Remembering to Remember: A Systematic Review and Meta-Analysis on Prospective Memory Rehabilitation in Adults with Acquired Brain Injury

Remembering to Remember: A Systematic Review and Meta-Analysis on Prospective Memory Rehabilitation in Adults with Acquired Brain Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Remembering to Remember: A Systematic Review and Meta-Analysis on Prospective Memory Rehabilitation in Adults with Acquired Brain Injury Mirco Soda, Luisa Bartucca, Elena Baruzzo, Edoardo Barvas, Madalina Bucur, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7113515/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted 15 You are reading this latest preprint version Abstract Prospective memory (PM) - the ability to remember to carry out intended activities - is often impaired following acquired brain injury (ABI), yet its rehabilitation remains challenging. WE conducted a systematic review and meta-analysis to evaluate the effectiveness, durability, and real-life impact of PM interventions in adults with non-progressive ABI. Following PRISMA guidelines, five databases were searched for studies published between January 2008 and December 2024. Twenty-seven studies met inclusion criteria, including 14 randomized controlled trials (RCTs), seven non-randomized trials, four pre-post studies, and two case series. Ten RCTs were included in the meta-analysis. Interventions encompassed compensatory strategies (e.g., memory aids, metacognitive training) and restitutive methods (e.g., computerized training, virtual reality). PM outcomes were measured using validated tools such as the Cambridge Prospective Memory Test and Rivermead Behavioural Memory Test. The pooled analysis showed a moderate, statistically significant effect of rehabilitation on PM performance. However, evidence for long-term maintenance and generalization to daily life was limited. Risk of bias was assessed with the Cochrane tool, and overall evidence quality was rated moderate using GRADE. These findings support the clinical value of cognitive rehabilitation for PM deficits after ABI, while highlighting the need for more consistent methodologies and long-term outcome data. Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Biological sciences/Neuroscience Biological sciences/Psychology Social science/Psychology Prospective Memory Neuropsychological Rehabilitation Memory systematic review Figures Figure 1 Figure 2 Figure 3 Highlights We reviewed studies on prospective memory (PM). Ten RCT were included in the quantitative meta-analysis. PM rehabilitation after ABI shows positive but still uncertain outcomes. RCTs showed moderate evidence based on GRADE methodology. New technologies (i.e., VR) look promising but they remain still under-investigated. Tests and diagnosis lack consistency. Real-life improvements are rarely assessed and poorly documented. 1. INTRODUCTION Memory impairments are among the most common consequences of brain injuries. These deficits often affect daily living activities, as well as social, leisure, and vocational activities [ 1 , 2 ]. Furthermore, memory disorders negatively impact other cognitive domains (e.g., language comprehension and planning of future activities), hampering their rehabilitation. Memory deficits might result from several neurological diseases. They are often caused by traumatic brain injuries (TBI), stroke, encephalitis, and hypoxic brain damage. Patients typically complain about difficulties in learning new information or, typically, remembering to perform intended actions. As for the neuropsychological rehabilitation in general, the two main approaches are remediation and compensation [ 3 ]. In the case of memory deficits, remediation refers to a series of techniques consisting of repetitive drills and memory training. The second approach, compensation, refers to the use of internal strategies (e.g., visual imagery and self-generated mnemonics to form associations) or external strategies (e.g., environmental changes, checklists, and personal electronic devices) aimed at reducing memory problems on a functional level without necessarily improving the underlying memory function [ 4 ]. However, memory is not a unitary system but includes different interrelated subsystems that might be damaged independently. Accordingly, memory rehabilitation targets different components, such as short-term memory (STM) and working memory (WM), long-term memory (LTM) and prospective memory (PM), or, finally, semantic memory. The focus of the present systematic review and meta-analysis is PM, given its critical relevance to daily functioning. Individuals who report memory difficulties frequently describe failures in remembering intended actions, highlighting the everyday significance of PM impairments. Current evidence in patients suffering from an acquired brain injury (ABI) supports and recommends the use of internal and external memory compensations for patients with mild memory impairments and the use of external compensations, with direct application to functional activities, for patients with severe memory deficits [ 5 , 6 , 7 , 8 , 9 ]. Specifically, the systematic review by Cicerone et al. [ 7 ] included two class II studies on LTM aimed at improving the recall of information in everyday tasks, and five class I, three class II, and one class III studies on PM. Both studies were group-based compensative interventions focused on strategies such as psychoeducation about memory, and internal and external memory strategy teaching; both showed significant improvement on everyday memory measures. Four out of the five class I studies on PM were based on external memory strategies (assistive technology training) and demonstrated the effectiveness of those techniques as a way to improve the likelihood of future intentions being carried out. One class I and two class II studies on PM used internal compensation strategies (visual imagery or self-imagination) and found an improvement in prospective remembering. The authors concluded that memory strategy training, including the use of internal and external compensation strategies, is recommended for the improvement of recall in everyday tasks in patients with mild memory impairments after TBI (Practice Standard), and for the improvement of PM in patients with TBI or stroke (Practice Standard). The same conclusion emerged from the systematic review on PM rehabilitation after ABI by Mahan et al. [ 6 ]: this review, including 11 papers, showed that PM abilities can improve by using simple reminder systems, such as audio-visual message alerts on a smartphone, with a generalization to everyday PM functioning. Two recent systematic reviews on the effectiveness of compensatory memory interventions are consistent with the positive results described in the previous studies. Lambez & Vakil’s review[ 10 ] included 22 controlled trials in adults with ABI in general, while the review by Hudes et al. [ 8 ] included 16 studies on TBI patients only. Both concluded for the effectiveness of compensatory memory strategies. Moreover, Lambez & Vakil [ 10 ] compared different approaches among compensatory memory interventions and found that those that combine external and internal strategies are the most effective in reducing memory impairment, followed by external strategies alone, and, finally, internal strategies only interventions. A final comment is that most of the cited reviews on PM rehabilitation highlight some limitations of the included studies, namely the variability of the studies’ design, samples, assessment and intervention, the lack of a standardized qualitative account of the injury profile, the lack of studies directly comparing different approaches (e.g., remediation vs compensation) in order to evaluate the superiority of one type of intervention over the other, and the limited number of studies and their low methodological quality for some new approaches such as Virtual Reality [ 6 , 11 , 12 ]. Despite these limitations, memory rehabilitation is increasingly popular and is recognized as a component of rehabilitation programs for patients with ABI in several national clinical guidelines (i.e., Italian Stroke Guidelines - SPREAD, American Stroke Association, UK Royal College of Physicians; INCOG guidelines). In particular, the INCOG 2.0 guidelines for Cognitive Rehabilitation Following TBI [ 9 ] recommend using internal compensation strategies (especially for patients with mild-to-moderate memory impairments) and external strategies (especially for patients with severe or moderate impairment). Conversely, they do not recommend remediation approaches when applied as a singular treatment or the use of Transcranial Direct Current Stimulation (tDCS) for memory rehabilitation outside clinical trials. One recent comprehensive systematic review on the efficacy of memory rehabilitation in patients with ABIs [ 7 ] covers the literature published until 2014. The review by Mahan et al. [ 6 ] on PM rehabilitation concerns children and adults with different etiologies and does not include a meta-analysis. Furthermore, it covers the literature until 2016. The two most recent reviews on PM rehabilitation either focused exclusively on older healthy adults [ 13 ] or included them alongside clinical groups [ 14 ]. Finally, the already reported one by Velikonja et al. [ 9 ], which covers the literature until 2021, is focused on patients with moderate-to-severe TBI. In the last decade, there has been an explosion in information and communication technologies offering new devices to overcome memory impairments, new rehabilitation tools such as Computer-Based Training, virtual reality, Transcranial Magnetic Stimulation (TMS) and tDCS and new modalities in which rehabilitation can be delivered (i.e., telerehabilitation). Two recent systematic reviews focused on the effect of TMS and tDCS on neuropsychological rehabilitation in patients with TBI [ 15 ] and stroke [ 16 ], covering the literature published until 2020 but included rehabilitation studies of cognitive functions other than memory. The only review on memory rehabilitation in patients with ABIs including novel approaches is the one by Spreij et al. [ 12 ], but it extends until 2014, and it mainly focuses on WM. In summary, even though several reviews on memory rehabilitation in patients with ABI have been published, most of the recent ones have considered specific subgroups of patients or specific rehabilitation approaches, while others have included general cognitive rehabilitation studies. Therefore, the present study aimed to provide a systematic review of the literature published in the last fifteen years on the effectiveness of PM rehabilitation, including new emerging approaches. Compared to other recent reviews, we specifically focused on non-progressive conditions (overall, TBI and stroke) and included interventions involving virtual reality, a tool increasingly employed in neurorehabilitation, particularly because of telerehabilitation. Our primary aim was to evaluate the effectiveness of PM rehabilitation. Additionally, we tried to assess whether improvements are maintained over time and whether they transfer to everyday activities. To this end, we assessed the overall level of evidence using the GRADE methodology and evaluated item-level risk of bias using the Cochrane Collaboration’s tool. Finally, we explored the influence of age and other clinical variables on treatment outcomes. 