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REVISTA IBEROAMERICANA
DE PSICOLOGA Y SALUD
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www.elsevier.es/rips
a
Department of Methodology for Behavioral Sciences, School of Psychology, University of Barcelona, Research Institute
of Brain, Cognition and Behavior (IR3C), Barcelona, Spain
b
School of Psychology, Universidad Michoacana de San Nicols de Hidalgo de Morelia, Morelia, MICH, Mexico
KEYWORDS Abstract The purpose of this study was to conduct a meta-analysis on the effects of neuropsy-
Neuropsychological chological rehabilitation procedures on the quality of life in non-Spanish-speaking individuals
rehabilitation; ZLWKVRPHFRJQLWLYHGHFLW6L[WHHQVWXGLHVSXEOLVKHGGXULQJWKHSHULRGZKLFK\LHOG-
Quality of life; ed relevant information regarding the sample sizes used, the types of statistical contrasts, the
&RJQLWLYHGHFLW evaluation instruments or pathologies among others, were analyzed. We carried out study fol-
Meta-analysis ORZLQJWKHXVXDOHVWLPDWLRQSURFHGXUHVEDVHGRQWKHGHQLWLRQRIWKHHIIHFWVL]HDQGWKHVFUX-
tiny of their relationship with relevant variables (e.g., sample sizes, type of population), or
methodological variables (e.g., type of research or sampling design). The data analysis shows a
VWDWLVWLFDOO\VLJQLFDQWHIIHFWr+ = .38; p .001) in all the variables associated with the charac-
teristics of the intervention (duration, type of intervention, gender, year of publication and,
more importantly, quality of life and neuropsychological outcomes). As a general conclusion, we
were able to determine that Quality of Life (QoL) can improve, under certain conditions,
through neuropsychological rehabilitation, but this change is not permanent.
2014 Sociedad Universitaria de Investigacin en Psicologa y Salud. Published by ELSEVIER ESPAA, S.L.U.
This is an open-access article distributed under the terms of the Creative Commons CC BY-NC ND Licence
(http://creativecommons.org/licenses/by-nc-nd/3.0/).
* Corresponding author: Departament de Metodologia de les Cincies del Comportament. Facultat de Psicologia. Universitat de Barcelona.
Passeig de la Vall dHebron, 171. 08035 Barcelona (Spain).
E-mail: jguardia@ub.edu (J. Gurdia-Olmos).
2171-2069 2014 Sociedad Universitaria de Investigacin en Psicologa y Salud. Publicado por ELSEVIER ESPAA, S.L.U.
12 J. Gurdia-Olmos et al.
ODEDVHGHODGHQLFLyQGHOWDPDxRGHOHIHFWR\HODQiOLVLVGHVXUHODFLyQFRQODVYDULDEOHVUHOH-
vantes (tamaos de muestra, tipo de poblacin, etc.), o variables metodolgicas (tipo de inves-
tigacin o diseo de la muestra, etc.) El anlisis de los datos muestra un efecto estadsticamen-
WHVLJQLFDWLYRr+ = .38, p .001) en todas las variables asociadas a las caractersticas de la
intervencin (duracin, tipo de intervencin, gnero, ao de publicacin y, ms importante, la
calidad de vida y los resultados neuropsicolgicos). Como conclusin general, la dimensin cali-
dad de vida (QoL) puede mejorar, bajo ciertas condiciones, a travs de la rehabilitacin neurop-
sicolgica, pero este cambio no es permanente.
2014 Sociedad Universitaria de Investigacin en Psicologa y Salud. Publicado por ELSEVIER ESPAA, S.L.U. Este
es un artculo Open Acces distribuido bajo los trminos de la licencia CC BY-NC-ND (http://creativecommons.
org/licenses/by-nc-nd/3.0/).
