One of the aims of this study was to test the effect of MOPS-VI on patient compliance. Participants were selected from a group of veterans initially non-adherent with clinic-based cognitive rehabilitative services. Non-adherence was defined by the following criteria: 1) failure to schedule a follow-up appointment after referral for cognitive rehabilitation therapy; or, 2) failure to attend more than 2 therapy sessions. It was hypothesized that the MOPS-VI therapeutic approach would increase adherence because of decreased travel time and increased scheduling convenience.
Among the veterans identified as non-adherent with speech therapy for cognitive rehabilitation services using these criteria, 9 signed the informed consent, 8 participated in pre-intervention testing, and 6 (67%) completed the intervention. The 3 who did not complete the intervention included 1 participant who signed the informed consent and was unable to be contacted for baseline testing, a second participant who dropped out after being diagnosed with cancer, and a third participant who was unable to complete the intervention due to redeployment shortly after completing baseline testing.
Six veterans who initially did not follow through with clinic-based cognitive treatment completed the MOPS-VI telemedicine treatment. Results from these 6 participants were thus the main focus of the study. These 6 MOPS-VI participants ranged in age from 23 to 38 years, with a mean age of 30.17 years. The control group consisted of participants seen face-to-face (clinic-based) who were selected according to inclusion/exclusion data and were similar to the treatment group participants. Of the 6 participants who completed the intervention, most of the sessions were completed sequentially and according to schedule. The few exceptions included 1 participant who re-scheduled his initial videophone session 2 times because he had not yet completed the self-guided module preceding the session and required 2 sessions for post-intervention testing. An additional participant called to re-schedule his third videophone session because of traffic. All other participants kept their originally scheduled appointments. Detailed compliance data was not available for control group participants due to the study design.
There were no significant differences between the groups in mean age, marital status, years of education, and TOMAL-2nd pre-test composite score, indicating that the matching procedure was successful. shows group demographic data.
Descriptive statistics for MOPS-VI and control group.
Results of a 2-way (pre- vs. post- assessments) × (standard vs. MOPS-VI) Analysis of Variance (ANOVA) revealed a significant pre-post assessment effect, F(1,10)=50.38, p<0.001, indicating that participants’ memory improved after treatment for both MOPS-VI and standard treatment groups (). There was no significant interaction between treatment groups and pre-post assessment, F(1,10)=3.43, p=0.09. There was no significant difference between face-to-face therapy and MOPS-VI therapy (F(1, 10)=0.39, p=0.55) suggesting that MOPS-VI therapy is as effective as clinic-based treatment and therefore is a viable alternative.
Analysis of variance of pre-treatment and post-treatment scores (composite TOMAL2nd) for two groups (MOPS-VI and standard treatment).
Because of the small n of the MOPS-VI Treatment Group, the nonparametric test, the Wilcoxon Signed Ranks Test was also conducted to compare the Composite Memory Index score pre- and post-intervention. The Z score was −2.21 with a p=0.027. Therefore, both the parametric and nonparametric statistical analyses indicated a significant improvement in pre- and post-treatment performance on the TOMAL-2.
Partial eta-squared was used to provide an estimate of the magnitude of the effects of treatment as assessed by changes over time. The change in TOMAL-2nd scores from the pre- to post-treatment contributed 0.83, which indicates a strong effect of treatment on composite test scores regardless of whether the treatment was clinic-based or MOPS-VI (). Although both therapy groups experienced a positive change in TOMAL-2nd test scores, the MOPS-VI group spent approximately 6 months less time in treatment (mean=3.87) compared to the control group (mean=9.33).
Figure 2 Pre-Post Mean composite scores. Pre-TOMAL 2nd – Pre-Intervention Test of Memory and Learning 2nd Edition Composite Memory Index Score, Post-TOMAL – Post-Intervention Test of Memory and Learning 2nd Edition Composite Memory Index Score. (more ...)