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Revista Iberoamericana de Psicología y Salud

ISSN: 2171-2069
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Sociedad Universitaria de Investigación en
Psicología y Salud
España

Guàrdia-Olmos, Joan; Peró-Cebollero, Maribel; Gudayol-Ferré, Esteve
Neuropsychological rehabilitation and quality of life: A meta-analysis
Revista Iberoamericana de Psicología y Salud, vol. 6, núm. 1, enero-junio, 2015, pp. 11-18
Sociedad Universitaria de Investigación en Psicología y Salud
A Coruña, España

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Mexico Received 2 February 2014. Revista Iberoamericana de Psicología y Salud (2015) 6. type of intervention. Rehabilitación neuropsicológica y calidad de vida: una aproximación meta-analítica PALABRAS CLAVE Rehabilitación Resumen  El propósito de este estudio fue generar un meta-análisis sobre los efectos de la re- neuropsicológica. through neuropsychological rehabilitation. los tipos de contrastes estadísticos. Published by ELSEVIER ESPAÑA. p . Se realizó el estudio siguiendo los procedimientos de estimación habituales. 11-18 REVISTA IBEROAMERICANA DE PSICOLOGÍA Y SALUD Revista Oficial de la Federación Iberoamericana de Asociaciones de Psicología (FIAP) [Official Journal of the Latin-American Federation of Psychological Associations] www. Morelia. Barcelona. blantes. As a general conclusion. Sixteen studies published during the 2001-2012 period which yield- Quality of life. . Research Institute of Brain. .. quality of life and neuropsychological outcomes). based on the definition of the effect size and the scru- tiny of their relationship with relevant variables (e.org/licenses/by-nc-nd/3.U.elsevier.. under certain conditions.38. S. with some cognitive deficit. the types of statistical contrasts.es/rips Neuropsychological rehabilitation and quality of life: A meta-analysis Joan Guàrdia-Olmosa.es. the Cognitive deficit.L. sample sizes.0/).g.001) in all the variables associated with the charac- teristics of the intervention (duration. Passeig de la Vall d’Hebron. que mostraron información relevante con respecto a los tamaños de muestra Meta-análisis utilizados. entre otros. ed relevant information regarding the sample sizes used. day 12/01/2015. Facultat de Psicologia.*.edu (J. Maribel Peró-Cebolleroa.g. sobre * Corresponding author: Departament de Metodologia de les Ciències del Comportament. los instrumentos de evaluación o diagnóstico. The data analysis shows a statistically significant effect (r+ = . Se analizaron dieciséis estudios publicados durante el pe- Déficits cognitivos. © 2014 Sociedad Universitaria de Investigación en Psicología y Salud. accepted 18 July 2014 KEYWORDS Abstract  The purpose of this study was to conduct a meta-analysis on the effects of neuropsy- Neuropsychological chological rehabilitation procedures on the quality of life in non-Spanish-speaking individuals rehabilitation.Document downloaded from http://zl. Any transmission of this document by any media or format is strictly prohibited. gender. This is an open-access article distributed under the terms of the Creative Commons CC BY-NC ND Licence (http://creativecommons.L. 08035 Barcelona (Spain). type of population). MICH. This copy is for personal use. Cognition and Behavior (IR3C). S. Universitat de Barcelona. year of publication and. evaluation instruments or pathologies among others. We carried out study fol- Meta-analysis lowing the usual estimation procedures. Guàrdia-Olmos). we were able to determine that Quality of Life (QoL) can improve. 171. School of Psychology. type of research or sampling design). E-mail: jguardia@ub. Spain b School of Psychology. Universidad Michoacana de San Nicolás de Hidalgo de Morelia. 2171-2069 © 2014 Sociedad Universitaria de Investigación en Psicología y Salud. were analyzed. or methodological variables (e. Publicado por ELSEVIER ESPAÑA. University of Barcelona. Esteve Gudayol-Ferréb a Department of Methodology for Behavioral Sciences. more importantly. ríodo 2001-2012. but this change is not permanent.elsevier.U. con algún déficit cognitivo. habilitación neuropsicológica en la dimensión Calidad de Vida en muestras de no hispano-ha- Calidad de vida.