Introduction danski, 2003; Sitzer, Twamley, & Jeste, 2006). These are un-
derstandable controversies given that most works use small
Health-Related Quality of Life (HRQoL) is a wide concept, samples of patients with different diseases, have different
EXWWKHUHH[LVWVFRQVHQVXVRQLWEHLQJDVXEMHFWLYHPHDVXUH designs, apply neuropsychological interventions of a differ-
of physical, emotional, and psychological conditions (Lon- ent nature, duration, intensity, and use diverse instruments
dos et al.6RPHVWXGLHVGHQH+54R/DVDQDVVHVV- to measure HRQoL.
ment of how a disease and its treatment affect a persons A previous work (Gurdia, Jarne, Urza, & Gudayol, 2012)
capability to develop everyday activities and play valuable dealing with the impact of neuropsychological rehabilitation
roles in their own life (Brissart, Leroy, & Debouverie, 2010; on QoL intended to approach this phenomenon by using me-
Fergusson et al., 2012). Neuropsychological diseases, like ta-analysis techniques while bearing in mind their possible
any other diseases, affect the quality of life (QoL) of those mediating effects in the analysis, as well as other substan-
who suffer from it (Murell, 1999). In spite of that, the HRQoL tive, methodological, and socio-demographic variables
of the persons suffering from neuropsychological alterations which may be affecting the results of the aforementioned
has not been widely studied, and it is often claimed that works. That study yielded the following conclusions: the
rehabilitating treatments in neuropsychological diseases im- positive effect of the rehabilitating intervention is generally
prove the patients quality of life without actually measur- linked to an improvement in the patients quality of life.
ing HRQoL (Londos et al., 2008). Other works (Cicerone, Likewise the use of retraining techniques (techniques in-
2005; Wilde et al., 2010) have recommended using HRQoL tended to restore the lost cognitive function) seems to have
PHDVXUHVDVRXWFRPHPHDVXUHVLQRUGHUWRJUDGHWKHHI- a positive effect on HRQoL that is more intense than the
cacy of neuropsychological rehabilitation in traumatic brain effect of compensatory techniques (techniques designed to
injury (TBI). Few works have studied the possible impact of LPSURYHVSHFLFDVSHFWVRIHYHU\GD\OLIHGHVSLWHWKHVSH-
neuropsychological interventions on the QoL of patients FLFFRJQLWLYHORVVH[SHULHQFHGE\WKHSDWLHQW7KDWSRVL-
ZLWKFRJQLWLYHDOWHUDWLRQV7KHUHH[LVWZRUNVRQSDWLHQWVZLWK tive effect of cognitive rehabilitation on HRQoL tends to
epilepsy, TBI, multiple sclerosis, cardiovascular events, mild decrease as time goes by between the clinical intervention
cognitive impairment, Alzheimers disease, and persons on and the follow-up; and when analyzing the data as a whole,
chemotherapy. The methodology used in those works in- HDFKVWXG\VVDPSOHVL]HDQGGHVLJQKDYHDGLUHFWLQXHQFH
cludes pre- and post-treatment observational studies on the effect size of the QoL improvement. In fact, the
(Cohen, Ylvisaker, Hamilton, Kemp, & Claiman, 2010; Lon- above-mentioned work re-analyzes data from Spanish-
dos et al., 2008; Rasquin et al., 2010), case and control speaking samples, and as the authors admit, most of
studies (Svendsen & Teasdale, 2006), and several clinical tri- the studies included in their study have a pre- post- simple
als (Brenk, Laun, & Haase, 2008; Clare et al., 2010; Davis, design where the variable control mechanisms are minimal,
Massman, & Doody, 2001; Engelberts et al., 2002; Gehring et and they tend to magnify the effect sizes of the phenome-
al., 2009; Hildebrand et al., 2007; Lincoln et al., 2002; So- non under study (Ahn, Myers, & Jin, 2012). Moreover the
lari, Pucci, Forni, Mancardi, & Pozzilli, 2004; Voght et al., VWXG\SXUSRVHIXOO\H[FOXGHGWKHZRUNVFRQGXFWHGZLWKQRQ
2009). Those studies present controversial results: whereas Spanish-speaking samples, and consequently, it involved
VRPHQGDSRVLWLYHHIIHFWRIQHXURSV\FKRORJLFDOUHKDELOLWD- relatively few works. On the date of its publication, there
tion on QoL (Brenk et al., 2008; Clare et al., 2010; Cohen et H[LVWHGQRRWKHUPHWDDQDO\VHVRQWKHVXEMHFWWKDWDOORZHG
al., 2010; Engelberts et al., 2002; Glanz et al., 2010; WKHDXWKRUVWRFRQWUDVWWKHLUQGLQJV7KHUHIRUHWKHLUFRQ-
Melchers, Maluck, Suhr, Scholten, & Lehmkuhl, 1999; Svend- clusions must be considered preliminary and they should be
