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

Published online by Cambridge University Press:  30 January 2019

Daniëlle van Duin Open the ORCID record for Daniëlle van Duin [Opens in a new window] ,
Lars de Winter ,
Matthijs Oud ,
Hans Kroon ,
Wim Veling  and
Jaap van Weeghel
Daniëlle van Duin*
Affiliation:
Phrenos Center of Expertise, Utrecht, the Netherlands Trimbos Institute, Utrecht, the Netherlands Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
Lars de Winter
Affiliation:
Phrenos Center of Expertise, Utrecht, the Netherlands
Matthijs Oud
Affiliation:
Trimbos Institute, Utrecht, the Netherlands
Hans Kroon
Affiliation:
Trimbos Institute, Utrecht, the Netherlands Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
Wim Veling
Affiliation:
University of Groningen, Groningen, the Netherlands University Medical Center Groningen, Groningen, the Netherlands
Jaap van Weeghel
Affiliation:
Phrenos Center of Expertise, Utrecht, the Netherlands Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
*
Author for correspondence: Daniëlle van Duin, E-mail: [email protected] and [email protected]
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Abstract

Background

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 separate domains of functioning.

Method

A meta-analysis of randomized controlled trials of PR combined with CR 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 1819 patients. Enhancing PR with CR had significant beneficial effects on vocational outcomes (e.g. employment rate: SMD = 0.41), and social skills (SMD = 0.24). No significant effects were found on relationships and outcomes of community functioning. Effects on vocational 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 a synergetic mechanism also works the other way around, with beneficial effects of the combined intervention compared with a stand-alone CR intervention.

Keywords

Cognitive skills trainingpsychiatric rehabilitationpsychotic disordersreal-life functioningsevere mental illness
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 9 , July 2019 , pp. 1414 - 1425
Copyright
Copyright © Cambridge University Press 2019 

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