Effectiveness comparisons of non-pharmacological interventions on cognitive function and activities of daily living in patients with post-stroke cognitive impairment: a network Meta-analysis / 中国实用护理杂志

ABSTRACT

To evaluate the effects of non-pharmacological interventions on cognitive function and activities of daily living in patients with post-stroke cognitive impairment (PSCI).Methods:Based on Cochrane Library, PubMed, Web of Science, Embase, CNKI, WanFang, and VIP databases, randomized controlled studies on rehabilitation therapy for PSCI patients were retrieved. And the retrieval date was from the establishment of the databases to 31 December 2021. Literature screening, data extraction, quality evaluation and data analysis were carried out.Results:A total of 26 studies were included, involving 12 interventions and 2007 patients with PSCI. The results of network Meta-analysis showed that compared with routine rehabilitation and/or routine rehabilitation care, cognitive therapy ( SMD=-1.30, 95% CI -2.09 - -0.52)、repetitive transcranial magnetic stimulation ( SMD=-1.67, 95% CI -2.54 - -0.81; SMD=-2.34, 95% CI -3.71 - -0.97), repetitive transcranial magnetic stimulation combined with cognitive therapy ( SMD=-1.56, 95% CI -2.76 - -0.36; SMD=-2.23, 95% CI -3.39 - -1.07), acupuncture combined with cognitive therapy ( SMD=-2.31, 95% CI -3.51 - -1.12; SMD=-2.98, 95% CI -4.13 - -1.84), virtual reality ( SMD=-1.01, 95% CI -1.98 - -0.04; SMD=-1.68, 95% CI -2.98 - -0.38), computer-assisted cognitive training combined with cognitive therapy ( SMD=-2.50, 95% CI -4.35 - -0.65; SMD=-3.17, 95% CI -4.99 - -1.35), music therapy ( SMD=-1.47, 95% CI -2.61 - -0.33), music therapy combined with cognitive therapy ( SMD=-2.35, 95% CI -4.04 - -0.67), recreational therapy ( SMD=-2.11, 95% CI -3.93 - -0.30), guided imagination therapy ( SMD=-2.48, 95% CI -4.00 - -0.96) had statistical significance in improving the cognitive function of PSCI patients ( P<0.05); recreational therapy ( SMD=-3.57, 95% CI -6.09 - -1.04; SMD=-3.70, 95% CI -7.22 - -0.18) had statistical significance in improving the ability of daily living activities of PSCI patients ( P<0.05). According to the area ranking results under the cumulative ranking probability graph, acupuncture combined with cognitive therapy (89.2%) and recreational therapy (85.1%) ranked first in improving cognitive function and activities of daily living, respectively. Conclusions:Acupuncture combined with cognitive therapy and recreational therapy have the best effect on improving cognitive function and activities of daily living in PSCI patients, respectively. However, considering the poor quality of the original literature included, more large samples and high-quality RCTs are needed for further verification.