sen & Teasdale, 2006), others do not (Davis et al., 2001). contrasted with results from non-Spanish-speaking samples,
This positive effect on the patients quality of life is observ- PXFKPRUHFRPPRQLQVFLHQWLFOLWHUDWXUH
able immediately after rehabilitation but is not persistent in Thus, the goal of the present study is to conduct a meta-
IROORZXSHYDOXDWLRQV6RODULHWDO2WKHUZRUNVQG analysis of the effects of neuropsychological rehabilitation
a positive effect of cognitive rehabilitation on some, but on the QoL of patients with neuropsychological alterations
not all, QoL measures (Seniow, Polanowska, Mandat, & Lau- by using non-Spanish-speaking samples, according to the
Neuropsychogical rehabilitation: A meta-analysis 13
estimate the effects of the intervention. In the latter cases, Two studies (12.5%) involved subjects with TBI (strokes
the Odds Ratio estimation was used as described by Rcker, FDXVHGE\WUDIFDQGZRUNDFFLGHQWVHOHYHQIRFXVHGRQ
Schwarzer and Carpenter (2008). With all these results, we individuals with other neuropsychological conditions, such
analyzed the 33 table generated by crossing the two main as Multiple Sclerosis, Alzheimers Disease, and Mild Cogni-
variables: the outcome measures in QoL (psychometric, tive Impairment, among others (68.65%). The rest of the
TXDOLWDWLYHRUPL[HGPHDVXUHVDQGWKHW\SHRIWUHDWPHQW studies (3) used subjects suffering from several pathologies.
UHWUDLQLQJFRPSHQVDWLRQRUPL[HG7KHGDWDZHUHWKHQ Finally, seven studies (43.75%) focused on retraining strate-
corresponded to each variable studied (effect size, sample gies, whereas two (12.5%) directed the treatment at com-
size, years of diagnosis, etc.) for every possible combina- SHQVDWLRQV\VWHPVDQGVHYHQVHWIRUWKPL[HG
tion. Therefore all the data tables from the studies were rehabilitation procedures (both retraining and compensa-
analyzed, and the odds ratio value was obtained for cases tion mechanisms).
where the table presented a 22 order, later transformed Finally, we would like to point out that the assessment of
to a correction value (r). For the remaining tables different statistical and methodological quality (scale 1 to 7, 1 for a
from and larger than 33, the correlation values were esti- ORZHYDOXDWLRQDQGIRUDQGH[FHOOHQWHYDOXDWLRQFRQ-
mated directly, which is usually the general indicator in GXFWHGE\IRXULQGHSHQGHQWH[SHUWVFRHIFLHQWRIFRQFRU-
meta-analysis works. All these analyses were conducted in- GDQFHRIRIWKHVHOHFWHGZRUNV\LHOGHGDPHDQRI
dependently by two of the authors of the current paper, (SD = 0.91), which would indicate a not especially high
with completely matching estimates of the size effect and PHWKRGRORJLFDODQGVWDWLVWLFDOWHVWLQWKHFRPSOH[LW\RIWKH
its corrections. designs and statistical treatments set forth. These types of
estimations are of little relevance, but they offer an ap-
Data analysis SUR[LPDWHLGHDRIWKHFRPSOH[LW\RIWKHVWUDWHJLHVXVHGDQG
are frequent in studies on meta-analyses.
Firstly, r values were corrected by means of their variance
to weigh them according to their sample sizes, since the p Mean effect size
value related to the effect size is not independent from the
sample size where it is estimated. This procedure was re- After obtaining the effect sizes based on correlation, the
peated following the scheme used by Redondo, Snchez- observed global mean was r+ = .38, which points at a highly
0HFDDQG*DUULGRZLWKWKHH[FHSWLRQWKDWLQWKDW VLJQLFDQWHIIHFWp .001). These results are important
ZRUND[HGHIIHFWPRGHOZDVXVHGDQGLQRXUFDVHZH EHFDXVHWKHREWDLQHGVLJQLFDWLRQVKRZVDKLJKHIIHFWVL]H
eventually opted for a random-effect model, given the high In order to establish better these results, the Binomial Ef-
variability of the observed distributions of the effect sizes. fect Size Display (BESD) was applied (Rosenthal & Rubin,
All the analyses were conducted with the IBM-SPSS soft- 1982; Valera-Espn & Snchez-Meca, 1997). The BESD esti-
ware, version 21.0, and some of the R software routines (R mated values obtained for the treatment groups were of
'HYHORSPHQW&RUH7HDPPRUHVSHFLFDOO\WKH0HWD 60.28% and obviously of 39.72% for the failure. This high
library (Schwarzer, 2013). SHUFHQWDJHZDUUDQWVWKHVLJQLFDQFHRIWKHUHVXOWVLQWKH
statistical and clinical domain. The analysis of the contin-
gency tables indeed shows a clear tendency toward the use
Results of intervention systems based on retraining by means of
simple designs of pre- and post-test repeated measures.