duration. and psychological conditions (Lon. TBI. 2007. Urzúa. Hildebrand et al. the goal of the present study is to conduct a meta- follow-up evaluations (Solari et al. on QoL intended to approach this phenomenon by using me- Fergusson et al. Any transmission of this document by any media or format is strictly prohibited. Forni. & Gudayol. positive effect of the rehabilitating intervention is generally prove the patients’ quality of life without actually measur. according to the . This positive effect on the patients’ quality of life is observ. Mancardi. clusions must be considered preliminary and they should be sen & Teasdale. 12 J.and post-treatment observational studies on the effect size of the QoL improvement. So. Ylvisaker. by using non-Spanish-speaking samples. 2010) have recommended using HRQoL tended to restore the lost cognitive function) seems to have measures as outcome measures in order to grade the effi. Davis. Sitzer. bajo ciertas condiciones. Mandat. ent nature. 2006). 2010. Laun. 2001. Lincoln et al. más importante..simple als (Brenk. tipo de intervención. the HRQoL tive. Moreover the lari.. Engelberts et al.. 2012). there tion on QoL (Brenk et al. Likewise the use of retraining techniques (techniques in- 2005. Clare et al. case and control speaking samples. 1999. S. most of studies (Svendsen & Teasdale. Lon. Svend. like ta-analysis techniques while bearing in mind their possible any other diseases. 2008.U.. . la base de la definición del tamaño del efecto y el análisis de su relación con las variables rele- vantes (tamaños de muestra. Este es un artículo Open Acces distribuido bajo los términos de la licencia CC BY-NC-ND (http://creativecommons.. Gehring et and they tend to magnify the effect sizes of the phenome- al. This copy is for personal use.) El análisis de los datos muestra un efecto estadísticamen- te significativo (r+ = . etc. it involved some find a positive effect of neuropsychological rehabilita. to measure HRQoL. 2010. Those studies present controversial results: whereas Spanish-speaking samples.post. Other works find analysis of the effects of neuropsychological rehabilitation a positive effect of cognitive rehabilitation on some. 2009. methodological. mild decrease as time goes by between the clinical intervention cognitive impairment. and when analyzing the data as a whole. others do not (Davis et al. chemotherapy. & Pozzilli.38.. Wilde et al. Rasquin et al. samples of patients with different diseases. Introduction danski. day 12/01/2015. 2004. and socio-demographic variables of the persons suffering from neuropsychological alterations which may be affecting the results of the aforementioned has not been widely studied... Clare et al. That posi- with cognitive alterations. o variables metodológicas (tipo de inves- tigación o diseño de la muestra. etc. 2012) capability to develop everyday activities and play valuable dealing with the impact of neuropsychological rehabilitation roles in their own life (Brissart. intensity. Cohen et existed no other meta-analyses on the subject that allowed al. 2006). ment of how a disease and its treatment affect a person’s A previous work (Guàrdia. Kemp. the studies included in their study have a pre. Como conclusión general. Some studies define HRQoL as an assess. 2008).elsevier. In fact. 1999). Pucci.. In spite of that. Publicado por ELSEVIER ESPAÑA. Other works (Cicerone. 2002. género. & Doody. 2002. & Lehmkuhl. relatively few works. Leroy. much more common in scientific literature. 2004). and use diverse instruments dos et al. That study yielded the following conclusions: the rehabilitating treatments in neuropsychological diseases im. 2003. a positive effect on HRQoL that is more intense than the cacy of neuropsychological rehabilitation in traumatic brain effect of compensatory techniques (techniques designed to injury (TBI). tipo de población. linked to an improvement in the patients’ quality of life. able immediately after rehabilitation but is not persistent in Thus. Massman. and as the authors admit. above-mentioned work re-analyzes data from Spanish- dos et al. and it is often claimed that works. apply neuropsychological interventions of a differ- of physical. p .. & Jin. design where the variable control mechanisms are minimal.. 2006). 2002. and persons on and the follow-up.. On the date of its publication. non under study (Ahn. Suhr.. Glanz et al. 2010. 2001). la calidad de vida y los resultados neuropsicológicos).0/).). 2010. Scholten. 2010. The methodology used in those works in.Document downloaded from http://zl.001) en todas las variables asociadas a las características de la intervención (duración. Guàrdia-Olmos et al.. & Lau. emotional. 2010. Jarne. 2008). Myers. Voght et al. & Haase. affect the quality of life (QoL) of those mediating effects in the analysis. study purposefully excluded the works conducted with non- 2009). and consequently.L. & Debouverie. Engelberts et al. multiple sclerosis. pero este cambio no es permanente. cardiovascular events. a través de la rehabilitación neurop- sicológica. 2010). the ­(Cohen. 2008. Twamley. the authors to contrast their findings. Maluck. Few works have studied the possible impact of improve specific aspects of everyday life despite the spe- neuropsychological interventions on the QoL of patients cific cognitive loss experienced by the patient). Hamilton.. as well as other substan- who suffer from it (Murell. 2008. org/licenses/by-nc-nd/3. 2012). © 2014 Sociedad Universitaria de Investigación en Psicología y Salud. but on the QoL of patients with neuropsychological alterations not all. Polanowska. año de publicación y. la dimensión cali- dad de vida (QoL) puede mejorar. Alzheimer’s disease.. have different but there exists consensus on it being a subjective measure designs. ing HRQoL (Londos et al. & Claiman. contrasted with results from non-Spanish-speaking samples..es.. There exist works on patients with tive effect of cognitive rehabilitation on HRQoL tends to epilepsy. Neuropsychological diseases. Therefore their con- Melchers. & Jeste.. QoL measures (Seniow. These are un- derstandable controversies given that most works use small Health-Related Quality of Life (HRQoL) is a wide concept. each study’s sample size and design have a direct influence cludes pre. and several clinical tri.