2. METHODS The systematic review and meta-analysis were performed with the aim of quantitatively and qualitatively assessing the efficacy of cognitive rehabilitation interventions specifically targeting PM deficits in adults with ABI, including stroke and TBI. The systematic review was performed following the PRISMA guidelines [ 17 ], encompassing both randomized controlled trials (RCT) and non-randomized controlled trials (nRCT) studies. The meta-analysis included only RCTs reporting standardized PM outcomes. 2.1. Search Strategy and Eligibility Criteria A literature search from January 2008 to December 2024 was initially performed across five electronic databases—namely, PubMed, PsycINFO, Web of Science, ScienceDirect, and Scopus. Keywords were: (1) “prospective memory”; “episodic memory”; “memory”; “amnesia” AND (2) “rehabilitation”; “remediation”; “intervention”; “treatment”; “neuro-rehabilitation”; “training”; “brain-trainer”; “PQRST”; “SQ3R”; “vanishing cues”; “external aids”; “errorless learning”; “repetition priming”; “neuro pages”; “spaced retrieval”; “mind maps”; “meta-memory techniques”; “visual imagery”; “TMS”; “tDCS”; “non-invasive brain stimulation”; “method of loci”; “first letter cues”; “environmental modification”. Eligible studies met the following inclusion criteria: (1) adult participants with non-progressive ABI; (2) intervention explicitly targeting PM functioning; (3) use of validated, continuous outcome measures of PM; and (4) provision of sufficient statistical data for effect size computation (e.g., means, standard deviations, or standard errors). Studies were excluded if they focused on other memory subtypes (e.g., working or semantic memory), involved participants with progressive neurological diseases (e.g., dementia), or lacked peer review, English-language publication, or adequate outcome data. Also, single case reports, studies on healthy adults or pharmacological treatments were excluded. Although unpublished studies can help mitigate publication bias, they were excluded due to inconsistent methodological quality and limited replicability. 2.2. Data Extraction and Coding Procedures Titles, abstracts, and keywords of the extracted studies were screened using Ryyan QCRI (RyyanQCRI, Qatar Computing Research Institute, HBKU, Doha, Quatar) [ 18 ]. After duplicates’ exclusion, each study was independently assessed by all reviewers to reduce selection bias. Studies were excluded if they did not meet one or more of the abovementioned criteria. Studies rated as relevant by at least 4 of the 8 reviewers were included for further consideration. Articles with conflicting ratings were resolved by discussion. Extracted data included: authors, design of the study, participants’ details (number of participants, type of ABI, age, time after lesion, deficit on inclusion), intervention characteristics (type of intervention and description, duration, intensity, eventually control condition), outcome measures, results, levels of evidence on Physiotherapy Evidence Database (PEDro) scale and on Cochrane Collaboration’s tool for assessing risk of bias, where applicable, and modified Sackett scale (mSS). Significance was settled at p < 0,05. For studies included in the meta-analysis, we extracted data on sample sizes, means, and standard deviations. When both pre- and post-treatment outcomes were reported, effect sizes were calculated based on the difference in change scores between the treatment and control groups. If only post-treatment values were available, we computed standardized mean differences (SMDs) based on post-intervention group comparisons. In cases where studies reported standard errors instead of standard deviations, we converted them using the formula: SD = SE × √n. When necessary, we contacted corresponding authors to obtain missing data. 2.3. Quality assessment Interventions were assessed for level of evidence and methodology quality and strength. Also in this case, two authors independently evaluated the characteristics and the quality of the previously included studies, with conflicts resolved by discussion between all the authors until consensus was reached. The methodological quality was assessed using the PEDro scale and the Cochrane Collaboration’s tool for assessing risk of bias [ 19 ], as reported above. A grade for the level of evidence was assigned to each study according to the mSS [ 20 , 21 ], following a method used in previous reviews [ 22 , 23 ]. The PEDro scale is an 11-item scale designed for rating the quality of clinical trials. This scale has been used to rate the quality in several systematic reviews [ 24 – 27 ]. Each satisfied yes/no item (except for item 1, which, unlike other scale items, pertains to external validity) contributes one point to the total PEDro score (range 0–10 points). Individual item level and total PEDro scores showed good agreement between raters [ 28 ]. Moreover, Foley et al. [ 28 ] have arbitrarily defined the following criteria for rating the methodologic quality of a study: 9 to 10, excellent; 6 to 8, good; 4 to 5, fair; and < 4, poor. In the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials, bias is assessed as a judgement (high, low, or unclear) for individual elements from five domains (selection, performance, attribution, detection, reporting) and others (Higgins et al 2011). The mSS, with 5 levels of evidence, was used to determine the strength of evidence for each intervention [ 29 ]. The modified scale was created to simplify the 10 subcategories present in the Sackett scale into a system with 5 levels. Level 1 included RCT with a PEDro score greater than or equal to 6, whereas RCTs with scores lower than 6 were given level 2(a) evidence. Prospective controlled trials and cohort studies were also included in level 2(b) evidence. Level 3 evidence consisted only of case control trials. Pre-post studies, post-test, and case series were considered level 4 evidence. Lastly, level 5 evidence consisted of observational studies, clinical consensus, and case reports. 2.4. Meta-Analytic Procedure and Statistical Model All statistical analyses were conducted using the Comprehensive Meta-Analysis software, Version 4 [ 30 ]. Hedges’ g was chosen as the effect size index, as it corrects for small sample bias and allows comparison across heterogeneous study designs. A random-effects model was employed to account for expected variability in intervention modalities, participant characteristics, and settings. Heterogeneity across studies was evaluated using the Q-statistic and I². In addition to standard heterogeneity indices, we calculated a 95% prediction interval to estimate the likely range of true effect sizes across future studies in similar contexts. 2.5. Assessment of Publication Bias and Sensitivity Analyses To evaluate the presence and impact of potential publication bias, we employed multiple procedures: visual inspection of funnel plots [ 30 ], Egger’s regression test for small-study effects, and Duval & Tweedie’s Trim and Fill method [ 31 ]. Adjusted estimates were computed under both fixed-effect and random-effects assumptions, and results are presented as sensitivity analyses rather than definitive corrections. Risk of Bias and Certainty Assessment Risk of bias was assessed using the GRADE framework ( https://www.gradepro.org ). 3. RESULTS 3.1. Study selection After removal of duplicates, the initial search identified 5434 articles that were evaluated according to the inclusion criteria. Screening of citations and references provided seven additional studies for review. Following screening of titles and abstracts, 176 articles were selected for full-text review. Of the 176 articles assessed in the full-text screening, 149 were excluded. The reasons for exclusion were the following: theoretical/non-empirical studies (54 excluded), reviews (34), papers not published in peer-reviewed journals (22), primary objective different from memory rehabilitation (11), articles not in English (6), single case reports (5), studies with no quantitative assessment of memory through validated neuropsychological tests (8), studies including patients with brain tumors or patients with neurodegenerative disease, therefore “progressive” diseases (6), studies where the intervention was pharmacological or a general stimulation of cognitive abilities (3). Ultimately, 27 articles met the full inclusion criteria and were used for this review. Figure 1 shows a flowchart of the selection process. —Insert Figure 1 about here— 3.2. Study Characteristics Details of the studies included in this review are shown in Tables 1 and 2. Of the 27 studies selected according to the inclusion criteria, 14 were RCT [ 32–41 ], seven were nRCT [ 42–48 ], four had a pre- and post-measurement design [ 49–52 ], and two involved case series [ 53,54 ]. Of the 14 RCT studies, 13 employed a between-subjects design and only one used a crossover within-subjects design [ 38 ]. Regarding nRCT studies, seven used a between-subjects design, four a within-subjects design and one a wait-list-based control. A total of 1405 participants were involved in the included records. Sample sizes ranged from 4 [ 54 ] to 328 [ 33 ], with a mean sample size of 52 (SD=65). The patients’ mean age ranged from 27,5 to 65, with the majority being in their early 30s or 40s. All participants had suffered an ABI (the lesion interval ranges from an average of approximately 38 days to around 80 months). Inspection of etiological factors indicated that 58,8% (n=826) had a diagnosis of TBI, 28,8% (n=404) of stroke, 0,6% of hypoxia (n=8), 0,1% of encephalitis or encephalopathy (n=2) and 11,7% (n=165) of other ABI (arteriovenous malformation, hydrocephalus, systemic lupus erythematosus, cyst or not specified). Twenty-two group studies reported results for PM rehabilitation (or LTM including PM) [ 32–53 ]. Five other studies [ 54–58 l reported results for both PM and STM/WM rehabilitation, covering a variety of neuropsychological approaches, including internal or external memory strategies, individual-based or group-based psychoeducational intervention, computer-based cognitive training, cognitive training with mobile technologies, internet-based cognitive training, virtual reality memory training and holistic rehabilitation approach. Regarding the duration of treatment, a high variability was generally observed between the different studies in terms of both dose (range from 5 hours to over 1000 hours) and intensity (ranged from 5-9 one-hour sessions within 8 weeks at several hours per day, three to four times a week for months or even years) (see Supplementary Tables S1, S2, S3, S4). 