Description of the results That is consistent with the data of previous meta-analyses
conducted with English-speaking samples. As stated by
)RUWKHVL[WHHQVWXGLHVDQDO\]HGWKHPHDQVDPSOHVL]HZDV 6LW]HUHWDOWKLVZRXOGEHH[SHFWHGLQFOLQLFDOWULDOV
165.25 (SD = 11.08) and when combined, the studies yielded applied in hospitals and is consistent with works similar to
a mean age of 56.26 years (SD = 9.13). The average time the present one, such as Cicerone (2005).
between the diagnosis of the disease and the onset of the
cognitive rehabilitation program was 4.12 months (SD = Moderating variables
1.11). The average number of sessions was 25 (SD = 3.11)
(range between 18 and 35). The average duration of the in- The initial analysis with the direct effect sizes show clear
tervention from the onset of the program was 14 weeks VWDWLVWLFDOVLJQLFDQFHQT(15) = 97.42; p .001), so we can
(SD = 1.94). assume the heterogeneity of the effect sizes derived from
Eleven (68.75%) of the studies used a clinical trial meth- the different studies. Therefore, the need arises to evalu-
odological strategy, two (12.5%) used case control, and the DWHWKHUROHRIWKHGLIIHUHQWPRGHUDWLQJYDULDEOHVLGHQWLHG
rest (3 studies) used a simple pre- and post-treatment de- LQWKLVVWXG\LQRUGHUWRVHDUFKIRUUHDVRQDEOHH[SODQDWLRQV
sign with repeated measures. In regard to measurement for that difference both in the boarding system and in the
SURFHGXUHVIWHHQXVHGVWUDWHJLHVVWULFWO\EDVHG mechanisms of intervention. The mean effect size is good
on psychometric-base questionnaires and/or scales (SF-36, complementary information. Accordingly, the meta-analyti-
WHOL, QoFS, etc.) to evaluate the outcome in QoL. No cal approach here presented may provide us with more
studies used qualitative evaluations by means of semi-struc- thorough data than merely checking the published works,
tured interviews, and only one (6.25%) used both strategies. ZKLFKLVWKHXVXDOPHWKRGRORJ\LQVFLHQWLFOLWHUDWXUHUH-
As for the publishing year, three studies were published be- views.
tween 2001 and 2003, three between 2004 and 2006, seven Therefore, the descriptive effect in favor of retraining
between 2007 and 2009, and three between 2010 and 2012. VWUDWHJLHVYHUVXVFRPSHQVDWLRQVWUDWHJLHVGLVFXVVHGLQWKH
Neuropsychogical rehabilitation: A meta-analysis 15
QH[WVHFWLRQPXVWEHFODULHGDFFRUGLQJWRWKHUROHRIWKH
Table 1 Results of the variance analyses for the
moderating variables we have determined, since it is rea-
qualitative moderating variables.
sonable that some of them may provide relevant informa-
Moderating variables kj r+j QB R2 tion regarding the differences we found. The tables below
VKRZWKHVWDWLVWLFDOVLJQLFDQFHIRXQGIRUTXDOLWDWLYHYDUL-
Method variables 33.01* .371
ables (Table 1) and for quantitative variables (Table 2).
