Compensatory Strategy Training Versus Computerized Restorative Function Training for Adults in the Chronic Stage After Acquired Brain Injury: A Systematic Review and Meta-analysis

Although compensatory strategy training (CST) interventions are often regarded as the golden standard in practice, computerized restorative function training (CRFT) interventions became increasingly popular in recent years to rehabilitate cognitive problems in individuals with brain injuries. In this systematic review and meta-analysis, we aimed to investigate the efficacy of CST interventions in comparison to CRFT interventions with a particular focus on generalization of treatment effects to daily life. More specifically, we evaluated the efficacy across the components of the International Classification of Functioning, Disability and Health (ICF) framework, with a particular focus on outcome measures at the activity and participation levels, as these are crucial for evaluating generalization. Database searches were conducted of studies investigating CST and CRFT interventions in comparison either with an active control condition or with one another. Scientific quality and risk of bias was rated using the RoB-2 Cochrane Tool. Thirty studies met the inclusion criteria. The findings indicated that CST results in significant improvements on task performance (at the ICF activity level), as measured by proxy ratings. These effects were most notable for interventions targeting executive functioning and immediately post-treatment, with long-term effects remaining unclear. Notably, CRFT showed no improvements, with the active control group demonstrating significantly better task performance post-treatment compared to the CRFT group. However, further research is necessary to conduct a robust direct comparison between both interventions, to evaluate the long-term effects at the ICF activity level, and to evaluate which intervention method leads to improvements at the participation level.