3.3 Methodological quality Among the 14 RCTs, 12 obtained a PEDro score >6 and hence were considered “high-quality” (mSS Level 1). Specifically, only one study obtained a PEDro score of 10, two studies a PEDro score of 9, three of 8, four of 7 and two of 6. The remaining two RCTs obtained a PEDro score of 5 and were considered as “fair-quality” RCTs (mSS Level 2a). Among the 13 studies using nRCT designs, eight studies were ranked as Level 2b and five as Level 4 at the mSS. The results of the assessment performed using the Cochrane Collaboration's tool for assessing risk of bias are shown in Table 1. —-Insert Table 1 about here-- 3.4 Qualitative summary and synthesis 3.4.1. PM rehabilitation techniques in RCT. Restitution-oriented therapies were applied in four out of the fourteen studies [ 41,55–57 ]. Eight studies were based on compensation techniques [ 32,34–40 ]. Das Nair et al. [ 33 ] used mixed techniques. Finally, Withiel et al. [ 58 ] compared a compensatory memory skills group with a restorative computerized group focused on functional goal attainment. The treatment was delivered either individually [ 34–36,38,39,41,55–57 ], or in group [ 32,33,40 ], with two further studies comparing the effectiveness of group versus individual interventions [ 37,58 ]. Different computerized interventions were used, such as a personal digital assistant [ 35 ], Google Calendar as a memory external aid [ 38 ], and other software such as VILAT-G [ 55 ] that trains semantic structuring of verbal information and spaced retrieval, or the computerized and adaptive cognitive training Lumosity TM [ 58 ]. A virtual reality program was used by Yip & Man [ 41 ], where a virtual store was developed for PM training. Furthermore, telerehabilitation was applied by Lemoncello et al.[ 36 ]: the authors employed a Television Assisted Prompting system, which provides audiovisual reminders at scheduled times, directly at home on the patient’s television. Interventions varied in number of sessions (range 4-21), with a frequency of 1-6 days per week, and in duration of each session (30 - 120 minutes). The etiology of the samples differed among the studies: three out of the fourteen included chronic TBI [ 33,39,40 ]. One more study included patients at 1-month post-discharge [ 34 ]. Two studies included only stroke patients [ 32,58 ]. The remaining studies included mixed ABI patients (TBI, encephalitis and cerebrovascular accidents). A follow-up was conducted in half of the studies and varied from 1 week to 12 months post-intervention [ 32–35,37,40,58 ]. Other studies only run an immediate post-training assessment [ 38,39,41,55–57 ]. 3.4.2 Treatment outcome PM and LTM outcome measures improved in many studies. When individual vs. group training were compared, contrasting results were obtained. Leśniak et al. [ 37 ] found a significant improvement after the individual training but not after the group training, in the delayed recall of Pattern Recognition Memory test (PRM), in the Rapid Visual Information Processing (RVP) and in the Spatial Span (SSP) test from the Cambridge Neuropsychological Test Automated Battery (CANTAB-PRM). However, patients allocated to the individual rehabilitation program performed some exercises that could be considered as remedial methods (for instance, some memory and attention exercises delivered from Rehacom or Cogniplus computer software); crucially, they showed greater gains when the assessment was based on computer-assisted tests. Therefore, the comparison between individual and group training should be interpreted with caution. Two studies reported a gain at the Cambridge Prospective Memory Test (CAMPROMPT), after a compensatory training in TBI patients [ 39 ], and after a virtual reality training in a group of patients with mixed etiologies [ 41 ]. In the latter study, there was also an improvement in immediate recall in PM tasks. A similar improvement was reported in a study by Fleming et al. [ 34 ], in which TBI patients performed a Compensatory strategy training associated to Metacognitive skills training (COMP-MST); nevertheless, a positive trend over time was observed also in patients who did COMP training alone and in the waitlist control group. Storzbach et al. [ 40 ] employed a manualized group-based compensatory cognitive training (CCT), which consisted in the use of daily strategies and external aids (calendar systems and assistive devices) to veterans who suffered from mild TBI. The authors found a significant post-treatment decrease of self-reported difficulties in memory (Prospective-Retrospective Memory Questionnaire, PRMQ), attention and planning problems (Multiple Sclerosis Neuropsychological Screening Questionnaire - Patient Version, MSNQ); furthermore, the use of cognitive strategies increased (Portland Cognitive Strategies Scale 2.0, PCSS). An improvement of PM in terms of completing intentions was described by using an active memory aid, namely Google Calendar, considered more effective than a standard diary [ 38 ]; activities remembered and completed in time were verified by a family member, and ABI participants appreciated Google Calendar more than common diaries as memory aids. Lemoncello et al. [ 36 ] found significant advantage of PM prompting using the Television Assisted Prompting system (72% completion of daily tasks) over no prompting (43%). Motivation played an important role in success. Hildebrandt et al. [ 55 ] stressed that rehabilitation can improve retrieval processes (not encoding and consolidation) by explaining strategies: VILAT-G computer training, compared to a group training, increased memory performance on the CVLT and story recall. During the sessions, patients were supported by a neuropsychologist, who taught the strategy of semantic structuring and spaced retrieval and in handling the program. Nevertheless, no generalization was found to PM measures. Withiel et al. [ 58 ] demonstrated that participants allocated to the Memory skills group (MSG) had greater improvement in PM at post-intervention, with significant reduction of everyday memory complaints, than those who did computerized cognitive training (CCT), but this effect was not maintained at follow-up. 3.4.3. Evidence of transfer Evidence of transfer was detected with restitution-oriented techniques, using virtual reality to improve everyday PM 41 . A significant improvement was also reported in a behavioral checklist of PM tasks in the real environment and on a self-efficacy questionnaire, while “traditional” internal-external strategies did not significantly change relatives’ ratings of PM failures and of psychosocial reintegration of patients 39 . A working memory training combined with semantic structuring and verbal fluency generalized to ability of remembering future events 56 , as measured by RMBT (Names, Belongings, Appointment), but not to Cognitive Failures Questionnaire (CFQ). The same author found far transfer effects on Everyday Memory Test (EMT), combining working memory and recollection training 57 . Focusing on studies that used compensation techniques, namely internal/external strategies and psychoeducation, Leśniak et al. [ 37 ] found an extended effect of training, showing an enhancement not only in neuropsychological tests, but also in objective tests of everyday memory, such as RBMT; however, they also found gains in a control group (no therapy) without detecting a specific effect of training. A significant improvement in Memory Self-Efficacy and in Quality of Life (QoL) was especially found in younger (< 65 years old) participants[ 32 ]. Using mixed techniques (internal and external strategies, psychoeducation) there were fewer memory failures on Goal Attainment Scale (GAS) [ 35 ], or there were improvements in everyday memory functioning measures, such as the Everyday Memory Questionnaire (EMQ) [ 33 ]. Accordingly, caregivers reported a reduced amount of forgetting at the Memory Functioning Questionnaire (MFQ) [ 35 ] and a decrease of memory failures at the EMQ in group treatment as compared to individual therapy [ 33 ]. The remaining studies did not find any evidence of transfer. 3.4.4. Maintenance over time Effectiveness of interventions over a longer time was assessed in six studies. Improvement was sustained after 6 months in Aben et al. 32 ; this result, together with an improved quality of life, was higher in people under 65, and remained stable over 12 months. Das Nair et al. [ 33 ] detected a maintenance of memory rehabilitation effects at 6 months, but not at 12 months. Leśniak et al. [ 37 ] found that with group training, improvement in RBMT continued at 4-month follow-up. Storzbach et al. [ 40 ] planned a 5-week follow-up that confirmed the results found at the post-treatment assessment: a reduction of cognitive complaints and an increased number of compensatory strategies in daily activities. In Withiel’ et al. (2019)’s study [ 58 ], gains in functional goal attainment and internal strategies after MSG were maintained for 6 weeks after training. Lastly, Fleming et al. [ 34 ] detected a clinically relevant change at 3-month follow-up on psychosocial reintegration (Sydney Psychosocial Reintegration Scale version 2, SPRS-2 Form B) and on Everyday PM failure (Brief Assessment of Prospective Memory, BAPM) as reported by participants’ caregivers, without finding significant differences between COMP-MST and COMP group. Some studies did not include a follow-up [ 38,39,41 ]. Finally, in Lannin et al. [ 35 ] this was limited to 8 weeks with no evidence of maintenance. 3.4.5. Neurological and demographic factors associated with rehabilitation effectiveness Two RCT studies included only stroke patients [ 32,58 ] and four studies only TBI [ 33,34,39,40 ]. Finally, two studies between those including patients with mixed etiologies [ 37,38 ] considered neurological factors as associated with outcome. The remaining RCT studies did not explore specific effects of treatment based on these variables. Concerning stroke, as already reported, a psychoeducational intervention was more useful for younger people [ 32 ]; nevertheless, older patients were mainly men, having lower memory scores, that could explain this result. There is a limited number of studies on early intervention after stroke, as spontaneous recovery can mask the effects of treatment. Concerning TBI, since patients are often unaware of their PM deficits, a combined training, consisting in a compensatory intervention preceded by a self-awareness training has been considered the best option [ 34,39 ] but the superiority of combined training on compensatory strategy training alone was not confirmed. An additional variable that could affect treatment effectiveness is time since the event, but results are inconsistent: Das Nair et al. [ 33 ] did not confirm this hypothesis with an heterogeneous sample in terms of clinical and demographic features, while in Leśniak et al. (2018)’s study [ 37 ], a significant improvement between pre- and post-assessment was found only in late recovery (>6 months from ABI). Finally, considering ABI patients in general, severity of memory and executive deficits affects the effectiveness of memory aids; moreover, patients with milder deficits benefited more from the use of Google Calendar than diary [ 38 ]. 