Ask an answerable question (PICO)：
Cognitive impairment is common among patients with Schizophrenia, and it affects their daily life and social relationship. Although medication helps to control clinical symptoms, yet it fails to completelyimprove cognitive functionin patients with schizophrenia. Aginghas become a critical issue in Taiwan.Multiple studies have demonstrated the benefits of cognitive remediation therapy (CRT) for younger patients with schizophrenia, but a few studies reported that CRT has benefits for middle-aged patients. It is unclear whether CRT is effective in middle-aged patients with schizophrenia. The purpose of our study is to understand whether CRT is effective for improving cognitive functionsin middle-agedpatients with chronic schizophrenia. We used the evidence-based nursing practice to investigate the efficacy of CRT on middle-agedpatients with chronic schizophrenia. PICO-P refers to chronic schizophrenia patients, I for CRT, C for regular care, and O for cognitive functions.
The Method and Analysis of Literature Review：
We transformed PICO into Keywords and MeSH Term, and used the combination of the Boolean logicand limit as the strategies to research databases including Cochrane Library, UpToDate, PubMed, CINAHL, and Airiti Library.
Critical Appraisal：
Search result: In total, there are 50 articles searched in the 5 databases. After screening, only one RCT paper with the higher level of evidencewas identified to match our PICO question. Literature appraisal was used with PEDro scale and followingthe VIP steps: validity, importance, and practicability.We identified the paper with5 points on the PEDro scaleas acceptable validity. Effect size was 0.68-0.71 as medium to high level. Odds ratio was 3.50-7.45. Number needed to treat was 4-6. To sum up, CRT is abeneficial intervention for patients. The paper was identifiedthe similar attributes of patientsas ours.CRT is a non-invasive treatment and convenient without extra cost. Hence, it issafe, effective, affordable and efficient to patients and clients.
Clinical Application of Evidence：
The study design was a single group before-and-after study. The trial recruited 10 chronic schizophrenia patients to receive CRT. Nurses and occupational therapists appliedcomputerized and paper-and-pencil tasks. Lumosity cognitive trainingprogramsand self-designed worksheets were used toconduct the CRT programs twice per week, including one computerizedsession and one paper-and-pencilsession. In each session, 10 minutes for the description of activities rules or computer operations, 40 minutes for practicingcognitive activities with cuing and teaching of cognitive strategies, and 10 minutes to discuss functional performance and cognitive strategies. The total duration of the intervention was 3 months.
Evaluation of Effectiveness：
Results indicatedthat after three months intervention of CRT, patients with schizophrenia made progress in total score and 6 subscores of the Mini-Mental State Examination (MMSE), but the change did not reach statistical significance(ps> 0.05).Comprehensive Occupational Therapy Evaluation Scale(COTES) indicated significant improvements in the scores ofconcentration, learning, problem solving and general cognition-related items (ps< 0.05), but the other 3 scores were no significant changes(ps> 0.05).
Conclusions and Recommendations：
Preliminary results revealed that CRT improvedconcentration, learning, problem solving of middle-aged schizophrenic patients. Due to the vision loss andthe fine motor skills degradation of aging, we suggested that computer interface should consistedlargerkeyboard and monitorfor the convenience of the middle-agedgroup.
