Many patients with exhaustion disorders continue to have significant difficulties with attention and memory function which reduce their work ability. This randomized study investigates whether the addition of a 12-week period of specific cognitive training or physical fitness training could further enhance cognitive function in patients with exhaustion disorder participating in a multimodal rehabilitation program.
This study was performed at The Stress Rehabilitation Clinic at the University hospital of Umeå. In total 161 patients with diagnosed exhaustion disorder were recruited consecutively to the study from March 2010 until June 2013. Participants were all in age span 18-60 years old, had an ongoing employment and were assessed as suitable for a 24-week multimodal rehabilitation, which consisted of cognitive behavioural therapy in group (maximum eight persons), prescription of physical activity/exercise (FaR©) and vocational measures with rehabilitation meetings. A randomization by group was performed after 12 weeks of multimodal rehabilitation to one of three conditions; A/ continued multimodal rehabilitation, B/ addition of a computer-based cognitive training, and C/ addition of physical fitness training. The added training was performed during the last 12 weeks of rehabilitation (week 12 to 24) and with three weekly training occasions. Primary endpoint was change in cognitive functioning, estimated as a global brain score. Secondary endpoints were changes in different specific neuropsychological tasks, estimated psychological wellbeing, physical capacity, work ability, health-related quality of life and cost-effectiveness. A long-term follow-up was performed one year after termination of the interventions (at week 76).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
161
A total of 36 training sessions, approximately 20 minutes long each. Five different tasks were used in training all tapping different aspects of cognitive control such as updating, shifting, visuo-spatial working memory and episodic memory binding.
A total of 36 training sessions, approximately 40 minutes long each, with physical fitness training performed as group indoor cycling. The participants were instructed to attain a load of approximately 65-80% of their maximum heart rate.
Stress Rehabilitation Clinic, Umeå university hospital, Västerbotten county council
Umeå, Sweden
Short-term change in global brain score
The global brain score was calculated from ten neuropsychological tasks covering different domains in cognitive functioning
Time frame: Week 12 and 24
Long-term change in global brain score
The global brain score was calculated from ten neuropsychological tasks covering different domains in cognitive functioning
Time frame: Week 12, 24 and 76, mixed model with several time points used to estimate long-term effects
Short-term change in "letter memory running span task"
A measure of the updating functioning
Time frame: Week 12 and 24
Long-term change in "letter memory running span task"
A measure of the updating functioning
Time frame: Week 12, 24 and 76, mixed model with several time points used to estimate long-term effects
Short-term change in "3-back task"
A measure of the updating functioning
Time frame: Week 12 and 24
Long-term change in "3-back task"
A measure of the updating functioning
Time frame: Week 12, 24 and 76, mixed model with several time points used to estimate long-term effects
Short-term change in the "colour word interference test (the Stroop test)"
A measure of the inhibition functioning, from D-KEFS
Time frame: Week 12 and 24
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Long-term change in the "colour word interference test (the Stroop test)"
A measure of the inhibition functioning, from D-KEFS
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in the "trail making test"
A measure of attentional shifting, from D-KEFS
Time frame: Week 12 and 24
Long-term change in the "trail making test"
A measure of attentional shifting, from D-KEFS
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in the "digit span forward test"
A measure of the working memory, from WAIS-R
Time frame: Week 12 and 24
Long-term change in the "digit span forward test"
A measure of the working memory, from WAIS-R
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in the "digit span backward test"
A measure of the working memory, from WAIS-R
Time frame: Week 12 and 24
Long-term change in the "digit span backward test"
A measure of the working memory, from WAIS-R
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in the "letter-number sequencing" test
A measure of the working memory, from WAIS-III
Time frame: Week 12 and 24
Long-term change in the "letter-number sequencing" test
A measure of the working memory, from WAIS-III
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in the "recall of concrete nouns" test (Buschke's selective reminding procedure)
A measure of the episodic memory
Time frame: Week 12 and 24
Long-term change in the "recall of concrete nouns" test (Buschke's selective reminding procedure)
A measure of the episodic memory
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in the "digit symbol" test
A measure of perceptual speed, from WAIS-R
Time frame: Week 12 and 24
Long-term change in the "digit symbol" test
A measure of perceptual speed, from WAIS-R
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in "Raven's advanced progressive matrices"
A measure of non-verbal reasoning ability
Time frame: Week 12 and 24
Long-term change in "Raven's advanced progressive matrices"
A measure of non-verbal reasoning ability
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in Shirom Melamed Burnout Questionnaire
A burnout measure
Time frame: Week 12 and 24
Long-term change in Shirom Melamed Burnout Questionnaire
A burnout measure
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in Short Form 36 item Health Questionnaire
Health-related quality of life estimate
Time frame: Week 12 and 24
Long-term change in Short Form 36 item Health Questionnaire
Health-related quality of life estimate
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in Checklist Individual Strength Questionnaire
Measure of fatigue
Time frame: Week 12 and 24
Long-term change in Checklist Individual Strength Questionnaire
Measure of fatigue
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in Hospital Anxiety and Depression Scale, HAD-S
A measure of anxiety and depression
Time frame: Week 12 and 24
Long-term change in Hospital Anxiety and Depression Scale, HAD-S
A measure of anxiety and depression
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in aerobic capacity
A submaximal cycle ergometer test performed to estimate maximal oxygen uptake
Time frame: Week 12 and 24
Long-term change in aerobic capacity
A submaximal cycle ergometer test performed to estimate maximal oxygen uptake
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Short-term change in work ability
Work Ability Index questionnaire, short version
Time frame: Week 12 and 24
Long-term change in work ability
Work Ability Index questionnaire, short version
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Long-term total sick leave change
Information about sick leave from registers at the Social Insurance Agency in Sweden
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects
Long-term cost-effectiveness
Estimation of Changes in Quality Adjusted Life Years by using the Short Form-(36) Health Survey
Time frame: Week 12, 24 and 76, mixed model with several time points to estimate long-term effects