3.4.6 PM rehabilitation techniques in nRCT Thirteen nRCTs studies focusing on PM rehabilitation were included: seven addressed TBI, five considered stroke and one studied ABI patients in general. Concerning TBI studies, compensatory methods were the preferred approach. Only two studies employed a restorative approach with patients who suffered a TBI at least 1 year before treatment: in detail, Raskin and Sohlberg [ 47 ] found a significant improvement in intentional memory (Assessment of Intentional Memory - total score), that increased at 1-year follow-up, and a reduction of the total number of PM failures; moreover, there was a generalization to the Everyday Memory Questionnaire (EMQ) and to the efficiency in accomplishing 10 everyday PM tasks that were identified and entered in a diary by the patient and the examiner at the beginning of the training period. The training started after assessing the baseline PM performance that lasted less than 10 minutes for all participants. PM tasks started with a delay of 1 minute longer than the individual patient’s baseline, increasing the delay (1 minute at a time) as the subject became skilled at that delay; the sessions lasted 1 hour and were delivered 2 times per week for 6 months. A similar approach was used by Raskin et al. [ 48 ] with moderate-severe TBI patients, combining visual imagery of events with rote repetition. Even this treatment was effective on memory for future intentions (performance on Memory for Intentions Test - MIST) and the positive effect generalized to attention and executive functions; in addition, like previous results, the use of diaries generalized and EMQ performance improved; all these gains were stable at 1-year assessment. Further studies on TBI patients, using a compensatory approach, applied various techniques: three studies used external aids, such as an internet-based calendar compared to an internet-based diary training, in which a therapist delivered the cognitive treatment through an online instant messaging system, as a telerehabilitation method [ 42 ] for a total of 60 sessions; compensatory strategies increased, especially in participants that already used them. In addition, patients' relatives reported improved memory and mood after completion of all sessions. An internet-based calendar to compensate PM difficulties was used also by Evald [ 50 ]. The treatment consisted in learning to use a smartphone (Windows Phone - version 7.5) to remember appointments and to compensate for memory difficulties. The treatment lasted 6 weeks, for a total of 9 hours (1 individual session and 5 group sessions). Post-treatment scores at the Prospective Memory Questionnaire (PMQ) and at the Prospective and Retrospective Memory Questionnaire (PRMQ) showed perceived reduced memory deficit. At 2-month follow-up a significant decrease of self-reported memory problems emerged. No effects were found on target behaviors that participants completed at home, on emotional complaints assessed using the Hospital Anxiety and Depression Scale (HADS), or quality of life measured by the World Health Organization Quality-of-Life Scale (WHO-QOL BREF). Similar compensation of PM deficits with external memory aids was found in Dowds et al. (2011)’s study [ 43 ]. By applying a multiple cross-over design, the authors compared how many time-related personalized tasks were completed in four different conditions, that randomly changed every week for each participant: in a first condition, participants used their spontaneous memory strategies, in a second condition they used a paper-based memory aid and in two additional conditions they used different palmtop computers as PDA memory aids, namely the Palm OS and the Microsoft’s Pocket PC OS. The completion of tasks was checked calling back participants to the research Centre whenever a task was accomplished. The PDA Palm version produced better results with respect to the alternative conditions. Two studies, instead, trained internal strategies, such as errorless learning and metacognitive strategies in a group treatment [ 52 ]. In detail, participants trained internal memory strategies (I-MEMS), consisting in semantic association, processing and chaining, visual-auditory imagery; however, in this study, additional external memory aids, already used by patients, were continued. This treatment led to an improvement in verbal LTM, with a transfer to everyday memory effectiveness (RBMT-II). The results of the immediate post-treatment assessment were maintained and slightly increased 1 month later, mainly in patients with mild to moderate TBI. Finally, Potvin et al. [ 46 ] studied the efficacy of visual imagery on PM, carrying out 10 weekly individual rehabilitation sessions (15 hours). PM exercises gradually increased in complexity and ecological aspects, using a spaced-retrieval technique, with the aim of applying visual imagery to everyday situations. Compared to the control group, receiving only a brief educational intervention at the end of the assessment session, patients in the rehabilitation group reached higher total scores on the Ecological Test of PM and made less intrusion errors; moreover, they recalled more actions on the time-based condition, but not on the event-based condition; self-evaluated PM failures seemed fewer at the post-test than at the initial assessment, in accordance with relatives’ reports on Comprehensive Assessment of Prospective Memory (CAPM). No training transfer effects were detected. Concerning stroke, all nRCT studies applied compensatory strategies. Miller & Radford, [ 45 ] delivered a mixed treatment, including psychoeducation, internal strategies and external memory aids, in groups of 8-12 participants. There was a significant improvement on learning and delayed recall that continued to improve over the 3-month follow-up. Demographic and clinical variables were relevant: both older age and lower degree of depression were associated with higher probability of completing the training; higher intelligence quotient (IQ) or education increased the number of strategies used; a shorter interval after stroke was related to more gains in PM, while a longer interval was associated to reduced improvement in PM. Virtual reality was also effective on PM abilities [ 51 ] applying visual imagery strategies to everyday context, as in Potvin et al. (2011)’s previously described study on TBI [ 46 ]. The improvement remained stable after four weeks. In recent years, telerehabilitation has received increasing attention. Withiel et al., [ 54 ] investigated the effectiveness of a manualized memory skills group training in four stroke patients (4–41 months since injury), inspired from a previous training, namely “Making the Most of your Memory: An Everyday Memory Skills Program”[ 59 ]. The training consisted in six weekly two-hour group sessions of psychoeducation, learning internal and external compensatory strategies, discussion everyday memory issues and homework assignments. In addition, patients’ family members participated in a separate session. The result was a reduction of memory complaints during the training and participants attaining at least one specific goal after the treatment, maintained at the follow-up (EMQ-R; CAPM). Lawson et al. [ 44 ] compared a face-to-face individual training with a telehealth delivery condition conducted via Zoom in stroke survivors, recruited at least 3-month from onset. Both treatments were delivered weekly, during a 6-week period, 2-hour per session. The training consisted in a modified version of the Monash Memory Skills Group program [ 58 ]. They found significant improvements in both groups in Goal Attainment Scaling, with maintenance of gains at six-week follow-up; then, they found a reduction in everyday lapses of PM, although confirmed at follow-up only for the telehealth group. While face-to-face participants demonstrated a constant increase of internal strategies application, patients in the telehealth group showed a significant increase only until the end of the program. In contrast, external strategies did not decrease over time in the two groups. Lawson et al. [ 44 ] also explored the promising role of booster sessions with a 12-week follow-up in maintaining gains on subjective measures of everyday memory and PM. Considering demographic variables, it is noted that telehealth subjects were younger than those in the face-to-face group. A few years later, Lawson et al. [ 53 ] proposed the same compensatory memory intervention of telerehabilitation to five chronic stroke patients with mild to moderate memory deficit. All participants reported attaining at least one of the two personally memory-related goals on Goal Attainment Scaling immediately post-training and maintained or improved their level of function in these specific areas at 6-week follow-up assessment. High rates of participant satisfaction and good adherence to treatment were observed. The last study, by Anaki et al. [ 49 ] concerned ABI of mixed etiologies (25 TBI and 15 non-TBI, i.e. CVA, anoxia, encephalitis, etc.) selected on average three years after the injury for a holistic and intensive rehabilitation program[ 60 ]. Internal and external techniques were trained and extended to ecological contexts. Patients are treated several hours per day, 3-4 times a week, for months or years. Training consisted in individual and group interventions, involving many actors: occupational therapists, psychologists, speech therapists, physiotherapists and caregivers. Post-treatment assessment was administered on average four years after the end of the rehabilitation program. Memory performance enhanced in RBMT-II in both the experimental and control groups (the latter received a similar program without specific memory exercises). Furthermore, more intensity produces better outcomes, mostly in non-TBI patients. 3.4. Meta-analysis results 3.5.1. Characteristics of Included Studies A total of 10 randomized controlled trials [ 33–37,41,55–58 ], involving 477 participants, met all the inclusion criteria and were included in the quantitative synthesis. The studies utilized a variety of intervention approaches, encompassing compensatory strategies (e.g., the utilization of memory aids, metacognitive training) and restitutive methods (e.g., computerized cognitive rehabilitation, virtual reality). The assessment of prospective memory involved the use of various validated instruments, including the EMQ, CAMPROMPT, RBMT, and PRMQ. 3.5.2. Main Effects of Rehabilitation on Prospective Memory The pooled analysis revealed a statistically significant moderate effect of cognitive rehabilitation on PM outcomes in individuals with ABI. Specifically, the mean effect size was Hedges' g = 0.55, with a 95% confidence interval ranging from 0.29 to 0.80. The result obtained corresponds to a Z-value of 4.20 (p < .001), thereby indicating a robust deviation from the null hypothesis that rehabilitation has no benefit over control conditions (see Figure 2: Forest plot of PM effect size). 