Cognitive rehabilitation for attention and memory in people with multiple sclerosis: a randomized controlled trial (CRAMMS). (February 2020)

• Record Type: Journal Article
• Authors: Lincoln, Nadina B; Bradshaw, Lucy E; Constantinescu, Cris S; Day, Florence; Drummond, Avril ER; Fitzsimmons, Deborah; Harris, Shaun; Montgomery, Alan A; das Nair, Roshan
• Other Names: Morgan Miriam non-byline-author.; Scott Julia non-byline-author.; Evans Susan non-byline-author.; McKeown Shirlee non-byline-author.; Bharadia Trishna non-byline-author.; Moore Perry non-byline-author.; Young Carolyn non-byline-author.; Sharrack Basil non-byline-author.; Isaac Claire non-byline-author.; Griffths David non-byline-author.; Fixter Vera non-byline-author.; Hanley Laura non-byline-author.; Evans Stephen non-byline-author.; Palmer Lena non-byline-author.; Tyrell Tracy non-byline-author.; Gaughan Shannon non-byline-author.; Elliot Gemma non-byline-author.; Keogh Sophie non-byline-author.; Oldknow Helen non-byline-author.; Edwards Catherine non-byline-author.; Schofield Nigel non-byline-author.; Clarke Sara non-byline-author.; Crossley Kara non-byline-author.; Griffiths Holly non-byline-author.; Knight Cara non-byline-author.; Martin Kristy non-byline-author.; Cunliffe Alexandra non-byline-author.; Pollard Catherine non-byline-author.; Wilson John non-byline-author.; Trigg Emma non-byline-author.; Vanzan Serena non-byline-author.; Dalton Joanna non-byline-author.; Pegnall Stephanie non-byline-author.; Carpenter Hannah non-byline-author.; Cogger Heather non-byline-author.; Harnell Rachel non-byline-author.; Klein Olga non-byline-author.; Mhizha-Murira Jacqueline non-byline-author.; Powers Katie non-byline-author.; Squires Luke non-byline-author.; Sprange Kirsty non-byline-author.; Evans Amy non-byline-author.; Hobbs Jo non-byline-author.; Wakefield Natalie non-byline-author.; Barnes Brian non-byline-author.; Crone Monica non-byline-author.; Foster Matthew non-byline-author.; Rumsey Chris non-byline-author.; Erven Alexandra non-byline-author.; Moss-Morris Rona non-byline-author.; Bowen Audrey non-byline-author.; O'Connor Rory non-byline-author.; Freeman Jenny non-byline-author.; Taylor Rod non-byline-author.; Rose Anita non-byline-author.;
• Is Part Of: Clinical rehabilitation. Volume 34:Number 2(2020)
• Page Start: 229
• Page End: 241
• Publication Date: 2020-02
• Subjects: Multiple sclerosis -- cognitive impairment -- memory -- cognitive rehabilitation -- cost-effectiveness; Medical rehabilitation -- Periodicals; 617.03
• DOI: 10.1177/0269215519890378
• Languages: English
• ISSNs: 0269-2155

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.