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T. D. Withiel et al.
findings as standard scores, in line with the clinical
translation goals of this paper.
Subjective memory. There was a significant interaction
between group and time-point when modelling change
in subjective everyday memory (see Table V). Post-
hoc analysis established that participants in the MSG
showed a significant reduction in the frequency of
everyday memory complaints following the interven-
tion. This interaction was, however, no longer signifi-
cant at follow-up and did not differ from WC or CCT
participants. Subjective PM did not significantly differ
between groups following intervention. However, a
significant group by time interaction was found when
modelling change on relatives’ reported PM failures,
whereby participants allocated to CCT intervention
displayed a significant reduction in frequency of close-
other reports of PM failures following intervention.
Improvement was not maintained at follow-up.
Regarding self-reported strategy use, there was a
significant interaction seen when modelling change
in frequency of internal strategy use. Although all
participants reported a significant increase in strategy
use at post-assessment, this improvement was only
maintained at follow-up for participants allocated to the
MSG. While all participants described improvement in
external strategy use over time, there was no significant
interaction. Model significance for subjective measures
can be found in Table SVI 1 and is shown in Fig. S2 1 .
Table V. Estimated marginal means and effect sizes for subjective
memory outcomes
Estimated marginal means
Measure
Everyday memory
MSG
CCT
WC
PM-self
MSG
CCT
WC
PM-close other
MSG
CCT
WC
Int. strategy use
MSG
CCT
WC
Ext. strategy use
MSG
CCT
WC
Baseline
Post-
intervention
Follow-up
Mean ± SE Cohen’s d
20.05 ± 2.71 13.77 ± 2.81*
21.37 ± 2.85 16.64 ± 2.96
19.97 ± 3.10 18.80 ± 3.07 14.48 ± 2.78
15.55 ± 3.10
16.12 ± 3.06 0.36
0.28
0.22
58.88 ± 4.05 54.72 ± 4.38
65.35 ± 4.05 55.30 ± 4.52
68.06 ± 4.66 55.78 ± 4.67 65.35 ± 4.26
59.79 ± 5.00
61.38 ± 4.67 0.26
0.21
0.25
61.72 ± 4.07 55.47 ± 4.40
64.70 ± 4.07 46.32 ± 4.40*
57.15 ± 4.73 56.81 ± 4.46 57.51 ± 4.53
49.22 ± 4.85
53.89 ± 4.73 0.18
0.64
0.13
Mean ± SE
Mean ± SE
3.50 ± 1.07 11.04 ± 1.17*
4.33 ± 1.10 10.11 ± 1.24
3.94 ± 1.25 7.33 ± 1.26
12.86 ± 1.12 16.78 ± 1.22
13.00 ± 1.15 15.35 ± 1.30
11.54 ± 1.31 13.69 ± 1.31
12.15 ± 1.18* 1.27
10.40 ± 1.36 0.84
8.68 ± 1.29 0.64
18.17 ± 1.23
13.88 ± 1.42
15.77 ± 1.34
0.84
0.13
0.63
*Significant interaction favouring intervention at p ≤ 0.05.
MSG: memory skills group; CCT: computerized cognitive training; WC: waitlist
control; PM: prospective memory; Int.: internal; Ext.: external; SE: standard
errors.
www.medicaljournals.se/jrm
DISCUSSION
To our knowledge, this study is the first phase II RCT
comparing real-world rehabilitation outcomes of CCT
and MSG rehabilitation in stroke survivors. Partici-
pants in the MSG reported significant improvement
in goal attainment above WC following intervention.
These gains were maintained at a 6-week follow-up,
with participants showing significant improvement
beyond both CCT and WC participants at this pri-
mary time-point. The magnitude of group differences
suggested a large treatment effect (see Table III).
These findings provide preliminary support for the
generalization of MSG outcomes to real-world im-
provements in memory functioning; a finding not
reported previously. While participants in the CCT
group described some increase in goal attainment,
performance did not improve beyond WC at any time-
point. These results do not support the generalization
of training to real-word benefit; a finding consistent
with recent commentary (6, 8). Within the context
of equivocal memory rehabilitation outcomes to date
(10), this study meaningfully contributes to the extant
body of literature through confirmation of real-world
improvement following group intervention training the
use of compensatory memory strategies and highlights
the potential utility of MSG in clinical practice. We
acknowledge that multiple cognitive deficits may af-
fect memory functioning after an acquired brain injury,
such as stroke. Unlike CCT, which specifically targets
an isolated domain of cognition, the MSG provides
a more holistic approach to rehabilitation and may
be better for addressing the multifaceted nature of
memory deficits following stroke. There is promising
evidence to indicate that CCT may be effective in
remediating impairment in attention and executive
functioning in acquired brain injury (33); 2 cognitive
domains known to be necessary for everyday memory
functioning. Future research should seek to explore the
real-world benefit of more globally targeted CCT on
everyday memory functioning.
Regarding secondary outcome measures, partici-
pants in the MSG displayed a significant improvement
in performance on visual WM and PM tasks, showing
greater improvement than CCT participants following
intervention. However, group differences ceased to be
significant at follow-up. Findings do not provide sup-
port for the sustained effects of either intervention on
neuropsychological measures of memory. Although
non-significant, this finding is not unexpected within
the theoretical framework of compensation. By cont-
rast, results are surprising within the framework of
restoration; whereby reduction in memory impairment
represents a necessary precursor to the transfer of train-