HomeCoRe for telerehabilitation in mild or major neurocognitive disorders: a non-inferiority randomized controlled trial

This randomized controlled trial (RCT) assessed the non-inferiority of HomeCoRe, a home-based version of the CoRe (Cognitive Rehabilitation) software, compared to its in-clinic counterpart in older adults with mild or major neurocognitive disorders. Seventy-seven participants were randomized to receive a 6-week cognitive training with either HomeCoRe (n = 40) or CoRe (n = 37). Global cognition, specific cognitive domains, and well-being were assessed at baseline and after training. Participant-centered outcomes were also examined, including Weighted Scores, which offer a composite measure capturing both individual session performance and overall rehabilitation progress. Results showed that HomeCoRe was non-inferior to CoRe in improving cognition. Both groups showed significant gains in working memory (p_HomeCoRe = 0.03; p_CoRe = 0.005) and logical-executive functions (p_HomeCoRe = 0.003; p_CoRe = 0.002), while only HomeCoRe was found to improve global cognition (p = 0.01). Weighted Scores significantly increased in both groups (p_HomeCoRe = 0.001; p_CoRe < 0.001). No significant differences emerged in mood or mental health outcomes. This study provides important evidence on how the mode of delivery can influence cognitive rehabilitation outcomes, representing one of the first RCTs to assess the same intervention delivered both in-person and remotely. The demonstration of HomeCoRe's non-inferiority highlights the potential of this promising alternative to in-clinic rehabilitation, promoting accessibility, engagement, and autonomy. Clinicaltrials.gov https://clinicaltrials.gov/ct2/show/NCT04889560 (registration date: May 17, 2021).