Implementing cognitive rehabilitation for people with Multiple Sclerosis: translating research into clinical practice

People with multiple sclerosis frequently report cognitive problems, which can affect function and quality of life. Although the effectiveness of cognitive rehabilitation to address these problems is evaluated in research studies, inadequate reporting of the content of the interventions may hamper clinical implementation. This research aimed to explore avenues to increase the clinical impact of trials of cognitive rehabilitation through the development of a clinician­informed, evidence­based checklist to guide researchers to better report cognitive rehabilitation studies in MS. The overarching design was exploratory mixed-methods, involving three separate intertwining studies. Study one: A systematic review of descriptions of the content of cognitive interventions to document salient details and omissions in reporting. Ten electronic databases were searched, and 54 studies involving various types of MS and techniques to improve difficulties with memory, attention and executive function were included in the review. The results showed that important features of cognitive rehabilitation were not reported well. This was particularly in relation to the content of interventions (reported completely in 48% of the articles), how the interventions were delivered (reported completely in 44% of the articles) and the mechanism of action of the interventions (reported completely in 39% of the articles). Study two: A video-based observational study, using time-sampling and content analysis to examine the content of treatment sessions delivered within the Cognitive Rehabilitation of Attention and Memory in MS (CRAMMS) trial. A total of 252 completely recorded treatment session videos were observed and coded. Content analysis indicated that all components of the CRAMMS manual were delivered as planned (intervention fidelity). The most frequently discussed topic for both therapists and the people with MS related to memory and attention coping strategies (17% and 16% of observations, respectively). Findings from studies one and two were integrated and informed the initial questionnaire for study three. Study three: A modified Delphi consensus study of three rounds, with clinicians and researchers who deliver cognitive rehabilitation to people with MS. This was conducted to ascertain the key aspects of cognitive rehabilitation that research studies should report to enable implementation in clinical practice. ‘Experts’ were asked to rate the importance of a number of reporting statements for inclusion in a reporting checklist (from low importance to high importance). Fourteen experts completed all three rounds. Based on the pre-specified criteria, consensus was achieved for 29 reporting statements. These statements were subsequently grouped based on how the expert panel rated their importance, forming a Priority 1 and 2 list of reporting statements. The checklist with the reporting statements should be used by researchers to describe cognitive rehabilitation programmes in the published literature. The evidence-based, clinician-informed checklist developed in this research is important because it will enable researchers to report important aspects of complex cognitive rehabilitation interventions. This should be regarded as the first step towards the implementation of such research in clinical practice