Study design
6WDWLVWLFDOO\VLJQLFDQWGDWDLQERWKWDEOHVSUHVHQWDUHOD-
Clinical trials 11 .22* tively clear scenario. First, regarding Table 1, we see that
One group design 2 .11 (QB(2) = 33.01; p .05), so we can infer that this type of
Pre-Post-test desig 3 .62** works use pre- and post-test designs with repeated mea-
Measurement procedures sures without much of a doubt about that effect (r+ = .62),
as compared to those using clinical trials (r+ = .22) or case
Psychometric approach 15 .88*
control strategies (r+ = 11). In relation to the measurement
Other psychometric 1 SURFHGXUHVWKHXVHRIVFDOHVLVWKHRQO\VLJQLFDQWVRXUFH
Extrinsic variables 32.41* .181 (r+ DQGLWDOORZVXVWRLQIHUWKDWWKHVFLHQWLFFRP-
Year of publication munity widely agrees on this point and that both effects are
important, given that R2 RIH[SODLQHGYDUL-
2001-2003 3 .06
ance), which should not be discarded. In fact, the effect of
2004-2006 3 .09 using psychometric scales for both pre- and post-test evalu-
2007-2009 7 .31* ations is decisive.
2010-2012 3 .11 Likewise, the papers published within the 2007-2009 pe-
riod (r+ = .31) show a tendency toward a somewhat higher
Substantive variables 42.13* .345
average effect size (QB(3) = 32.41; p .05), so it would be
Disease etiology reasonable to think that over time the number of studies
Traumatic Brain Injury (TBI) 2 .10 has increased, and the studies have become clearer with
Other Etiologies (OE) 11 .47** PRUHVLJQLFDQWHIIHFWVL]HVRIH[SODLQHGYDULDQFH
0L[HG 3 .07 In other words, in two years there has not only been a clear
breakthrough in the number of studies published with non-
Neuropsychological intervention
Spanish-speaking samples.
Retraining 7 .67** We would like to point out that the estimated effect is
Compensatory 2 .25* distributed asymmetrically among the studies using samples
0L[HG 7 .039 RISDWLHQWVZLWKH[WHUQDORULQWHUQDOSDWKRORJLHVDFFRUGLQJ
WRWKHGHQLWLRQDERYH([WHUQDOSDWKRORJLHVr+ = .10) were
Note. * p .05 ** p .01; k = Number of studies for each category;
r+j PHDQ RI WKH FRUUHODWLRQ FRHIFLHQW QB = statistical not statistically significant, but internal pathologies
VLJQLFDWLRQWHVWR2 GHWHUPLQDWLRQFRHIFLHQW (r+ ZHUHFOHDUO\VLJQLFDQWLQVWHDGp .01). The ef-
fect of samples with both pathologies has been discarded
Table 2 Results of the weighted simple regression analyses for the quantitative moderating variables.
GXHWRQRQVLJQLFDQFHr+ = .07). Finally, the combined ef- seem to dilute over time. Both variables are essential given
fect derived from retraining interventions was highly statis- WKHYDULDWLRQSHUFHQWDJHVWKH\H[SODLQDQGUHVSHF-
tically significant (r + = .67; p .01), as was the effect tively. Finally, in order to evaluate the possible bias of pub-
associated to the compensatory intervention (r + = .25; lication, we estimated the Egger test (Egger, Smith,
p 'HVSLWHEHLQJVWDWLVWLFDOO\VLJQLFDQWWKH\DUHIDU Schneider, & Minder, 1997), which was non-significant
from the effect obtained by retraining interventions. Prob- (p = .86). Therefore it was unnecessary to include informa-
ably, that effect is partly due to the different tradition in tion of the Funnel plot.
the clinical studies applied to the one we discussed above,
which focused on retraining as a choice of intervention in
UHODWLYHO\VLPSOHGHVLJQV1RDVVRFLDWHGHIIHFWWRWKHPL[HG Discussion
strategy was noted (r+ ,QJHQHUDOWKHH[SODLQHG
variance was high (R2 = .345 or 34.5% of the total) and sta- The results allow us to draw several conclusions. Firstly, it is
WLVWLFDOO\VLJQLFDQWQB(2) = 42.13; p .05). important to highlight that the number of papers with non-
If we focus on Table 2, regression models show some ef- Spanish-speaking samples analyzed (16) was lower than the
fects to be highlighted. The percentage of works focusing number of papers with Spanish-speaking samples (21) re-
solely on neuropsychological interventions (QR(8) = 3.228) was ported on Gurdia et al. (2012), since the publications in
QRWVLJQLFDQW,QVWHDGWKHPRQWKVJRQHE\IURPWKHGLDJ- non-Spanish-speaking countries vastly outnumber any oth-
nosis to the onset of the intervention (QR(5) = 7.931; p .05), ers. The reason may lie in the fact that this type of works
and the number of sessions (QR(12) = 9.271; p .05) applied commonly use clinical samples, and intervention times are
were significant. The duration of the intervention pro- glaringly longer in Spanish-speaking healthcares than in
gram was statistically significant (QR(12) = 8.222; p .05), non-Spanish-speaking ones. Additionally, in the Spanish-
therefore it seems that longer rehabilitation programs bring speaking world, it is somewhat more common to use Quality
more effect to the therapy results. Likewise, although there of Life measurements as indicators of effect associated to
ZDVQRFOHDUVWDWLVWLFDOVLJQLFDQFHQR(12) = 7.121), a tendency the neurorehabilitation program. The tradition in the Span-
FDQEHHVWDEOLVKHGWRZDUGUDWLRVLJQLFDQFHEHWZHHQZHHNO\ ish-speaking neuropsychological approach is somewhat lon-
sessions and the number of weeks of the program. This adds ger than in the non-Spanish-speaking one.