g.and post-treatment designs). b) mean age.84). Below is the list for methodological characteristics regis- sion criteria: a) works where the concept of QoL was not tered: a) type of study design (clinical trials. studies had to comply psychological outcome measures. we intend to compare our results to those of the indi. the work was conducted by two indepen- ences between. eigh. . and g) ratio between number of ies had to be conducted on non-Spanish-speaking countries. Rosa and Olivares (1999). sixteen due to the impossibility to estimate the effect size Calculating the effect size for lack of some relevant data (e. Sco. in this type of tests.es. The degree of fit was obtained with Co- Spanish-speaking samples and those with non-Spanish. vention (number of weeks). (2012). prior to that period. samples of chil. This copy is for personal use. We also excluded studies according to the following exclu. In general. c) sample identifiable. Firstly. We considered a series of variables relevant to the majority of studies selected according to the scheme used by Sán- chez-Meca. and b) mean effect size in neuro- To be included in this meta-analysis. Clinical Trials. there exist very few (focused on retraining strategies or on compensatory tech- studies and they are much apart in time. In addi. 2001 and 2012.and post-treatment change scores or adolescents or were case studies (Seniow et al. Quality of Life. To validate the paper’s of the meta-analysis by Guàrdia et al. e) intensity of rehabilitation study design had to be recognizable and undoubted in rela. Neuropsychogical rehabilitation: A meta-analysis 13 phases proposed by Botella and Gambara (2006). and Latindex.elsevier. Multiple Sclerosis or Alzheimer’s Disease.644 subjects.88. case studies were excluded. a manual search was conducted in some psychologi. hen’s kappa coefficient (k = . analyzed (marked with * in the reference section) with a vidual works that approached this topic. (samples exclusively from TBI. p .or non-Spanish-speaking samples. methodological. nor the procedures for QoL outcomes (psychometric approaches measures used. d) the papers had to include at (% works). f) duration of the inter- tion to the other variables set forth in this work. sample sizes clearly identified or lack of a statistical contrast estimator). one-group de- operationalized empirically.. SciELO. or extrinsic characteristics. Any transmission of this document by any media or format is strictly prohibited. specify that we conducted a search based on the Boolean The extrinsic characteristics analyzed were exclusively criteria derived from the use of the following key words: the publishing year stratified in four-year periods between Neuropsychological Neurorehabilitation. c) they had to be niques or mixed interventions). the number of women treated versus placed in teen papers for using non-psychometric QoL measures. other etiologies (OE) such as that is. They were classified Method as substantive. or pre. study period. and b) the methodological as. that is. posed coding. Complementing the above. sessions and duration in weeks. teen works for having sample sizes below 30 subjects. either.. we studied it on the sixteen selected studies Also. focused exclusively on neuropsychological interventions pus. standardized means for comparison studies between groups they did not use standardized criteria to evaluate QoL. Pubmed. d) months between diagnosis of the illness and least one psychometric standardized QoL measure. c) works with a treatment indexed in Journal Citation Reports. The differ. each variable’s description was simple usual bibliographical databases. a detailed analysis of those led us to discard thir. and to include samples of subjects. and obtained an interclass correlation coefficient indicating cal or medical bibliographical sources (for example. involved manually calculating the application of a percent- This procedure yielded 71 studies within the period at hand. and d) number of measurement waves. yet or in relation to the baseline measure and the standard dif- four more because they were applied to samples of children ference between the pre. In order to assess the reliability of the pro- mation Clinical Effect Size. signs. Esti. we also reported per- and finally another one which was not obtained within the centages of improved subjects that were likewise used to . e) the neuropsychological treatment. an. we obtained the estimate of the difference between other three because. procedures (number of sessions). sixteen studies were eventually tion. assessing the effect of a neurorehabilitation pro. apart from Coding of the variables the fact that the conditions of assistance and neurorehabili- tating intervention are not comparable.Document downloaded from http://zl. in accordance with speaking samples are so large in most cases that it is impos. 2003). and h) the studies had through the studied samples (percentage of women). quency (e. PsycInfo. selection process. we would like to size. f) the stud. In some cases. neither the design type. despite using psychometric registers. b) the studies had to have been published from 2001 mixed etiology (ME)). We selected the following g) the samples had to comprise adults only. control groups in studies with group designs). for example. or the statistical contrasts were clearly such as the SF-36 or other valid instruments). by organizations of renowned prestige such as the World Some of the aforementioned variables required previously Health Organization or individual universities) hoping to find generating pertinent contingency tables from the original studies on the subject that had not been registered in the studies. We defined the following dependent variables in order to Search of studies estimate the intervention’s effect: a) mean effect size in QoL outcome measures. which. or samples with gram. sible to carry out one integrated study with all the papers.001). Studies listed in more than and the reconstruction of the table of observed frequencies one of the aforementioned sources were not duplicated. day 12/01/2015. b) measurement pects were unclear. and to the results combined total of 2. age to each sample size in order to obtain the observed fre- However. the sample sizes in works with dent researchers. reports high reliability in the coding (r = . Fleis’ criteria (1981). implies a very high agreement.g. stantive characteristics registered: a) disease etiology nal works focused on neuropsychological rehabilitation. Therefore. with Spanish. b) neuropsychological intervention to 2012 given that. Below is the list of sub- with the following inclusion criteria: a) they had to be origi. socio-demographic characteristics: a) gender distribution dren and adolescents were excluded.

