A Cochrane review «Cognitive rehabilitation for attention deficits following stroke»1 «Loetscher T, Potter KJ, Wong D, das Nair R. Cognitive rehabilitation for attention deficits following stroke. Cochrane Database Syst Rev 2019;11():CD002842. . »1 included 6 studies with a total of 223 subjects. Two studies recruited most participants within the first two months after stroke, 3 mainly within one year and one study recruited participants up to 4 years after stroke. Attention deficits were identified on tests of attention using specified cut-offs in 2 studies, on tests for attention without specification of cut-offs in 2 studies, and based on self or therapist reported attention deficits in 2 studies. All trials compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no statistically significant effect of cognitive rehabilitation for persisting effects on global measures of attention (SMD 0.16, 95% CI -0.23 to 0.56; p =0.41; 2 studies, n=99), standardised attention assessments (p ≥0.08; 2 studies, n=99) or functional outcomes (p ≥0.15; 2 studies, n=99). In contrast, a statistically significant effect was found in favour of cognitive rehabilitation when compared with control for immediate effects on measures of divided attention (SMD 0.67, 95% CI 0.35 to 0.98; p <0.0001; 4 studies, n=165) but no significant effects on global attention (p =0.06; 2 studies, n=53), other attentional domains (p ≥0.16; 6 studies, n=223) or functional outcomes (p ≥0.21; 3 studies, n=109).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, interventions and outcomes) and imprecise results (limited study size for each comparison).