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. 2021 Sep 29;27:100217. doi: 10.1016/j.scog.2021.100217

Table 3.

Publications on the effect of cognitive interventions on functioning.

Review name [Quality] Type of review No. of studies (total sample size) Population Intervention Functioning outcomes assessed Key results
Neurocognitive interventions
Prikken 2019 [Q = Medium] SLR with meta-analysis Total studies: 24 (n = 1262)
Studies assessing functioning: 10 (n = 521)		 SCZ spectrum disorders Computerized cognitive drill and practice training (adjunctive psychosocial rehabilitation excluded) Domains: social, occupational, global
(Unclear if both FC and RWF included)		 Computerized cognitive drill and practice training (without adjunctive psychosocial rehabilitation) did not have significant effects on functioning (ES, 0.19; 95% CI, -0.01 to 0.39; p = 0.07).
Chan 2015 [Q = High] SLR with meta-analysis Total studies: 9 (n = 740) SCZ, SAD or bipolar affective disorder CACR Domain: occupational
(Only RWF)		 CACR resulted in significantly improved occupational outcomes including employment rate, total days of work in a year, and total annual earnings:
  • •

    Employment rates: 41% with CACR vs. 24% without CACR (RD, 20%; 95% CI, 5% to 35%)

  • •

    Total days of work: 19.5 days longer per year with vs without CACR (95% CI, 2.5 to 36.6 days)

  • •

    Total annual earnings: US$ 959 per year more with vs without CACR (95% CI, US$285 to US$1634)
Revell 2015 [Q = High] SLR with meta-analysis Total studies: 11 (n = 615) FEP CR Domains: social, independent living
(FC and RWF)		 In patients with FEP, CR had a significant impact on social functioning and ADLs (ES [Cohen's d], 0.18; 95% CI, 0.01 to 0.36; p < 0.05).
CR with adjunctive psychosocial rehabilitation had significantly stronger effects on functioning than CR alone (CR plus rehabilitation: ES, 0.39; 95% CI, 0.12 to 0.66, vs CR alone: ES, 0.03; 95% CI, −0.20 to 0.26; p < 0.05).
Wykes 2011 [Q = Medium] SLR with meta-analysis Total studies: 40 (n = 2104)
Studies assessing functioning: 19 (n = 1036)		 SCZ CR Domains: social, occupational, independent living
(FC and RWF)		 CR had a significant impact on functioning with small to mediuma ES (ES [Cohen's d], 0.42; 95% CI, 0.22 to 0.62).
CR with adjunctive psychosocial rehabilitation had significantly stronger effects on functioning than CR alone (CR plus rehabilitation: ES, 0.59; 95% CI, 0.30 to 0.88, vs CR alone: ES, 0.28, 95% CI, −0.02 to 0.58; p = 0.02).
McGurk 2007 [Q = Medium] SLR with meta-analysis Total studies: 26 (n = 1151)
Studies assessing functioning: 11 (n = 615)		 SCZ CR Domains: social, occupational, independent living
(FC and RWF)		 CR had a significant impact on functioning, with small to mediuma ES (ES, 0.35; 95% CI, 0.07 to 0.62).
CR with adjunctive psychosocial rehabilitation had significantly stronger effects on functioning than CR alone (CR plus rehabilitation: ES, 0.47, vs CR alone: ES, 0.05; p < 0.01).
Medalia 2013 [Q = NA] Narrative review NA SCZ CR Domains: social, occupational, independent living
(FC and RWF)		 CR was most likely to impact functional outcome when individuals were given opportunities to practice their cognitive skills in real-world settings. Functioning was enhanced by integrating CR programs with psychosocial rehabilitation programs.



Social cognitive interventions
Vass 2018 [Q = Medium] SLR Total studies: 17 (n=681)
Studies assessing functioning: 12 (n = 490)		 SCZ, SAD SC domain targeted: ToM
5 ToM-focused studies and 7 non-ToM studies		 Domains: social, occupational, independent living
(FC and RWF)		 Both targeted ToM interventions and non-ToM interventions generally showed an effect on social functioning. ToM-focused interventions did not appear to be specifically associated with improved functioning compared to other SC interventions.
Grant 2017 [Q = Medium] SLR Total studies: 32 (n = 1440)
Studies assessing functioning: 19 (NR)		 SCZ, SAD SC domains targeted: ToM, AR, AS and SP Domains: social, occupational, independent living
(FC and RWF)		 Limited evidence showed that SC interventions translated into functioning improvement. Specifically, only improved SP appeared to be significantly associated with functioning. Of the 19 studies, 10 reported significant impact of the SC intervention on functioning.
Co-occurrence of significant improvement in SC with significant improvement in functioning was seen only for SP (p = 0.02).

ADL, activities of daily living; AR, affect recognition; AS, attributional state; CACR, computer-assisted cognitive remediation; CI, confidence interval; CR, cognitive remediation; ES, effect size; FC, functional capacity; FEP, first episode psychosis; NA, not applicable; NR, not reported; Q, quality; RD, risk difference; RWF, real-world functioning; SAD, schizoaffective disorder; SC, social cognition; SCZ, schizophrenia; SLR, systematic literature review; SP, social perception; ToM, theory of mind; US, United States.

a

ES interpretation as reported by the respective study authors.