day 12/01/2015. and. The average time the present one. complementary information. QoFS. the need arises to evalu- odological strategy. which would indicate a not especially high with completely matching estimates of the size effect and methodological and statistical test in the complexity of the its corrections. estimate the effects of the intervention. among others (68. dance of . since the p Mean effect size value related to the effect size is not independent from the sample size where it is estimated. which is the usual methodology in scientific literature re- As for the publishing year. 2013). in that significant effect (p . or mixed measures) and the type of treatment studies (3) used subjects suffering from several pathologies. (retraining. the different studies. fect Size Display (BESD) was applied (Rosenthal & Rubin. and only one (6. tween 2001 and 2003.11).25%) used both strategies.0. The average duration of the in. thorough data than merely checking the published works.08) and when combined. 1997).42. we would like to point out that the assessment of to a correction value (r). sample gies. we individuals with other neuropsychological conditions. (SD = 0. The average number of sessions was 25 (SD = 3.25 (SD = 11. we because the obtained signification shows a high effect size. given the high In order to establish better these results. seven Therefore. All these analyses were conducted in.75%) focused on retraining strate- corresponded to each variable studied (effect size.) to evaluate the outcome in QoL.and post-treatment de. compensation. so we can (SD = 1. No cal approach here presented may provide us with more studies used qualitative evaluations by means of semi-struc. a fixed-effect model was used. which is usually the general indicator in ducted by four independent experts (coefficient of concor- meta-analysis works. .28% and obviously of 39. strategies versus compensation strategies—discussed in the .26 years (SD = 9.12 months (SD = Moderating variables 1. Description of the results That is consistent with the data of previous meta-analyses conducted with English-speaking samples. whereas two (12. with the exception that. and 7 for and excellent evaluation)—con- mated directly. etc. such as Cicerone (2005). eventually opted for a random-effect model. and the odds ratio value was obtained for cases tion mechanisms). For the remaining tables different statistical and methodological quality (scale 1 to 7. which points at a highly Meca and Garrido (2002). and Mild Cogni- variables: the outcome measures in QoL (psychometric.Document downloaded from http://zl. eleven focused on Schwarzer and Carpenter (2008).38. Valera-Espín & Sánchez-Meca.65%). where the table presented a 232 order. such analyzed the 333 table generated by crossing the two main as Multiple Sclerosis. version 21. Firstly. this would be expected in clinical trials 165. the peated following the scheme used by Redondo. 1 for a from and larger than 333. The data were then Finally. three studies were published be. the mean sample size was Sitzer et al.elsevier. assume the heterogeneity of the effect sizes derived from Eleven (68. later transformed Finally.001). This copy is for personal use. or mixed). tive Impairment. and some of the R software routines (R mated values obtained for the treatment groups were of Development Core Team. in this study in order to search for reasonable explanations sign with repeated measures.72% for the failure. (2006). years of diagnosis. seven studies (43. Therefore. designs and statistical treatments set forth. In regard to measurement for that difference both in the boarding system and in the procedures. This high library (Schwarzer. the meta-analyti- WHOL. between the diagnosis of the disease and the onset of the cognitive rehabilitation program was 4. the descriptive effect in favor of retraining between 2007 and 2009. 1982.75%) used strategies strictly based mechanisms of intervention. fifteen (93.77 dependently by two of the authors of the current paper. With all these results. All the analyses were conducted with the IBM-SPSS soft. and seven (43. These types of estimations are of little relevance.75%) set forth mixed tion. and three between 2010 and 2012. percentage warrants the significance of the results in the statistical and clinical domain. the correlation values were esti. the Meta 60.94)—of the selected works yielded a mean of 5. After obtaining the effect sizes based on correlation. Therefore all the data tables from the studies were rehabilitation procedures (both retraining and compensa- analyzed.es. observed global mean was r+ = .11) (range between 18 and 35).75%) of the studies used a clinical trial meth.) for every possible combina. caused by traffic and work accidents).13). Sánchez. the Binomial Ef- variability of the observed distributions of the effect sizes. three between 2004 and 2006. The BESD esti- ware. Alzheimer’s Disease.and post-test repeated measures. The initial analysis with the direct effect sizes show clear tervention from the onset of the program was 14 weeks statistical significance (QT(15) = 97. p . The mean effect size is good on psychometric-base questionnaires and/or scales (SF-36. the studies yielded applied in hospitals and is consistent with works similar to a mean age of 56.5%) involved subjects with TBI (strokes the Odds Ratio estimation was used as described by Rücker. Two studies (12. in our case.5%) directed the treatment at com- size. pensation systems. but they offer an ap- Data analysis proximate idea of the complexity of the strategies used and are frequent in studies on meta-analyses. These results are important work. and the ate the role of the different moderating variables identified rest (3 studies) used a simple pre. more specifically. 2011).94). Any transmission of this document by any media or format is strictly prohibited.91). views. 14 J. tured interviews. In the latter cases. low evaluation.5%) used case control. etc. This procedure was re. The rest of the qualitative. The analysis of the contin- gency tables indeed shows a clear tendency toward the use Results of intervention systems based on retraining by means of simple designs of pre. r values were corrected by means of their variance to weigh them according to their sample sizes. Accordingly. . Guàrdia-Olmos et al. As stated by For the sixteen studies analyzed. two (12.001).

