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Clin Rehabil. 2020 Feb;34(2):229-241. doi: 10.1177/0269215519890378. Epub 2019 Nov 26.

Cognitive rehabilitation for attention and memory in people with multiple sclerosis: a randomized controlled trial (CRAMMS).

Author information

1
Division of Rehabilitation and Ageing, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
2
Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK.
3
Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
4
School of Health Sciences, University of Nottingham, Nottingham, UK.
5
Swansea Centre for Health Economics, Swansea University, Swansea, UK.
6
Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK.
7
Institute of Mental Health, Nottingham, UK.

Abstract

OBJECTIVE:

To assess the clinical and cost-effectiveness of cognitive rehabilitation for attention and memory problems in people with multiple sclerosis.

DESIGN:

Multicentre, pragmatic, randomized controlled trial.

SETTING:

Community.

PARTICIPANTS:

People with multiple sclerosis aged 18-69 years, who reported cognitive problems in daily life and had cognitive problems on standardized assessment.

INTERVENTIONS:

A group cognitive rehabilitation programme delivered in 10 weekly sessions in comparison with usual care.

MAIN MEASURES:

The primary outcome was the Multiple Sclerosis Impact Scale Psychological subscale at 12 months after randomization. Secondary outcomes included measures of everyday memory problems, mood, fatigue, cognitive abilities and employment at 6 and 12 months after randomization.

RESULTS:

In all, 245 participants were allocated to cognitive rehabilitation and 204 to usual care. Mean Multiple Sclerosis Impact Scale Psychological at 12 months was 22.2 (SD = 6.1) for cognitive rehabilitation and 23.4 (SD = 6.0) for usual care group; adjusted difference -0.6, 95% confidence interval (CI) = -1.5 to 0.3, P = 0.20. No differences were observed in cognitive abilities, fatigue or employment. There were small differences in favour of cognitive rehabilitation for the Multiple Sclerosis Impact Scale Psychological at 6 months and everyday memory and mood at 6 and 12 months. There was no evidence of an effect on costs (-£808; 95% CI = -£2248 to £632) or on quality-adjusted life year gain (0.00; 95% CI = -0.01 to 0.02).

CONCLUSION:

This rehabilitation programme had no long-term benefits on the impact of multiple sclerosis on quality of life, but there was some evidence of an effect on everyday memory problems and mood.

KEYWORDS:

Multiple sclerosis; cognitive impairment; cognitive rehabilitation; cost-effectiveness; memory

PMID:
31769299
DOI:
10.1177/0269215519890378

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