3.5.3. Heterogeneity and Prediction Interval The analysis identified moderate heterogeneity across studies. The Q-statistic was 16.73 with 9 degrees of freedom (p = 0.05), and the I² statistic was 46%, suggesting that nearly half of the variance in observed effects is attributable to true between-study differences rather than sampling error. Assuming a normal distribution of the true effects, the 95% prediction interval ranged from –0.15 to 1.26, implying that while the average effect is beneficial, future studies may observe effects ranging from negligible to large, depending on context and implementation. 3.5.4. Publication Bias and Sensitivity Analyses Multiple indicators pointed to the possible presence of publication bias. Egger’s regression test yielded an intercept of 2.98 (p = 0.040), suggesting asymmetry in the funnel plot (Figure 3) and a tendency for smaller studies to report larger effect sizes. The classic fail-safe N was calculated at 76, indicating that 76 unpublished null studies would be required to overturn the statistical significance of the observed effect publication bias report. Using the Trim and Fill method, three studies were imputed to the left of the mean (see Figure 3), yielding an adjusted effect size of Hedges’ g = 0.347 (95% CI: 0.054, 0.640) under a random-effects model. This adjustment reduced the pooled estimate but preserved statistical significance, affirming the overall robustness of the findings. The certainty of the evidence was evaluated by considering factors such as the risk of bias, inconsistency, indirectness, imprecision, and publication bias. The GRADE assessment for PM outcomes was rated as moderate, primarily due to concerns regarding blinding (Table 2). While moderator analyses could have offered valuable insights into the differential impact of intervention types or outcome measures, the limited number of included studies did not permit their reliable execution. As a result, planned exploratory comparisons—such as those contrasting compensatory versus restitutive approaches, or performance-based versus self-reported measures of prospective memory—were not pursued in the present analysis. —Insert Figure 2 and Figure 3, about here— —Insert Table 2 about here— 4. DISCUSSION We systematically reviewed the literature on the effectiveness of PM rehabilitation, in adult patients after stroke or TBI. Very few additional different etiologies (such as infective diseases) were considered. We did not include patients with epilepsy (see Joplin et al. 61 for a review on memory rehabilitation in this group of patients), multiple sclerosis (see Mazo et al. 62 , although limited to WM), and neurodegenerative diseases. More specifically, we were interested in highlighting whether new treatments, such as NIBS, virtual reality or computer-based rehabilitation are employed with success in combination or alone, compared to more “traditional” techniques (a summary of the different techniques adopted in the reviewed studies can be found in Table 3). We evaluated the methodology of studies, the outcomes, the level of generalization and maintenance over time. Furthermore, we verified the effects of demographic variables on results. Finally, we performed a meta-analysis on the effects of treatment on PM, and we also assessed the level of evidence with the GRADE methodology for RCT studies. —insert Table 3 about here— Before discussing the results, it is important to outline several limitations of the reviewed articles. First, terminology is inconsistent across studies: long-term memory (LTM) tests have been used both for baseline and outcome assessments, even though the primary target of training is prospective memory (PM). Second, patients with mixed etiologies are often grouped together, which hinders the ability to analyze the effects of specific etiologies. This is a significant limitation, as recently highlighted in a voxel-based lesion-symptom mapping study[ 63 ]. Third, neuropsychological batteries and outcome measures vary widely. In many cases, it appears that parallel forms of the tests were not used, and outcomes were not evaluated by independent, blinded examiners. Fourth, we identified a limited number of studies comparing paper-and-pencil aids with digital tools, and, unexpectedly, none of these employed non-invasive brain stimulation (NIBS). This can be partially explained by the fact that most structures involved in memory systems are not reachable for stimulation. However, PM deficits could possibly benefit from NIBS applied over the dorsolateral prefrontal cortex[ 64 ]. Finally, outcome measures related to everyday functioning are typically based on scales or questionnaires, which are rarely reported in detail (see for instance 33,37,48,57 ). We included 14 RCT. Both, restorative and compensation treatments were used, balanced between individual and group treatment, or both. Computer rehabilitation training programs were applied, as well as virtual reality programs (see for example Yip & Man 41 ) or technical devices of which the most fruitful appeared to be Google Calendar 38 . It must be noted, however, that this study received a PEDro score <6 and high risk of selection, performance, detection and reporting bias according to the Cochrane scale, therefore the results must be considered with caution. Individual vs. group treatment does not seem to produce significant differences but, again, the observation is speculative and limited by the scarce number of confrontations. Similarly, when asked, caregivers reported a decrease of memory failure, but data are limited to two studies 33,35 . Also in these cases, the meta-analysis revealed a positive effect of treatment but, again, given the limited number of studies, we did not differentiate among treatments. Moreover, the level of improvement was very different, ranging from very mild effects to moderate ones. More studies are required to confirm these results. However, the level of evidence as assessed with the GRADE methodology, was moderate. Information about maintenance is scarce. A follow-up to a maximum of 12 months has been conducted only in seven RCTs. There was limited evidence that age affects recovery when the etiology is stroke 32 while time since TBI did not prove to affect treatment. Finally, we considered a group of five studies treating both WM and PM. Four of these were RCTs and, among them, three studies employed restitution-oriented therapies while the remaining one compared restorative vs. compensatory methods. The nRCT study used compensatory methods instead. No clear results were obtained, nor was evidence of transfer assessed with ecological measures. Improvements were maintained only for WM. The results of the meta-analysis, however, are encouraging and suggest that, at least in the case of PM, rehabilitation should be recommended, but more evidence is required to confirm this positive result, and it would be relevant to differentiate the outcomes of different treatments. 4.4. Limitations of this review We must acknowledge the limitations of this review that were in part due, as reported, to the number and quality of the examined studies. Standardized tests were not always used and differed in almost every study. Techniques are highly variable, as well as the software employed. The review was limited to studies published in English. 4.5. Directions of future research Summing up, our findings add new data to the existing literature, including new techniques such as Virtual Reality. Moreover, with respect to previous reviews, we did not focus only on traumatic brain injuries. The level of evidence was assessed using the GRADE methodology. Finally, we suggest directions for future research. Namely, the selection of patients should be more homogeneous concerning the demographic variables: for example, in many studies participants ranged between 18 and 70 years, and this could have affected the use of new technologies, in which younger people are certainly more familiar; younger people can be more motivated than older people; the cerebrovascular response to cognitive stimulation differs depending on age 65 . Etiology must be considered, ecological outcomes should be constantly evaluated: too frequently, the success of a treatment is based on the test score even when no parallel forms of the same test are adopted. Another crucial point is to have an examiner assessing the post-treatment performance, different from the person who conducted the treatment; this is not specified in most of the papers we analyzed, and this was not considered in previous reviews. A final remark is that the treatment of PM is still very tentative due to the lack of systematic studies. Probably, memory treatment could benefit from a multicentric consortium of memory centers, employing comparable assessment methods, treatment techniques and specific outcome evaluation, distinguishing patients with different etiology and demographic variables. Only in this way, enough homogeneous patients can be recruited to develop effective guidelines for the treatment of such a disabling deficit. Declarations Funding: This work was supported by a grant from the Italian Ministry of Health (RF 19) to CP. Competing Interests: The authors declare no competing financial or non-financial interests. Data Availability: This study is a systematic review and meta-analysis. The data analyzed were extracted from previously published studies. As such, the original data are not owned by the authors. However, the dataset compiled and used for the meta-analysis is available from the corresponding author upon reasonable request. Author Contribution M.S., L.B., E.B., E.Ba., S.T., and L.Z. conceived the study and developed the review and meta-analysis protocol. All authors participated at different stages in literature screening and data extraction. M.S., L.B., E.B., E.Ba., S.T., and L.Z. conducted data extraction and quality assessment for the systematic review and contributed to the preparation of all tables, except those related to the meta-analysis. M.B. performed data extraction for the meta-analysis, carried out all statistical analyses, and produced the corresponding figures and tables. C.P. supervised the project, drafted the manuscript, and revised its final version. All authors contributed to data interpretation, critically reviewed the manuscript, and approved the final version for submission. Data Availability This study is a systematic review and meta-analysis. The data analyzed were extracted from previously published studies. As such, the original data are not owned by the authors. However, the dataset compiled and used for the meta-analysis is available from the corresponding author upon reasonable request. References Vakil, E. The Effect of Moderate to Severe Traumatic Brain Injury (TBI) on Different Aspects of Memory:A Selective Review. J. Clin. Exp. Neuropsychol. 