Cognitive and Motor Therapy After Stroke Is Not Superior to Motor and Cognitive Therapy Alone to Improve Cognitive and Motor Outcomes: New Insights From a Meta-analysis

To evaluate whether cognitive-and-motor therapy (CMT) is more effective than no therapy, motor therapy or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting, and which CMT approach is most effective.AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October, 2022.Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010, that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive or cognitive-motor outcome. Two CMT approaches exist: CMT Dual-task ("classical" dual-task where the secondary cognitive task has a distinct goal) and CMT Integrated (where cognitive components of the task are integrated into the motor task).Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multi-level random-effects meta-analysis was conducted.CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49 [0.10, 0.88]) and cognitive-motor outcomes (g = 0.29 [0.03, 0.54]). CMT showed no significant effects compared with motor therapy on motor, cognitive and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18 [0.01, 0.36]) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07 [-0.04, 0.18]). Comparison of CMT Dual-task and Integrated revealed no significant difference for motor (F1, 141=0.80, P= .371) or cognitive outcomes (F1, 72=0.61, P=.439).CMT was not superior to mono-therapies to improve outcomes after stroke. CMT approaches were equally effective suggesting that training that enlists a cognitive load per se, may benefit outcomes. (PROSPERO CRD42020193655).