The Effectiveness of Cognitive Rehabilitation on Working Memory in Clinical and Non-clinical Populations in Iran: A Meta-Analysis Study

Background & Objective: Working memory is a fundamental component of cognitive functioning and plays a crucial role in daily activities, learning, and information processing. Impairments in this domain can lead to reduced efficiency of environmental interactions and diminished quality of life. Cognitive rehabilitation is a relatively new therapeutic approach designed to improve or compensate for cognitive deficits, particularly in working memory. This meta-analysis aimed to evaluate the effectiveness of cognitive rehabilitation for working memory in Iranian studies. Methods: This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In total, ۲۷ quasi-experimental studies conducted in Iran between ۲۰۱۵ and ۲۰۲۵ were included. Relevant studies were retrieved from credible Iranian databases, including Noormags, MagIran, the Comprehensive Humanities Portal, Elmnet, Civilica, and SID. Studies were selected based on criteria such as the use of valid assessment tools, an experimental or quasi-experimental design, and sufficient data for calculating effect sizes. All included studies examined the impact of cognitive rehabilitation on working memory. Comprehensive Meta-Analysis software (CMA۲) and Hedges' g index were used to estimate effect sizes. Results: Effect sizes across studies ranged from ۰.۴۶۱ to ۲.۷۵۵, with eight studies reporting non-significant effects. The pooled random-effects estimate was ۱.۰۸۵ (P < ۰.۰۵), indicating a significant positive impact of cognitive rehabilitation on working memory. Heterogeneity indices (Q = ۱۰۵.۳۷۶, I² = ۷۵.۳۳%, Tau² = ۰.۴۷۳) indicated substantial heterogeneity across studies. Subgroup analysis revealed a significant effect in females (۱.۲۴۵, P < ۰.۰۵) and a non-significant effect in males (۰.۷۱۹, P = ۰.۳۴۷). The most substantial effects were observed in healthy individuals and those with attention-deficit/hyperactivity disorder, multiple sclerosis, autism, cancer, and learning disabilities. In contrast, effects were non-significant among individuals with substance use tendencies and those with brain injuries. The year of publication had no significant effect (β = -۰.۰۳۳۸, P = ۰.۵۵۶۹). Despite some asymmetries in the funnel plot, publication bias analyses indicated that the overall effect was relatively stable (Fail-Safe n = ۱۳۱۱; Trim & Fill-adjusted effect size = ۱.۱۱۶, ۹۵% confidence interval: ۰.۸۰۷–۱.۴۲۵). Overall, cognitive rehabilitation had a significant positive effect on working memory, although heterogeneity and potential publication bias were present. Conclusion: This meta-analysis demonstrates that cognitive rehabilitation has a positive and significant effect on working memory. Despite heterogeneity among studies and potential publication bias, the overall impact remains stable and robust. Future research should employ more rigorous experimental designs, larger sample sizes, and longitudinal follow-up to determine the long-term sustainability of these effects. Additionally, comparing different cognitive rehabilitation methods could further enrich the existing evidence.

کلیدواژه ها:

Cognitive disorders ، Cognitive rehabilitation ، Cognitive performance ، Psychological interventions ، Meta-analysis ، Working memory