The big picture of poststroke aphasia, neglect, and cognitive impairment trials: an overview of 3 systematic reviews

Background Over half of stroke survivors present with a cognitive deficit, often resulting in poorer outcomes and decreased quality of life.Objective To provide an overview of randomized controlled trials (RCTs) of poststroke cognitive rehabilitation, we (1) examined study design and participant characteristics, including trends over time, sample sizes, methodological quality, sex distribution, time poststroke, and intervention type; and (2) recorded and compared outcome measures (OMs).Methods This study provides an overview of English-language poststroke cognitive rehabilitation RCTs, based on data from 3 systematic reviews (neglect, aphasia, and general cognitive impairment). MEDLINE, Embase, CINAHL, PsycINFO, Scopus, and Web of Science were searched for English RCTs published up to December 31, 2024. For each systematic review, screening, data extraction, and quality assessment were conducted by 2 independent reviewers. Data extractions from the 3 systematic reviews were pooled into a single dataset for analysis.Results A total of 596 RCTs were analyzed, with a median sample size of 36 and 42% female participants. The number of RCTs and sample sizes increased steadily over time. However, there was no improvement in methodological quality, measured by PEDro scores, and female recruitment declined over time. Most RCTs targeting general cognition (54%) and neglect (82%) were conducted in the acute and subacute poststroke phases, whereas the majority of aphasia RCTs (57%) were conducted in the chronic phase. Technological interventions, including non-invasive brain stimulation and computerized training, have become more common in recent years. OMs used across trials showed substantial heterogeneity.Conclusion Despite substantial growth in poststroke cognitive rehabilitation research, methodological quality, sex representation, and OM standardization have not improved in parallel. Persistent OM heterogeneity and misalignment with clinical guidelines limit knowledge translation, highlighting the need for adequately powered trials, and the development of aligned core outcome sets to support clinical decision-making.