B = is the non-standardized regression coefficient.and post-test evalu- 2007-2009 7 . so we can infer that this type of Pre-Post-test desig 3 . Neuropsychogical rehabilitation: A meta-analysis 15 next section—must be clarified according to the role of the Table 1  Results of the variance analyses for the moderating variables we have determined. 2010-2012 3 . the papers published within the 2007-2009 pe- riod (r+ = .10 has increased. First.228(8) . as compared to those using clinical trials (r+ = . Retraining 7 . .121(12) . .20   Intervention’s duration (Number of weeks) 13 . .and post-test designs with repeated mea- Measurement procedures sures without much of a doubt about that effect (r+ = . p .232 7.10) were Note.154*(15) . Mixed 3 .05).21   Intensity of rehabilitation procedures (Number of sessions) 13 .07 In other words.01* .33 Note.47** more significant effect sizes (18.17 Subject variables Gender   (% of women in the samples) 16 . . Any transmission of this document by any media or format is strictly prohibited.88) and it allows us to infer that the scientific com- Year of publication munity widely agrees on this point and that both effects are important.elsevier.211**(15) .01). QB = statistical not statistically significant.01.Document downloaded from http://zl.05).01.11 (QB(2) = 33.1% of explained variance). .47) were clearly significant instead (p .399 14.41* . .22) or case Psychometric approach 15 .62).13* .41. R2 = the determination coefficient.25* distributed asymmetrically among the studies using samples Mixed 7 .392 17. * p .62** works use pre.31) show a tendency toward a somewhat higher Substantive variables 42. Moderating variables kj B QR(df) R2 Substantive variables   Mean effect size in neuropsychological outcome measures 16 .39 Method variables Sample   size 16 . .543**(15) . k = number of studies.345 average effect size (QB(3) = 32. sonable that some of them may provide relevant informa- Moderating variables kj r+j QB R2 tion regarding the differences we found. Study design Statistically significant data in both tables present a rela- Clinical trials 11 .121 7. In relation to the measurement Other psychometric 1 – procedures.01. the effect of 2004-2006 3 .17   Ratio between number of sessions by duration in weeks 13 . k = Number of studies for each category.05 ** p .371 ables (Table 1) and for quantitative variables (Table 2).67** We would like to point out that the estimated effect is Compensatory 2 .077 9. In fact. This copy is for personal use. The ef- fect of samples with both pathologies has been discarded Table 2  Results of the weighted simple regression analyses for the quantitative moderating variables.992**(15) . p .09 interventions (% works)   Months between illness diagnosis and neuropsychological treatment 6 .22* tively clear scenario. since it is rea- qualitative moderating variables. The tables below show the statistical significance found for qualitative vari- Method variables 33.712(15)** .29 Number   of measurement waves 16 –. and the studies have become clearer with Other Etiologies (OE) 11 .278 12. given that R2 = . we see that One group design 2 . (r+ = . which should not be discarded.05 ** p .399 16.09 using psychometric scales for both pre. R2 determination coefficient.039 of patients with external or internal pathologies according to the definition above. regarding Table 1. * p . in two years there has not only been a clear breakthrough in the number of studies published with non- Neuropsychological intervention Spanish-speaking samples.181 (r+ = .38 Works   with treatment focused exclusively on neuropsychological 9 .218 8.271*(12) .222*(12) .06 ance).1% of explained vari- 2001-2003 3 . so it would be Disease etiology reasonable to think that over time the number of studies Traumatic Brain Injury (TBI) 2 . . day 12/01/2015.22 Age   (years) 16 –. but internal pathologies signification test.88* control strategies (r+ = 11).es. QR = statistical signification test for each regression coefficient. r+j = mean of the correlation coefficient. the use of scales is the only significant source Extrinsic variables 32.11 Likewise.31* ations is decisive. External pathologies (r+ = .299 9.219 3.371 (37.931*(5) .

effects is clear. but it is important to highlight a to influence the phenomenon under study.05). Additionally.05). that effect p . so that those certain tendency to improve neuropsychological values over works where the neuropsychological intervention was based strictly QoL measures. an evident bias in favor of yield more modest results. that effect is partly due to the different tradition in tion of the Funnel plot.211. .992.154. as they psychological deficit’s etiology is another substantive . which was non-significant from the effect obtained by retraining interventions. both quantitative post.67. p .345 or 34. lication.25.01). Guàrdia-Olmos et al.039). In general. . However.05).05). which focused on retraining as a choice of intervention in relatively simple designs.5% of the total) and sta. The reduction of post.13. The percentage of works focusing number of papers with Spanish-speaking samples (21) re- solely on neuropsychological interventions (QR(8) = 3. Both variables are essential given fect derived from retraining interventions was highly statis.05).121). thus nounced in the case of women and younger subjects (the yielding a greater effect size than other interventions. partially. p . It is also important to note that the effect of the between the number of sessions and the duration of the in- duration of the follow-ups (measurement waves) is also tervention in weeks. p .01). The results allow us to draw several conclusions. the patient’s quality tive rehabilitation programs are effective with an effect of life tends to diminish. ropsychological intervention applied. effect of neuropsychological rehabilitation techniques on The crucial data in Table 2 are the results obtained with QoL. . 