27 , 977–1021 (2005). Schaapsmeerders, P. et al. Long-Term Cognitive Impairment After First-Ever Ischemic Stroke in Young Adults. Stroke 44 , 1621–1628 (2013). Wilson, B. A. Cognitive rehabilitation in the 21st century. Neurorehabil. Neural Repair 16 , 207–210 (2002). Rees, L. et al. Cognitive interventions post acquired brain injury. Brain Inj. 21 , 161–200 (2007). Velikonja, D. et al. INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part V: Memory. J. Head Trauma Rehabil. 29 , 369–386 (2014). Mahan, S., Rous, R. & Adlam, A. Systematic Review of Neuropsychological Rehabilitation for Prospective Memory Deficits as a Consequence of Acquired Brain Injury. J. Int. Neuropsychol. Soc. JINS 23 , 254–265 (2017). Cicerone, K. D. et al. Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Arch. Phys. Med. Rehabil. 100 , 1515–1533 (2019). Hudes, R. et al. Evaluating the effectiveness of compensatory memory interventions in adults with acquired brain injury: A systematic review and meta-analysis of memory and everyday outcomes. Neuropsychology 36 , 243–265 (2022). Velikonja, D. et al. INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory. J. Head Trauma Rehabil. 38 , 83–102 (2023). Lambez, B. & Vakil, E. The effectiveness of memory remediation strategies after traumatic brain injury: Systematic review and meta-analysis. Ann. Phys. Rehabil. Med. 64 , 101530 (2021). Elliott, M. & Parente, F. Efficacy of memory rehabilitation therapy: a meta-analysis of TBI and stroke cognitive rehabilitation literature. Brain Inj. 28 , 1610–1616 (2014). Spreij, L. A., Visser-Meily, J. M. A., van Heugten, C. M. & Nijboer, T. C. W. Novel insights into the rehabilitation of memory post acquired brain injury: a systematic review. Front. Hum. Neurosci. 8 , 993 (2014). Tse, Z. C. K. et al. Prospective Memory Training in Older Adults: A Systematic Review and Meta-Analysis. Neuropsychol. Rev. 33 , 347–372 (2023). Jones, W., Benge, J. & Scullin, M. Preserving Prospective Memory in Daily Life: A Systematic Review and Meta-Analysis of Mnemonic Strategy, Cognitive Training, External Memory Aid, and Combination Interventions. NEUROPSYCHOLOGY 35 , 123–140 (2021). Hara, T., Shanmugalingam, A., McIntyre, A. & Burhan, A. M. The effect of non-invasive brain stimulation (Nibs) on attention and memory function in stroke rehabilitation patients: A systematic review and meta-analysis. Diagnostics 11 , (2021). Hara, T., Shanmugalingam, A., McIntyre, A. & Burhan, A. The Effect of Non-Invasive Brain Stimulation (NIBS) on Executive Functioning, Attention and Memory in Rehabilitation Patients with Traumatic Brain Injury: A Systematic Review. DIAGNOSTICS 11 , (2021). Moher, D. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst. Rev. 4 , 1 (2015). Ouzzani, M., Hammady, H., Fedorowicz, Z. & Elmagarmid, A. Rayyan-a web and mobile app for systematic reviews. Syst. Rev. 5 , 210 (2016). Higgins, J. P. T. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343 , d5928 (2011). Sackett, D. L. et al. Evidence-Based Medicine: How to Practice and Teach EBM . (Churchill Livingstone, 2000). Moseley, A. M., Herbert, R. D., Sherrington, C. & Maher, C. G. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Aust. J. Physiother. 48 , 43–49 (2002). Bucur, M. & Papagno, C. A systematic review of noninvasive brain stimulation for post-stroke depression. J. Affect. Disord. 238 , 69–78 (2018). Bucur, M. & Papagno, C. Are transcranial brain stimulation effects long-lasting in post-stroke aphasia? A comparative systematic review and meta-analysis on naming performance. Neurosci. Biobehav. Rev. 102 , 264–289 (2019). da Silva, F. C. et al. Effects of physical exercise programs on cognitive function in Parkinson’s disease patients: A systematic review of randomized controlled trials of the last 10 years. PLoS ONE 13 , e0193113 (2018). Alashram, A. R., Annino, G., Padua, E., Romagnoli, C. & Mercuri, N. B. Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology. J. Clin. Neurosci. Off. J. Neurosurg. Soc. Australas. 66 , 209–219 (2019). Sherrington, C., Herbert, R. D., Maher, C. G. & Moseley, A. M. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Man. Ther. 5 , 223–226 (2000). Wollesen, B., Wildbredt, A., Schooten, K. V. van, Lim, M. & Delbaere, K. The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis. Eur. Rev. Aging Phys. Act. (2020) doi:10.1186/s11556-020-00240-y. Foley, N. C., Teasell, R. W., Bhogal, S. K. & Speechley, M. R. Stroke Rehabilitation Evidence-Based Review: methodology. Top. Stroke Rehabil. 10 , 1–7 (2003). Straus, S. E., Glasziou, P., Richardson, W. S. & Haynes, R. B. Evidence-Based Medicine: Evidence-Based Medicine E-Book . (Elsevier Health Sciences, 2018). Borenstein, M., Hedges, L., Higgins, J. & Rothstein, H. Comprehensive Meta‐Analysis Software. in 425–441 (2021). doi:10.1002/9781119558378.ch49. Duval, S. & Tweedie, R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56 , 455–463 (2000). Aben, L., Heijenbrok-Kal, M. H., Ponds, R. W. H. M., Busschbach, J. J. V. & Ribbers, G. M. Long-lasting effects of a new memory self-efficacy training for stroke patients: a randomized controlled trial. Neurorehabil. Neural Repair 28 , 199–206 (2014). das Nair, R. et al. Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial. Clin. Rehabil. 33 , 1171–1184 (2019). Fleming, J. et al. Efficacy of Prospective Memory Rehabilitation Plus Metacognitive Skills Training for Adults With Traumatic Brain Injury: A Randomized Controlled Trial. Neurorehabil. Neural Repair 36 , 487–499 (2022). Lannin, N. et al. A randomized controlled trial of the effectiveness of handheld computers for improving everyday memory functioning in patients with memory impairments after acquired brain injury. Clin. Rehabil. 28 , 470–481 (2014). Lemoncello, R., Sohlberg, M. M., Fickas, S. & Prideaux, J. A randomised controlled crossover trial evaluating Television Assisted Prompting (TAP) for adults with acquired brain injury. Neuropsychol. Rehabil. 21 , 825–846 (2011). Leśniak, M. M., Mazurkiewicz, P., Iwański, S., Szutkowska-Hoser, J. & Seniów, J. Effects of group versus individual therapy for patients with memory disorder after an acquired brain injury: A randomized, controlled study. J. Clin. Exp. Neuropsychol. 40 , 853–864 (2018). McDonald, A. et al. Google Calendar: a new memory aid to compensate for prospective memory deficits following acquired brain injury. Neuropsychol. Rehabil. 21 , 784–807 (2011). Shum, D., Fleming, J., Gill, H., Gullo, M. J. & Strong, J. A randomized controlled trial of prospective memory rehabilitation in adults with traumatic brain injury. J. Rehabil. Med. 43 , 216–223 (2011). Storzbach, D. et al. Compensatory Cognitive Training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans With Mild Traumatic Brain Injury. J. Head Trauma Rehabil. 32 , 16–24 (2017). Yip, B. C. B. & Man, D. W. K. Virtual reality-based prospective memory training program for people with acquired brain injury. NeuroRehabilitation 32 , 103–115 (2013). Bergquist, T. et al. The effect of internet-based cognitive rehabilitation in persons with memory impairments after severe traumatic brain injury. Brain Inj. 23 , 790–799 (2009). Dowds, M. M. et al. Electronic reminding technology following traumatic brain injury: effects on timely task completion. J. Head Trauma Rehabil. 26 , 339–347 (2011). Lawson, D. W. et al. Telehealth Delivery of Memory Rehabilitation Following Stroke. J. Int. Neuropsychol. Soc. JINS 26 , 58–71 (2020). Miller, L. A. & Radford, K. Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients. Neuropsychol. Rehabil. 24 , 721–737 (2014). Potvin, M.-J., Rouleau, I., Sénéchal, G. & Giguère, J.-F. Prospective memory rehabilitation based on visual imagery techniques. Neuropsychol. Rehabil. 21 , 899–924 (2011). Raskin, S. A. & Sohlberg, M. M. Prospective memory intervention: A review and evaluation of a pilot restorative intervention. Brain Impair. 10 , 76–86 (2009). Raskin, S. A., Smith, M. P., Mills, G., Pedro, C. & Zamroziewicz, M. Prospective memory intervention using visual imagery in individuals with brain injury. Neuropsychol. Rehabil. 29 , 289–304 (2019). Anaki, D., Devisheim, H., Goldenberg, R. & Feuerstein, R. Long-Term Effects of Intensive Rehabilitation on Memory Functions in Acquired Brain-Damaged Patients. Arch. Clin. Neuropsychol. Off. J. Natl. Acad. Neuropsychol. 39 , 1398–1407 (2024). Evald, L. Prospective memory rehabilitation using smartphones in patients with TBI. Disabil. Rehabil. 40 , 2250–2259 (2018). Mitrovic, A., Mathews, M., Ohlsson, S., Holland, J. & McKinlay, A. Computer-based post-stroke rehabilitation of prospective memory. J. Appl. Res. Mem. Cogn. 5 , 204–214 (2016). O’Neil-Pirozzi, T. M. et al. A controlled treatment study of internal memory strategies (I-MEMS) following traumatic brain injury. J. Head Trauma Rehabil. 25 , 43–51 (2010). Lawson DW, Stolwyk RJ, Ponsford JL, & Wong D. Evaluating telehealth delivery of a compensatory memory rehabilitation programme following stroke: A single-case experimental design. Neuropsychol. Rehabil. 32 , 897–921 (2022). Withiel, T. D., Stolwyk, R. J., Ponsford, J. L., Cadilhac, D. A. & Wong, D. Effectiveness of a manualised group training intervention for memory dysfunction following stroke: a series of single case studies. Disabil. Rehabil. 42 , 3033–3042 (2020). Hildebrandt, H., Gehrmann, A., Modden, C. & Eling, P. Enhancing memory performance after organic brain disease relies on retrieval processes rather than encoding or consolidation. J. Clin. Exp. Neuropsychol. 33 , 257–270 (2011). Richter, K. M., Mödden, C., Eling, P. & Hildebrandt, H. Working memory training and semantic structuring improves remembering future events, not past events. Neurorehabil. Neural Repair 29 , 33–40 (2015). Richter, K. M., Mödden, C., Eling, P. & Hildebrandt, H. Improving everyday memory performance after acquired brain injury: An RCT on recollection and working memory training. Neuropsychology 32 , 586–596 (2018). Withiel, T. D. et al. Comparing memory group training and computerized cognitive training for improving memory function following stroke: A phase II randomized controlled trial. J. Rehabil. Med. 51 , 343–351 (2019). Radford, K., Say, M. J., Thayer, Z. & Miller, L. A. Making the Most of Your Memory: An Everyday Memory Skills Program. (Sydney: ASSBI Resources., 2010). Dorfzaun-Harif, I. et al. An innovative model for the dynamic neurocognitive rehabilitation for individuals with acquired brain injury. Transylvanian Journal of Psychology 16 , 3–30. Joplin, S., Stewart, E., Gascoigne, M. & Lah, S. Memory Rehabilitation in Patients with Epilepsy: a Systematic Review. Neuropsychol. Rev. 28 , 88–110 (2018). Mazo, G. et al. Rehabilitation of working memory after acquired brain injury and multiple sclerosis: A systematic review. Neuropsychol. Rehabil. 