to the notion that a greater effect is obtained in programs in- )XUWKHUPRUHZHPXVWQRWHWKHH[LVWHQFHRIDSRVLWLYH
volving more sessions during a longer period of time. effect of neuropsychological rehabilitation techniques on
The crucial data in Table 2 are the results obtained with QoL. We can thus state that the different neuropsychologi-
the data derived from the outcome in neuropsychological cal intervention therapies improve the patients quality of
SHUIRUPDQFH7KHUHVXOWLVKLJKO\VLJQLFDQWQR(15) = 14.712; life, with a moderate effect size. However, that effect
p IRUQHXURSV\FKRORJLFDOPHDVXUHVH[FOXVLYHO\7KXV tends to decrease over time. As time goes by after the neu-
we can interpret that the studies analyzed show that cogni- ropsychological intervention applied, the patients quality
tive rehabilitation programs are effective with an effect of life tends to diminish, which suggests that the therapys
VL]HWKDWPD\EHUHVSRQVLEOHIRUXSWRRIWKHH[SODLQHG positive effect on the variable is not permanent. In addi-
variation, and, even more importantly, that effect is more WLRQWKHUHKDELOLWDWLRQVHIIHFWRQ4R/LVYHU\PXFKLQX-
intense when they are estimated by comparing the pre- and enced by several moderating variables, both quantitative
post- levels of these patients perceived QoL, up to 39% of and qualitative. As for the effect of the substantive vari-
WKHH[SODLQHGYDULDWLRQ7KHUHDUHQRGLIIHUHQFHVEHWZHHQ ables, we must note that the type of therapy applied seems
one choice and the other, but it is important to highlight a to influence the phenomenon under study, so that those
certain tendency to improve neuropsychological values over works where the neuropsychological intervention was based
strictly QoL measures. on the use of retraining techniques are the ones showing the
These comments need to be clarified, partially, by the greatest improvements in their patients quality of life,
role of the subject and the methodological variables includ- whereas those using compensatory treatment strategies
ed in Table 2. There is, indeed, an evident bias in favor of yield more modest results. However, that fact can be due,
women and younger patients. In the case of women, the at least partly, to the slightly higher number of participants
effect is clear (QR(15) = 9.154; p .05), and even more con- in that sub-sample than in other intervention groups, which
clusive in the mean age of the groups treated (Q R(15) = is hardly surprising when we consider that those techniques
17.992; p .01). It should all be interpreted in the sense have a greater tradition in neuropsychological intervention.
that the favorable effect in post-evaluations is more pro- For that reason, this fact could be biasing the results, thus
nounced in the case of women and younger subjects (the yielding a greater effect size than other interventions. Oth-
FRHIFLHQWRIUHJUHVVLRQLVQHJDWLYH = .392). Likewise, er substantive variables interfering with the neuropsycho-
the effect attributed to the study of sample sizes and the logical rehabilitations effect on QoL are all those related to
number of measurements is also crucial. As regards the sam- the intensity and the duration of the interventions. If we
ple size, the results we obtained (QR(15) = 12.543; p .01) increase the weeks of duration of the intervention, the
show that the effect size is higher and clearer with large number of sessions of the intervention, and the relationship
samples. It is also important to note that the effect of the between the number of sessions and the duration of the in-
duration of the follow-ups (measurement waves) is also tervention in weeks, then the effects on QoL increase, too.