16 J. a tendency the neurorehabilitation program. women and younger patients. in the Spanish- therefore it seems that longer rehabilitation programs bring speaking world. and. No associated effect to the mixed Discussion strategy was noted (r+ = . . However. . we must note the existence of a positive volving more sessions during a longer period of time. which suggests that the therapy’s size that may be responsible for up to 38% of the explained positive effect on the variable is not permanent. to the slightly higher number of participants effect is clear (QR(15) = 9. b = –.07). the variation percentages they explain: 29% and 33% respec- tically significant (r + = . regression models show some ef. the explained variance was high (R2 = . Thus. This copy is for personal use. to the notion that a greater effect is obtained in programs in. The negative Nevertheless. . the rehabilitation’s effect on QoL is very much influ- intense when they are estimated by comparing the pre. If we ple size.222. Despite being statistically significant. p . role of the subject and the methodological variables includ. glaringly longer in Spanish-speaking healthcares than in gram was statistically significant (QR(12) = 8. up to 39% of and qualitative. Likewise. There is. Spanish-speaking samples analyzed (16) was lower than the fects to be highlighted. then the effects on QoL increase.931. the intensity and the duration of the interventions. As for the effect of the substantive vari- the explained variation. . ers. There are no differences between ables. Firstly. In the case of women. Likewise. The reason may lie in the fact that this type of works and the number of sessions (QR(12) = 9. the effect size mined by the conditions of the health services. as the follow-up duration increases. The neuro- decreases. p . 1997). We can thus state that the different neuropsychologi- the data derived from the outcome in neuropsychological cal intervention therapies improve the patients’ quality of performance.01). indeed. non-Spanish-speaking countries vastly outnumber any oth- nosis to the onset of the intervention (QR(5) = 7.es. the combined ef. p .levels of these patients’ perceived QoL. p .228) was ported on Guàrdia et al. which clusive in the mean age of the groups treated (Q R(15) = is hardly surprising when we consider that those techniques 17.Document downloaded from http://zl. those variables must be understood within value of the coefficient of regression (b = -. p . clearly significant (QR(15) = 16. due to non-significance (r+ = .392). we must note that the type of therapy applied seems one choice and the other.271. the months gone by from the diag.399) would show the patients’ clinical context. p . This adds ger than in the non-Spanish-speaking one. in order to evaluate the possible bias of pub- associated to the compensatory intervention (r + = . Any transmission of this document by any media or format is strictly prohibited.05) applied commonly use clinical samples. p . exclusively. important to highlight that the number of papers with non- If we focus on Table 2. . . since the publications in not significant. The tradition in the Span- can be established toward ratio significance between weekly ish-speaking neuropsychological approach is somewhat lon- sessions and the number of weeks of the program. The result is highly significant (QR(15) = 14. that fact can be due. & Minder. it is somewhat more common to use Quality more effect to the therapy results. as was the effect tively. it is tistically significant (QB(2) = 42. this fact could be biasing the results. the show that the effect size is higher and clearer with large number of sessions of the intervention. tends to decrease over time.01) increase the weeks of duration of the intervention. Finally. even more importantly. Oth- coefficient of regression is negative. by the greatest improvements in their patients’ quality of life. . life. non-Spanish-speaking ones. whereas those using compensatory treatment strategies ed in Table 2. er substantive variables interfering with the neuropsycho- the effect attributed to the study of sample sizes and the logical rehabilitation’s effect on QoL are all those related to number of measurements is also crucial. . since they are often deter- that. too. and intervention times are were significant. day 12/01/2015. they are far Schneider. As regards the sam. In addi- variation. Therefore it was unnecessary to include informa- ably. Smith. the results we obtained (QR(15) = 12. in that sub-sample than in other intervention groups. and the relationship samples.and enced by several moderating variables. the at least partly.712. although there of Life measurements as indicators of effect associated to was no clear statistical significance (QR(12) = 7. For that reason. on the use of retraining techniques are the ones showing the These comments need to be clarified. with a moderate effect size.86). (p = . Prob. that the favorable effect in post-evaluations is more pro. that effect is more tion. Instead. we estimated the Egger test (Egger.543. the clinical studies applied to the one we discussed above. The duration of the intervention pro.elsevier. As time goes by after the neu- we can interpret that the studies analyzed show that cogni. Furthermore. seem to dilute over time. It should all be interpreted in the sense have a greater tradition in neuropsychological intervention. Finally.01) for neuropsychological measures. (2012). and even more con.

However. we can conclude that neuropsychological reha- The patients’ age also had an important mediating effect.. A. Neuropsychogical rehabilitation: A meta-analysis 17 variable seeming to influence the effects of rehabilitation 2011). Myers. 1073-1074. A. We must point out that such *Clare. (2012). Short-term cognitive combination of both techniques. J. 425-440. Linden. R. Laun. both studies also agree on clinical trial classic methodology obtained greater increases this change seemingly not being permanent. L. H. this paper than in Guàrdia et al. (2010). E. K. In patients with cognitive alterations due to other etiologies. the ef- QoL after rehabilitation. Asano. Goal-oriented cognitive outcome (Niemeier. R. outcome of the neuropsychological rehabilitation (Arango. as of Spanish-speaking samples (Guàrdia et al. (2010). M. the works using a and even disappear. given that it favors the idea studies.. M. 44. Botella. In contrast. The fact that in QoL after clinical interventions than the studies using a the central conclusion of both meta-analyses agrees on sub- pre-test post-test methodology and the case and control stantive variables is important. N... the present work. since in the latter the rehabilitation bore no signifi. The patients’ average age in this study is lower References than in the study with Spanish-speaking samples. Yet again. variables usually affect the neuropsychological treatment’s Parkinson. nance between the results obtained in both populations When comparing the results of the present works to those allow us to guarantee a clear line in the effects found. G. our conclusions are accurate. 