acceptability profile, similar to that of other evidence-based psychosocial interventions.

Highlights

BackgroundCognitive remediation (CR) for people diagnosed with schizophrenia is a behavioral trainingbased intervention targeting cognitive processes (Wykes, Huddy, Cellard, McGurk, & Czobor, 2011)
A total of 151 studies, reporting 169 comparisons between CR and control interventions with 10 477 participants were included in the analyses; 3 ongoing studies were identified
The CR drop-out rate was comparable to one found across different psychosocial interventions for individuals diagnosed with schizophrenia (Szymczynska et al, 2017; Villeneuve et al, 2010), and lower with respect to drop-out rates reported in pharmacological trials (Bighelli et al, 2020; Cramer & Rosenheck, 1998; Kemmler, Hummer, Widschwendter, & Fleischhacker, 2005; Lieberman & Hsiao, 2006), which often involve shorter observation periods (Bighelli et al, 2020)

Summary

Introduction

Cognitive remediation (CR) for people diagnosed with schizophrenia is a behavioral trainingbased intervention targeting cognitive processes (Wykes, Huddy, Cellard, McGurk, & Czobor, 2011). It produces significant gains in cognitive performance, and in real-world psychosocial functioning, as demonstrated in systematic and recent meta-analyses (Kambeitz-Ilankovic et al, 2019; Lejeune, Northrop, & Kurtz, 2021; Vita et al, 2021), even for people who are more clinically compromised (Vita et al, 2021). Eligible studies were randomized clinical trials comparing CR with any other control condition in patients diagnosed with schizophrenia spectrum disorders and that reported drop-out in treatment and control arms separately. CR for people diagnosed with schizophrenia is effective and has a good acceptability profile, similar to that of other evidence-based psychosocial interventions

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Discussion

Conclusion