FOHDUO\VLJQLFDQWQR(15) = 16.211; p .01). The negative Nevertheless, those variables must be understood within
YDOXHRIWKHFRHIFLHQWRIUHJUHVVLRQ = -.399) would show WKHSDWLHQWVFOLQLFDOFRQWH[WVLQFHWKH\DUHRIWHQGHWHU-
that, as the follow-up duration increases, the effect size mined by the conditions of the health services. The neuro-
decreases. The reduction of post- effects is clear, as they psychological deficits etiology is another substantive
Neuropsychogical rehabilitation: A meta-analysis 17
$VLQJOHEOLQGUDQGRPL]HGFRQWUROOHGWULDORIFOLQLFDOHIFDF\ *Niemeier, J. P., Kreutzer, J. S., Marwitz, J. H., Gary, K. W., & Ket-
American Journal of Geriatric Psychiatry, 18, 928-939. FKXP-0(IFDF\RIDEULHIDFXWHQHXUREHKDYLRXUDO
*Cohen, M., Ylvisaker, M., Hamilton, J., Kemp, L., & Claiman, B. intervention following traumatic brain injury: A preliminary in-
(2010). Errorless learning of functional life skills in an individual vestigation. Brain Injury, 25, 680-690.
ZLWKWKUHHDHWLRORJLHVRIVHYHUHPHPRU\DQGH[HFXWLYHIXQFWLRQ
5DVTXLQ60%RXZHQV6)'LMFNV%:LQNHQV,%DN[:*
impairment. Neuropsychological Rehabilitation, 20, 355-376. & Van Heugten, C. M. (2010). Effectiveness of a low intensity
*Davis, R. N., Massman, P. J., & Doody, R. S. (2001). Cognitive inter- outpatient cognitive rehabilitation programme for patients in
vention in Alzheimer disease: A randomized placebo-controlled the chronic phase after acquired brain injury. Neuropsychologi-
study. Alzheimer Disease Association Disorder, 15, 1-9. cal Rehabilitation, 20, 760-777.
*Engelberts, N. H., Klein, M., Adr, H. J., Heimans, J. J., Trenit, D. R Development Core Team (2011). R: A language and environment
G., & Van der Ploeg, H. M. (2002). The effectiveness of cogni- for statistical computing. Vienna, Austria: R Foundation for
WLYHUHKDELOLWDWLRQIRUDWWHQWLRQGHFLWLQIRFDOVHL]XUHV$UDQ- Statistical Computing. Retrieved from http://www.R-project.
domized controlled study. Epilepsia, 43, 587-595. org
Egger, M., Smith, G. D., Schneider, M., & Minder C. (1997). Bias in Redondo, S., Snchez-Meca, J., & Garrido, V. (2002). Los programas
meta-analysis detected by a simple, graphical test. British psicolgicos con delincuentes y su efectividad: La situacin eu-
Medical Journal, 315, 629-634. ropea (Psychological programmes with offenders and their ef-
Ferguson, R. J., McDonald, B. C., Rocque, M. A., Furstenberg, C. T., fectiveness: The European situation). Psicothema, 14, 164-173.
Horrigan, S., Ahles, T. A., & Saykin, A. J. (2012). Development Rossental, R., & Rubin, D. B. (1982). A simple, general purpose dis-
of CBT for chemotherapy-related cognitive change: Results of a SOD\RIPDJQLWXGHRIH[SHULPHQWDOHIIHFWJournal of Educa-
waitlist control trial. Psycho-Oncology, 21, 176-186. tional Psychology, 74, 166-169.
Fleis, J. L. (1981). Statistical methods for rates and proportions. Rcker, G., Schwarzer, G., & Carpenter, J. (2008). Arcsine test for
New York, NY: John Wiley & Sons. publication bias in meta-analyses with binary outcomes. Statis-
*Gehring, K., Sitskoorn, M. M., Gundy, C. M., Sikkes, S.A., Klein, M., tical Medicine, 27, 746-763.