801-804. Evans. H. Likewise. Van der Spuy. Accordingly. Therefore. (2006). there- cant effect on QoL..elsevier. Y. rehabilitation for people with early-stage Alzheimer disease: . from the methodological point of view. Any transmission of this document by any media or format is strictly prohibited. Use of the estimated intra- time elapsed between the onset of the disease and the ad- class correlation for correcting differences in effect size by ministration of neuropsychological treatment is shorter in level. 6. (2012). S. for which reason it might also be expected that they on QoL. most of the studies included fore. Archives of Physical and Medical Reha- age. Doing and reporting a meta- ing techniques. the originals included in this meta-anal. Accordingly. which ity of the pathology or the patient’s socio-economic con- could bias the statistical effects found in this work. with a moderate Younger persons seem to obtain greater increases in their effect size. Whitaker. and very few were treated with a *Brenk. International Journal of Clinical and Health Psycholo- ples. important Arango. Finch. as the follow-up time goes by.. highlight the following conclusions. but in the study with Spanish-speaking sam. important limitation. which entails a possible ables. C. or its intensity. & Ketchum. analysis. J. C. we must well as serious limitations in the effect’s perdurability. T. D.. Marwitz. As for text.. 166. the year of publication influenc. In both works. which is that it was not possible to ology. they could affect QoL. the opposite tendency was observed. i. the conso- bias effect on the estimated effect size. this meta-analysis. Leaving aside the latter consideration. Important differences also exist This research was made possible by the PSI2010-21214-C02-01 between them regarding several substantive variables that project and was carried out by members of the Generalitat have an important mediating effect on QoL. Likewise. in general. in de Catalunya’s SGR 388 Consolidated Research Group... D. Leroy. … Rugg. bilitation has a positive effect on HRQoL.. Brain In- type of treatment administered. PROCOG-SEP. & Debouverie. in the present training improves mental efficiency and mood in patients with study. (2012). C.. J. Woods. Evidence-based practice and the limits of studies as regards substantive variables such as the patients’ rational rehabilitation. compensatory techniques. & 2009. 2012).es. there are more of them using a clinical trial methodology and. a significant jury. K. This is because the works considered here riod is higher than in the other periods studied.e.. 86. 2011). with a have not involved analyzable data in relation to those vari- greater accumulated sample size. for which reason the number of patients included in analyze the mediating effect of such variables as the sever- this sub-sample is much larger than in the other two.. (2012). fects of neuropsychological rehabilitation tend to diminish With regard to the method’s variables. Traumatic brain injury in Spanish-speaking in- differences exist between both meta-analyses regarding the dividuals: Research findings and clinical implications. Moriello. Revue de Neurologie. were treated with a combination of techniques than with Brissart. the duration and the intensity of neuro- psychological interventions were higher than in Guàrdia et al. among the studies included in The authors declare that they have no conflicts of interest. the general conclusions of the suffered from traumatic brain injury. neuropsychological interventions do should have a direct effect on the patients’ quality of life. but instead they do on present work agree with those of Guàrdia et al.Document downloaded from http://zl. However. Cognitive rehabilita- tion in multiple sclerosis: results and presentation of a new pro- compensatory strategies only. D. & Gambara. H. a great number of patients were treated only with gy. European Neurology. proportion of the patients were treated using only retrain. influence the the extrinsic variables. (2005). Therefore. 406-411.. es the effect size of post-intervention QoL. as is known. gram. This copy is for personal use. D. & Jin. & Haase. it is 2012). Even more significant are the differences between both Cicerone. day 12/01/2015. Our study presents an in the present meta-analysis used the clinical trial method. M. Kreutzer. (2008). the treatment. 490-502. that our interpretation of the data is correct and. The present pa- per has a higher total sample size than the Spanish-speaking Conflicts of interest samples and comprises originals with a higher average num- ber of participants. Both present important differences as regards the results obtained. These are variables which. 26. Acknowledgements ysis have a higher methodological quality than those includ- ed in Guàrdia et al. 60. 304-309. (2012). and they are indeed part of highest in the group of papers published between 2007 and that construct (Mayo. More patients multiple sclerosis. not seem to bear a positive effect on QoL in persons who Despite all these differences. Behavioural Research Methods. (2012). and the Ahn. the number of works published in this pe. Gary. the time elapsed between the onset of the disease and bilitation. both cases.