35 , 92–130 (2025). van Grinsven, E. E. et al. The impact of etiology in lesion-symptom mapping - A direct comparison between tumor and stroke. NeuroImage Clin. 37 , 103305 (2023). Varastegan, S. et al. Remember NIBS? tACS improves memory performance in elders with subjective memory complaints. GeroScience 45 , 851–869 (2023). Beishon, L. C. et al. Age-related differences in cerebrovascular responses to cognitive stimulation using a novel method. Neuropsychol. Dev. Cogn. B Aging Neuropsychol. Cogn. 29 , 929–942 (2022) Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1R.docx Table2R.docx Table3R.docx Supplementarymaterial.docx Cite Share Download PDF Status: Published Journal Publication published 14 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 13 Oct, 2025 Reviews received at journal 25 Sep, 2025 Reviewers agreed at journal 17 Sep, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers agreed at journal 27 Aug, 2025 Reviewers agreed at journal 25 Aug, 2025 Reviews received at journal 24 Aug, 2025 Reviewers agreed at journal 14 Aug, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers invited by journal 22 Jul, 2025 Editor assigned by journal 22 Jul, 2025 Editor invited by journal 22 Jul, 2025 Submission checks completed at journal 17 Jul, 2025 First submitted to journal 17 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7113515","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":489586085,"identity":"f76ed00e-a399-43b4-aa2b-4aa954f8ebd3","order_by":0,"name":"Mirco Soda","email":"","orcid":"","institution":"Hospital of Bolzano-Bozen (SABES-ASDAA)","correspondingAuthor":false,"prefix":"","firstName":"Mirco","middleName":"","lastName":"Soda","suffix":""},{"id":489586086,"identity":"7ca2040d-fb9f-47e6-aa19-33e8bdf8340c","order_by":1,"name":"Luisa Bartucca","email":"","orcid":"","institution":"Hospital of Bressanone-Brixen (SABES-ASDAA)","correspondingAuthor":false,"prefix":"","firstName":"Luisa","middleName":"","lastName":"Bartucca","suffix":""},{"id":489586087,"identity":"2abea9f0-9fb7-4d96-b489-6a3a58b624c9","order_by":2,"name":"Elena Baruzzo","email":"","orcid":"","institution":"University of Trento","correspondingAuthor":false,"prefix":"","firstName":"Elena","middleName":"","lastName":"Baruzzo","suffix":""},{"id":489586088,"identity":"a16edec5-459b-493e-beac-022caeb97fa8","order_by":3,"name":"Edoardo Barvas","email":"","orcid":"","institution":"Ospedale di Stato della Repubblica di San Marino","correspondingAuthor":false,"prefix":"","firstName":"Edoardo","middleName":"","lastName":"Barvas","suffix":""},{"id":489586089,"identity":"adb5b0af-dcee-4c65-ba5d-6c2ae61d5013","order_by":4,"name":"Madalina Bucur","email":"","orcid":"","institution":"University of Trento","correspondingAuthor":false,"prefix":"","firstName":"Madalina","middleName":"","lastName":"Bucur","suffix":""},{"id":489586090,"identity":"968f84c8-48b8-4c27-8aef-714c2f06f355","order_by":5,"name":"Stefano Terruzzi","email":"","orcid":"","institution":"University of Trento","correspondingAuthor":false,"prefix":"","firstName":"Stefano","middleName":"","lastName":"Terruzzi","suffix":""},{"id":489586091,"identity":"e5dba3f4-f9a2-4c29-b635-ab5936589539","order_by":6,"name":"Luca Zigiotto","email":"","orcid":"","institution":"Azienda Provinciale per i Servizi Sanitari (APSS)","correspondingAuthor":false,"prefix":"","firstName":"Luca","middleName":"","lastName":"Zigiotto","suffix":""},{"id":489586092,"identity":"3d34e0e0-d5dc-4fe0-8891-0f526e111296","order_by":7,"name":"Costanza Papagno","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYEgAfiA+AMQ8eNQwNqBwJYHcA0A9PHj0oGkxOEDAGv729ucPfu6ok2eQbn724MevO3LGN3IPHv64g0HGHocWiTNnDBt7z7AZNsgcMzfs7XtmbHYjL+HAwTO4HWYgkcPYwNvGw9ggkWAmwdtzOHHbjRyDAwfb8GlJf9j4t03CvkEi/ZvkX6CWzTMIakkwbOZtM0hskMgxk+b5cThxgwQBLSC/zJZtS0hukzlTbizbcNhY4swbgwNn2yR4eA7gDLEHH9+21dn2S7dve/jmz2E5/vYc4w+VbTb27A04rIEBNgkGNgbGNoT1BNRD1LAxMPwhQuEoGAWjYBSMOAAAG3BeC+szbccAAAAASUVORK5CYII=","orcid":"","institution":"University of Trento","correspondingAuthor":true,"prefix":"","firstName":"Costanza","middleName":"","lastName":"Papagno","suffix":""}],"badges":[],"createdAt":"2025-07-13 13:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7113515/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7113515/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-29423-2","type":"published","date":"2026-01-14T16:29:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87576294,"identity":"6fb7a3d1-95da-44b2-b86a-c8c82596708e","added_by":"auto","created_at":"2025-07-25 11:41:54","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":414357,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA Flow diagram\u003c/p\u003e","description":"","filename":"Fig.1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/dc7f72584346bccb16a2e985.jpeg"},{"id":87578094,"identity":"47d24b04-62bb-4a6d-bbf9-8f042bf28613","added_by":"auto","created_at":"2025-07-25 11:57:54","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":112004,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot\u003c/p\u003e","description":"","filename":"Fig2highres.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/cafd1432643d56804597a9ea.jpg"},{"id":87576309,"identity":"43785681-07e2-463b-91ba-148f4ed35785","added_by":"auto","created_at":"2025-07-25 11:41:54","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":19343,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel plot of standard error by Hedges’g\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/c4059a923da942604e89093e.jpg"},{"id":100614535,"identity":"323d511d-e6ce-41d8-b9a2-ea32df4616d2","added_by":"auto","created_at":"2026-01-19 17:21:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1399973,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/025b3259-250b-4eaa-a536-3791d14e39e8.pdf"},{"id":87577071,"identity":"413e6c7b-8fca-4a42-90ab-02482ae0f15b","added_by":"auto","created_at":"2025-07-25 11:49:54","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16667,"visible":true,"origin":"","legend":"","description":"","filename":"Table1R.docx","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/b50e1a830e12840dcf03b38b.docx"},{"id":87576300,"identity":"985ad98a-0b05-45f2-b6ed-f79d73ee6ed8","added_by":"auto","created_at":"2025-07-25 11:41:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2602291,"visible":true,"origin":"","legend":"","description":"","filename":"Table2R.docx","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/6ee184e43f3a6cb90b8fed44.docx"},{"id":87576301,"identity":"d13b6ae2-7f22-4841-a75d-1ef3ed051b3a","added_by":"auto","created_at":"2025-07-25 11:41:54","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":41721,"visible":true,"origin":"","legend":"","description":"","filename":"Table3R.docx","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/8d6b31f11dabad5a13ac78ab.docx"},{"id":87576304,"identity":"6110111a-c57f-432f-95dc-11310423c091","added_by":"auto","created_at":"2025-07-25 11:41:54","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":130144,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-7113515/v1/7d72c599f7c14d6ce3e17471.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Remembering to Remember: A Systematic Review and Meta-Analysis on Prospective Memory Rehabilitation in Adults with Acquired Brain Injury","fulltext":[{"header":"Highlights","content":"\u003cp\u003eWe reviewed studies on prospective memory (PM).\u003c/p\u003e\n\u003cp\u003eTen RCT were included in the quantitative meta-analysis.\u003c/p\u003e\n\u003cp\u003ePM rehabilitation after ABI shows positive but still uncertain outcomes.\u003c/p\u003e\n\u003cp\u003eRCTs showed moderate evidence based on GRADE methodology.\u003c/p\u003e\n\u003cp\u003eNew technologies (i.e., VR) look promising but they remain still under-investigated.\u003c/p\u003e\n\u003cp\u003eTests and diagnosis lack consistency.\u003c/p\u003e\n\u003cp\u003eReal-life improvements are rarely assessed and poorly documented.\u003c/p\u003e"},{"header":"1. INTRODUCTION","content":"\u003cp\u003eMemory impairments are among the most common consequences of brain injuries. These deficits often affect daily living activities, as well as social, leisure, and vocational activities [\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e]. Furthermore, memory disorders negatively impact other cognitive domains (e.g., language comprehension and planning of future activities), hampering their rehabilitation.\u003c/p\u003e\u003cp\u003eMemory deficits might result from several neurological diseases. They are often caused by traumatic brain injuries (TBI), stroke, encephalitis, and hypoxic brain damage. Patients typically complain about difficulties in learning new information or, typically, remembering to perform intended actions.\u003c/p\u003e\u003cp\u003eAs for the neuropsychological rehabilitation in general, the two main approaches are remediation and compensation [\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e]. In the case of memory deficits, remediation refers to a series of techniques consisting of repetitive drills and memory training. The second approach, compensation, refers to the use of internal strategies (e.g., visual imagery and self-generated mnemonics to form associations) or external strategies (e.g., environmental changes, checklists, and personal electronic devices) aimed at reducing memory problems on a functional level without necessarily improving the underlying memory function [\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e].\u003c/p\u003e\u003cp\u003eHowever, memory is not a unitary system but includes different interrelated subsystems that might be damaged independently. Accordingly, memory rehabilitation targets different components, such as short-term memory (STM) and working memory (WM), long-term memory (LTM) and prospective memory (PM), or, finally, semantic memory. The focus of the present systematic review and meta-analysis is PM, given its critical relevance to daily functioning. Individuals who report memory difficulties frequently describe failures in remembering intended actions, highlighting the everyday significance of PM impairments.