Postma, T. J., Aaronson, N. K. (2009). Cognitive rehabilitation Snchez-Meca, J., Rosa, A.I., & Olivares, J. (1999). Las tcnicas
in patients with gliomas: A randomized, controlled trial. Jour- cognitivo-conductuales en problemas clnicos y de la salud:
nal of Clinical Oncology, 27, 3712-3722. Meta-anlisis de la literatura espaola (Cognitive-behavioural
*ODQ]%,+HDO\%&5LQWHOO'--DIQ6.%DNVKL5 techniques in clinical and health problems: Meta-analysis of
Weiner, H. L. (2010). The association between cognitive impair- Spanish literature). Psicothema, 11, 641-654.
ment and quality of life in patients with early multiple sclero- Schwarzer, G. (2013). Meta-analysis with R. Retrieved from http://
sis. Journal of Neurology Science, 290, 75-79. cran.r-project.org/web/packages/meta/meta.pdf
Gurdia, J., Jarne, A., Urza, A., & Gudayol, E. (2012) Neuropsy- Seniow, J., Polanowska, K., Mandat, T., & Laudanski, K. (2003). The
chological rehabilitation and quality of life in patients with cog- cognitive impairments due to the occipito-parietal brain injury
nitive impairments: A meta-analysis study in Spanish-speaking after gunshot. A successful neurorehabiliation case study. Brain
populations. Neurorehabilitation, 30, 35-42. Injury, 7, 701-713.
*Hildebrandt, H., Lanz, M., Hahn, H. K., Hoffmann, E., Schwarze, Sitzer, D. I., Twamley, E. W., & Jeste, D. V. (2006). Cognitive train-
B., Schwendemann, G., & Kraus, J. A. (2007). Cognitive training ing in Alzheimers disease: A meta-analysis of the literature.
in MS: Effects and relation to brain atrophy. Restoring Neuro- Acta Psychiatrica Scandinavica, 114, 75-90.
logical Neuroscience, 25, 33-43. *Solari, A. L., Pucci, E., Forni, M., Mancardi, G., & Pozzilli, G.
*Lincoln, N. B., Dent, A., Harding, J., Weyman, N., Nicholl, C., (2004). CRIMS trial. Computer-aided retraining of memory and
Blumhardt, L. D., & Playford, E. D. (2002). Evaluation of cogni- attention in people with multiple sclerosis: A randomized dou-
tive assessment and cognitive intervention for people with mul- ble-blind controlled trial. Journal of Neurology Science, 222,
tiple sclerosis. Journal of Neurology and Neurosurgery Psychia- 99-104.
try, 72, 93-98.
6YHQGVHQ+$ 7HDVGDOH7:7KHLQXHQFHRIQHXUR-
*Londos, E., Boschian, K., Linden, A., Persson, C., Minthon, L., & psychological rehabilitation on symptomatology and quality of
/H[HOO-(IIHFWVRIDJRDORULHQWHGUHKDELOLWDWLRQSUR- life following brain injury: A controlled long-term follow-up.
gram in mild cognitive impairment: A pilot study. American Brain Injury, 20, 1295-1306.
Journal of Alzheimers Disease and Other Dementias, 23, 177- 9DOHUD(VStQ$ 6iQFKH]0HFD-3UXHEDVGHVLJQL-
183. FDFLyQ\PDJQLWXGGHOHIHFWR5HH[LRQHV\SURSXHVWDVAnales
Mayo, N. E., Moriello, C., Asano, M., Van der Spuy, S., & Finch, L. de Psicologa, 13, 85-90.
7KHH[WHQWWRZKLFKFRPPRQKHDOWKUHODWHGTXDOLW\RI *Voght, A., Kappos, L., Calabrese, P., Stcklin, M., Gschwind, L., Op-
life indices capture constructs beyond symptoms and function. wis, K., & Penner, I. K. (2009). Working memory training in pa-
Quality of Life Research, 20, 621-627. tients with multiple sclerosiscomparison of two different train-
*Melchers, P., Maluck, A., Suhr, L., Scholten, S., & Lehmkuhl, G. ing schedules. Restoring Neurological Neuroscience, 27, 225-235.
(1999). An early onset rehabilitation program for children and Wilde, E., Witheneck, G., Bogner, J. G., Bushnick, T., Cifu, D.X.,
adolescents after Traumatic Brain Injury (TBI): Methods and Dikmen, S.D., Von Steinbuechel, N. (2010). Recommenda-
UVWUHVXOWVRestoring Neurological Neuroscience, 14, 153-160. tions for the use of common outcome measures in traumatic
Murell, R. (1999). Quality of life and Neurological Illness. A review brain injury research. Archives of Physical Medicine and Reha-
of the literature. Neuropsychology Review, 9, 209-229. bilitation, 91, 1650-1660.