*Solari. Brain populations. G. C. Suhr. (2009). (2001). 641-654.. 23. J. Kreutzer. Injury. & Finch. A. chum.. J. J. I.r-project.. Lanz. P. 9. A. S. 629-634. Arcsine test for New York. (2010). 20. J.. 14. M. Hoffmann. Bushnick. L. The extent to which common health-related quality of *Voght. H. bilitation... The chological rehabilitation and quality of life in patients with cog. S. & techniques in clinical and health problems: Meta-analysis of Weiner. 114. *Lincoln. 74. M. Journal of Alzheimer’s Disease and Other Dementias.. 164-173. T. outpatient cognitive rehabilitation programme for patients in vention in Alzheimer disease: A randomized placebo-controlled the chronic phase after acquired brain injury. E. A. G. 30. R. 621-627. 315. Guàrdia-Olmos et al. Adèr. Neuropsychology Review. (1999). Weyman. 18. Brain Injury. J. org Egger. Schneider. (2003). Sikkes. *Svendsen. K. 27. publication bias in meta-analyses with binary outcomes. Polanowska. (1982). with three aetiologies of severe memory and executive function *Rasquin. The influence of neuro- *Londos. J. Errorless learning of functional life skills in an individual vestigation. Bakx. & Van Heugten. J. J. *Engelberts. Dent. Valera-Espín. Rücker. Pruebas de signifi- 183... R. L.. J.. Stöcklin. Heimans. A. T. 11. 290. Efficacy of a brief acute neurobehavioural *Cohen. Persson.pdf Guàrdia. 27. J. A successful neurorehabiliation case study.. A.X.. A. A. 21. C.. N. tients with multiple sclerosis–comparison of two different train- *Melchers. G. Klein. wis. day 12/01/2015. Bias in Redondo. Marwitz. N. Urzúa. M.. & Saykin. A. J. 680-690. Hamilton. J. Working memory training in pa- Quality of Life Research.. B.. J. J.. E.. J. … Aaronson.. J. 13. (2011). A. K. I.. Schwendemann. S.. 93-98. American Brain Injury. 43. 1650-1660. E. Asano. Quality of life and Neurological Illness. S. Horrigan. C. G. 3712-3722. I. Pucci. Witheneck. CRIMS trial. S. Evaluation of cogni. S. A simple. J.. Austria: R Foundation for tive rehabilitation for attention deficit in focal seizures: A ran. Epilepsia.. K. K.. Las técnicas in patients with gliomas: A randomized. 14. B.. try. J. (1999). cran. Computer-aided retraining of memory and Blumhardt. Schwarzer. Rosa. & psychological rehabilitation on symptomatology and quality of Lexell.. B.. Statis- *Gehring. Meta-analysis with R. E.es. 760-777. NY: John Wiley & Sons. M. (2010). Journal of Educa- waitlist control trial... M. R: A language and environment G. G.. C.. L. A. (1997).. 25.. Minthon. Calabrese. The association between cognitive impair.. I.. logical Neuroscience.. (2010). Journal of Neurology and Neurosurgery Psychia. H... L. M. A single-blind randomized controlled trial of clinical efficacy. Effectiveness of a low intensity *Davis. H. Scholten. P.. H. J. D. Hahn. Jour. Nicholl. V.I. Rocque. 75-90. Furstenberg... … Von Steinbuechel. A. C. A. An early onset rehabilitation program for children and Wilde. S. Linden. Development Rossental. Mandat. M.... Journal of Neurology Science. Retrieved from http://www. Cognitive train- B.. 15.. M. *Hildebrandt. S.org/web/packages/meta/meta.. ment and quality of life in patients with early multiple sclero. P. life following brain injury: A controlled long-term follow-up. ing schedules. (2002). & Laudanski. general purpose dis- of CBT for chemotherapy-related cognitive change: Results of a play of magnitude of experimental effect. Cognitive training ing in Alzheimer’s disease: A meta-analysis of the literature. G. tical Medicine. Seniow. S. B. British psicológicos con delincuentes y su efectividad: La situación eu- Medical Journal. T.. N.. 222. D. D. Meta-análisis de la literatura española (Cognitive-behavioural *Glanz. Recommenda- first results. 99-104. (2012). This copy is for personal use. L. controlled trial. 1-9. Cognitive rehabilitation Sánchez-Meca. Cognitive inter. B. Journal of Neurology Science. J. J... Schwarzer. Kemp. Neurorehabilitation. N. M. Gary. (2008). & Pozzilli. cal Rehabilitation. K... Psycho‐Oncology. ropea (Psychological programmes with offenders and their ef- Ferguson. H. N.. Fleis. Healy. Statistical Computing. 91. 928-939. Ylvisaker.. R Development Core Team (2011). A review brain injury research. 587-595. Maluck. & Teasdale.. tional Psychology.... (2002). Vienna. & Claiman. Psicothema. (2008). attention in people with multiple sclerosis: A randomized dou- tive assessment and cognitive intervention for people with mul.. ble-blind controlled trial. Van der Spuy. B. (2006).. 701-713. D. Sánchez-Meca. Forni. Gundy. Cifu. (2002). M. Bogner. (2007). (1997). Restoring Neuro.. Moriello. & Rubin. Rintell. K. D. adolescents after Traumatic Brain Injury (TBI): Methods and Dikmen. Neuropsychologi- study. Twamley. Bouwens. fectiveness: The European situation). J. D... 355-376. graphical test. Trenité. 20. 33-43. Mancardi. Schwarze.. Winkens... K.. T. 166-169. R. 1295-1306.. Los programas meta-analysis detected by a simple..... L. 18 J. M. N. tions for the use of common outcome measures in traumatic Murell.. Ahles. Psicothema. & Doody. The effectiveness of cogni. & Playford. & Ket- American Journal of Geriatric Psychiatry.. N. L. 35-42. V. McDonald.. impairment. 20. G. (2004).. 25. & Van der Ploeg. G. (1999). S... & Gudayol.. D. P. W. A. A. (2009). D. M. 85-90. 153-160. R. *Niemeier. R.Document downloaded from http://zl. C. H. Neuropsychological Rehabilitation. 75-79. T. Gschwind. (1981).elsevier. J. Dijcks.. Acta Psychiatrica Scandinavica. G.. S. L. E. & Garrido. Statistical methods for rates and proportions. Jaffin. M. W. D. (2013). domized controlled study. Any transmission of this document by any media or format is strictly prohibited. C. 209-229. Kappos. K.D. cognitivo-conductuales en problemas clínicos y de la salud: nal of Clinical Oncology. Harding.. Effects of a goal-oriented rehabilitation pro. gram in mild cognitive impairment: A pilot study. J. Restoring Neurological Neuroscience. & Kraus. G. Anales Mayo. cación y magnitud del efecto: Reflexiones y propuestas. C. M.. Sitzer. 27. Archives of Physical Medicine and Reha- of the literature. Retrieved from http:// sis. 177. Sitskoorn. for statistical computing. Smith.. 20.A. M. Postma. E.. 225-235. 72. intervention following traumatic brain injury: A preliminary in- (2010). M. G. & Jeste.. cognitive impairments due to the occipito-parietal brain injury nitive impairments: A meta-analysis study in Spanish-speaking after gunshot. Restoring Neurological Neuroscience. Alzheimer Disease Association Disorder.. Spanish literature). T. K. (2006).. & Carpenter. H. . B. tiple sclerosis.. J. 7. Op- life indices capture constructs beyond symptoms and function. E. E. Bakshi. W. M... (2012) Neuropsy. de Psicología. & Lehmkuhl. 746-763. F. M. & Olivares. H... in MS: Effects and relation to brain atrophy. W. (2011)..R-project. Jarne. L. Massman. R.. Klein. L.. K. Boschian. 176-186. & Penner. & Sánchez-Meca. & Minder C.