To assess the effectiveness of digital cognitive rehabilitation programs on the quality of life (QoL) of Multiple Sclerosis (MS) patients.
Cognitive impairment affects 43-70% of MS patients, impacting memory, information processing, and executive function, which can affect patients' QoL. Digital interventions can be home-based, which is advantageous for those with mobility issues. Although cognitive rehabilitation has shown promise in improving cognition, no review has evaluated its impact on QoL.
Medline, PsycInfo, and Embase databases were searched for English-language RCTs of adult MS patients undergoing online cognitive rehabilitation, with QoL outcomes reported. Virtual reality interventions were excluded. Risk of bias was assessed using the ROB-2 tool. A meta-analysis using pre- and post-intervention QoL scores was conducted, and Hedges's g standardized mean difference was calculated. Heterogeneity was analyzed using meta-regression. PRISMA guidelines were followed.
378 papers were found and seven were included in the review, representing a total of 456 patients (mean age = 48.73). Five studies used the RehaCom software for cognitive rehabilitation. QoL outcomes were collected using MSQoL-54 (n=4) and EQ-5D (n=3). The total number of sessions ranged from 8 to 36, lasting 40 to 75 minutes over 5 weeks to 3 months. Only two studies showed statistically significant improvements in post-intervention QoL scores. The meta-analysis showed minimal improvement in QoL (Hedge's g = 0.04; 95% CI = -0.41 to 0.49), with high heterogeneity (I² = 86.99%), but adjusted meta-regression reduced this to 44.47%. The meta-regression found that longer interventions improved outcomes, while frequent weekly sessions had a negative effect.
The evidence supporting cognitive rehabilitation to improve QoL in MS patients is weak, and this study's meta-analysis did not yield conclusive effect sizes. However, it highlights the need for research on why cognitive gains do not translate to better QoL, potentially due to factors like mobility issues.