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1- University of Isfahan
2- Isfahan University of Medical Sciences
3- University of Guilan
Abstract:   (106 Views)
Introduction:Multiple sclerosis (MS) is a progressive neurological illness attributed to plaques in the brain or spinal cord. Patients with MS may experience impaired cognitive functions, including attention and memory deficits. These problems can have significant negative impact on the quality of life of patients with MS.
The treatment process for these problems begins with an extensive assessment of the neuropsychology, and after identifying them through cognitive rehabilitation, an attempt is made to increase the cognitive abilities of these patients.
The initial objective of this study was to investigate and identify the cognitive problems in these patients based on the theory of information processing model. This theory is one of the cognitive theories regarding memory that provides a good platform for assessing the cognitive status of patients. The second phase of the study, based on the evaluation of the initial phase, was to design a specific and appropriate cognitive rehabilitation program for these patients. The final phase of the study was to evaluate the effectiveness of this program on improving patients' cognitive abilities.
Methods: The method of this research is a sequential advanced combination that was performed in 3 phases. In phase one, 103 patients with MS were compared with 86 controls among those referred to the Isfahan Ayatollah Kashani Hospital MS Unit; the causal-comparative method was used for comparison between groups. In phase two,a qualitative method was used for developing a rehabilitation protocol prepared according to the results of the first phase. In phase three,a randomized-controlled clinical trial method for implementing intervention. In phase one, 103 patients with MS were compared with 86 controls among those referred to the Isfahan Ayatollah KashaniHospital MS Unit.
Five subtests of Minimal assessment of cognitive function in multiple sclerosis (MACFIMS) were applied to evaluate cognitive function: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), California Verbal Learning Test second edition (CVLT-II), Brief Visuospatial Memory Test-Revised (BVMT-R) and Oral Word Association Test (COWAT).Based on the results, a cognitive rehabilitation protocol was then developed. To evaluate the content validity of rehabilitation program was evaluated by experts’ opinions; the numeric value of content validity ratio was calculated through Lawshe formula and table.
In the final phase, the effectiveness of the designed protocol was evaluated; 50 patients with MS,who were already assessed in phase 1, were selected. Then they were randomly divided into experimental and control groups. The cognitive protocol for the experimental group was 12 sessions once a week individually and the control group did not receive any treatment. At the end of the course, both groups were re-evaluated and repeated after one month for follow-up. In the first and last stages, the results were analyzed by analysis of covariance in SPSS-22 software.
Results:Comparison of the mean scores of cognitive tests indicated a significant difference between MS patients and the control group (P <0.0001). Content validity ratio (CVR) for expert opinionson cognitive protocolwas0.75-1.0. The difference between the mean scores of cognitive tests between the case and the control groups was significant after the implementation of the cognitive protocol at one month follow-up. This significance was observed in the mean scores of all cognitive tests except the mean scores of long-term auditory memory and long-term visual memory.
Conclusion: Based on the results, it can be concluded that the designed cognitive rehabilitation protocol has been effective and may be used as a useful instrument to improve the cognitive abilities of patients with MS.
     
Type of Study: Research |
Received: 2021/05/7 | Accepted: 2021/07/16

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