Neuropsychology Review

, Volume 28, Issue 3, pp 285–309 | Cite as

General and Domain-Specific Effectiveness of Cognitive Remediation after Stroke: Systematic Literature Review and Meta-Analysis

  • Jeffrey M. RogersEmail author
  • Rachael Foord
  • Renerus J. Stolwyk
  • Dana Wong
  • Peter H. Wilson


Cognitive remediation (CR) has been shown to improve cognitive abilities following a stroke. However, an updated quantitative literature review is needed to synthesize recent research and build understanding of factors that may optimize training parameters and treatment effects. Randomized controlled trials of CR were retrieved from seven electronic databases. Studies specific to adult stroke populations were included. Treatment effects were estimated using a random effects model, with immediate and longer-term follow-up outcomes, and moderator effects, examined for both overall and domain-specific functioning. Twenty-two studies were identified yielding 1098 patients (583 in CR groups). CR produced a small overall effect (g = 0.48, 95% CI 0.35–0.60, p < 0.01) compared with control conditions. This effect was moderated by recovery stage (p < 0.01), study quality (p = 0.04), and dose (p = 0.04), but not CR approach (p = 0.63). Significant small to medium (g = 0.25–0.75) post-intervention gains were evident within each individual outcome domain examined. A small overall effect (g = 0.27, 95% CI 0.04–0.51, p = 0.02) of CR persisted at follow-up (range 2–52 weeks). CR is effective and efficient at improving cognitive performance after stroke. The degree of efficacy varies across cognitive domains, and further high-quality research is required to enhance and sustain the immediate effects. Increased emphasis on early intervention approaches, brain-behavior relationships, and evaluation of activity and participation outcomes is also recommended.


Cognitive disorders Cognitive remediation Cognitive rehabilitation Meta-analysis Stroke Systematic review 



This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflicts of Interest

The authors report no conflicts of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.South Eastern Sydney Local Health DistrictSydneyAustralia
  2. 2.Faculty of Health SciencesUniversity of SydneySydneyAustralia
  3. 3.School of PsychologyAustralian Catholic UniversityMelbourneAustralia
  4. 4.Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological SciencesMonash UniversityMelbourneAustralia
  5. 5.Monash-Epworth Rehabilitation Research CentreMelbourneAustralia
  6. 6.School of Psychology and Public HealthLa Trobe UniversityBundooraAustralia
  7. 7.Centre for Disability and Development ResearchAustralian Catholic UniversityMelbourneAustralia

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