\u003c/p\u003e\u003cp\u003eCurrent evidence in patients suffering from an acquired brain injury (ABI) supports and recommends the use of internal and external memory compensations for patients with mild memory impairments and the use of external compensations, with direct application to functional activities, for patients with severe memory deficits [\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e]. Specifically, the systematic review by Cicerone et al. [\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e] included two class II studies on LTM aimed at improving the recall of information in everyday tasks, and five class I, three class II, and one class III studies on PM. Both studies were group-based compensative interventions focused on strategies such as psychoeducation about memory, and internal and external memory strategy teaching; both showed significant improvement on everyday memory measures. Four out of the five class I studies on PM were based on external memory strategies (assistive technology training) and demonstrated the effectiveness of those techniques as a way to improve the likelihood of future intentions being carried out. One class I and two class II studies on PM used internal compensation strategies (visual imagery or self-imagination) and found an improvement in prospective remembering. The authors concluded that memory strategy training, including the use of internal and external compensation strategies, is recommended for the improvement of recall in everyday tasks in patients with mild memory impairments after TBI (Practice Standard), and for the improvement of PM in patients with TBI or stroke (Practice Standard). The same conclusion emerged from the systematic review on PM rehabilitation after ABI by Mahan et al. [\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e]: this review, including 11 papers, showed that PM abilities can improve by using simple reminder systems, such as audio-visual message alerts on a smartphone, with a generalization to everyday PM functioning. Two recent systematic reviews on the effectiveness of compensatory memory interventions are consistent with the positive results described in the previous studies. Lambez \u0026amp; Vakil\u0026rsquo;s review[\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e] included 22 controlled trials in adults with ABI in general, while the review by Hudes et al. [\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e] included 16 studies on TBI patients only. Both concluded for the effectiveness of compensatory memory strategies. Moreover, Lambez \u0026amp; Vakil [\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e] compared different approaches among compensatory memory interventions and found that those that combine external and internal strategies are the most effective in reducing memory impairment, followed by external strategies alone, and, finally, internal strategies only interventions.\u003c/p\u003e\u003cp\u003eA final comment is that most of the cited reviews on PM rehabilitation highlight some limitations of the included studies, namely the variability of the studies\u0026rsquo; design, samples, assessment and intervention, the lack of a standardized qualitative account of the injury profile, the lack of studies directly comparing different approaches (e.g., remediation vs compensation) in order to evaluate the superiority of one type of intervention over the other, and the limited number of studies and their low methodological quality for some new approaches such as Virtual Reality [\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e]. Despite these limitations, memory rehabilitation is increasingly popular and is recognized as a component of rehabilitation programs for patients with ABI in several national clinical guidelines (i.e., Italian Stroke Guidelines - SPREAD, American Stroke Association, UK Royal College of Physicians; INCOG guidelines). In particular, the INCOG 2.0 guidelines for Cognitive Rehabilitation Following TBI [\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e] recommend using internal compensation strategies (especially for patients with mild-to-moderate memory impairments) and external strategies (especially for patients with severe or moderate impairment). Conversely, they do not recommend remediation approaches when applied as a singular treatment or the use of Transcranial Direct Current Stimulation (tDCS) for memory rehabilitation outside clinical trials.\u003c/p\u003e\u003cp\u003eOne recent comprehensive systematic review on the efficacy of memory rehabilitation in patients with ABIs [\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e] covers the literature published until 2014. The review by Mahan et al. [\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e] on PM rehabilitation concerns children and adults with different etiologies and does not include a meta-analysis. Furthermore, it covers the literature until 2016. The two most recent reviews on PM rehabilitation either focused exclusively on older healthy adults [\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e] or included them alongside clinical groups [\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e]. Finally, the already reported one by Velikonja et al. [\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e], which covers the literature until 2021, is focused on patients with moderate-to-severe TBI.\u003c/p\u003e\u003cp\u003eIn the last decade, there has been an explosion in information and communication technologies offering new devices to overcome memory impairments, new rehabilitation tools such as Computer-Based Training, virtual reality, Transcranial Magnetic Stimulation (TMS) and tDCS and new modalities in which rehabilitation can be delivered (i.e., telerehabilitation). Two recent systematic reviews focused on the effect of TMS and tDCS on neuropsychological rehabilitation in patients with TBI [\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e] and stroke [\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e], covering the literature published until 2020 but included rehabilitation studies of cognitive functions other than memory. The only review on memory rehabilitation in patients with ABIs including novel approaches is the one by Spreij et al. [\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e], but it extends until 2014, and it mainly focuses on WM.\u003c/p\u003e\u003cp\u003eIn summary, even though several reviews on memory rehabilitation in patients with ABI have been published, most of the recent ones have considered specific subgroups of patients or specific rehabilitation approaches, while others have included general cognitive rehabilitation studies. Therefore, the present study aimed to provide a systematic review of the literature published in the last fifteen years on the effectiveness of PM rehabilitation, including new emerging approaches. Compared to other recent reviews, we specifically focused on non-progressive conditions (overall, TBI and stroke) and included interventions involving virtual reality, a tool increasingly employed in neurorehabilitation, particularly because of telerehabilitation. Our primary aim was to evaluate the effectiveness of PM rehabilitation. Additionally, we tried to assess whether improvements are maintained over time and whether they transfer to everyday activities. To this end, we assessed the overall level of evidence using the GRADE methodology and evaluated item-level risk of bias using the Cochrane Collaboration\u0026rsquo;s tool. Finally, we explored the influence of age and other clinical variables on treatment outcomes.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cp\u003eThe systematic review and meta-analysis were performed with the aim of quantitatively and qualitatively assessing the efficacy of cognitive rehabilitation interventions specifically targeting PM deficits in adults with ABI, including stroke and TBI. The systematic review was performed following the PRISMA guidelines [\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e], encompassing both randomized controlled trials (RCT) and non-randomized controlled trials (nRCT) studies. The meta-analysis included only RCTs reporting standardized PM outcomes.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Search Strategy and Eligibility Criteria\u003c/h2\u003e\u003cp\u003eA literature search from January 2008 to December 2024 was initially performed across five electronic databases\u0026mdash;namely, PubMed, PsycINFO, Web of Science, ScienceDirect, and Scopus. Keywords were: (1) \u0026ldquo;prospective memory\u0026rdquo;; \u0026ldquo;episodic memory\u0026rdquo;; \u0026ldquo;memory\u0026rdquo;; \u0026ldquo;amnesia\u0026rdquo; AND (2) \u0026ldquo;rehabilitation\u0026rdquo;; \u0026ldquo;remediation\u0026rdquo;; \u0026ldquo;intervention\u0026rdquo;; \u0026ldquo;treatment\u0026rdquo;; \u0026ldquo;neuro-rehabilitation\u0026rdquo;; \u0026ldquo;training\u0026rdquo;; \u0026ldquo;brain-trainer\u0026rdquo;; \u0026ldquo;PQRST\u0026rdquo;; \u0026ldquo;SQ3R\u0026rdquo;; \u0026ldquo;vanishing cues\u0026rdquo;; \u0026ldquo;external aids\u0026rdquo;; \u0026ldquo;errorless learning\u0026rdquo;; \u0026ldquo;repetition priming\u0026rdquo;; \u0026ldquo;neuro pages\u0026rdquo;; \u0026ldquo;spaced retrieval\u0026rdquo;; \u0026ldquo;mind maps\u0026rdquo;; \u0026ldquo;meta-memory techniques\u0026rdquo;; \u0026ldquo;visual imagery\u0026rdquo;; \u0026ldquo;TMS\u0026rdquo;; \u0026ldquo;tDCS\u0026rdquo;; \u0026ldquo;non-invasive brain stimulation\u0026rdquo;; \u0026ldquo;method of loci\u0026rdquo;; \u0026ldquo;first letter cues\u0026rdquo;; \u0026ldquo;environmental modification\u0026rdquo;.\u003c/p\u003e\u003cp\u003eEligible studies met the following inclusion criteria: (1) adult participants with non-progressive ABI; (2) intervention explicitly targeting PM functioning; (3) use of validated, continuous outcome measures of PM; and (4) provision of sufficient statistical data for effect size computation (e.g., means, standard deviations, or standard errors). Studies were excluded if they focused on other memory subtypes (e.g., working or semantic memory), involved participants with progressive neurological diseases (e.g., dementia), or lacked peer review, English-language publication, or adequate outcome data. Also, single case reports, studies on healthy adults or pharmacological treatments were excluded. Although unpublished studies can help mitigate publication bias, they were excluded due to inconsistent methodological quality and limited replicability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Data Extraction and Coding Procedures\u003c/h2\u003e\u003cp\u003eTitles, abstracts, and keywords of the extracted studies were screened using Ryyan QCRI (RyyanQCRI, Qatar Computing Research Institute, HBKU, Doha, Quatar) [\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e]. After duplicates\u0026rsquo; exclusion, each study was independently assessed by all reviewers to reduce selection bias. Studies were excluded if they did not meet one or more of the abovementioned criteria. Studies rated as relevant by at least 4 of the 8 reviewers were included for further consideration. Articles with conflicting ratings were resolved by discussion. Extracted data included: authors, design of the study, participants\u0026rsquo; details (number of participants, type of ABI, age, time after lesion, deficit on inclusion), intervention characteristics (type of intervention and description, duration, intensity, eventually control condition), outcome measures, results, levels of evidence on Physiotherapy Evidence Database (PEDro) scale and on Cochrane Collaboration\u0026rsquo;s tool for assessing risk of bias, where applicable, and modified Sackett scale (mSS). Significance was settled at p\u0026thinsp;\u0026lt;\u0026thinsp;0,05.\u003c/p\u003e\u003cp\u003eFor studies included in the meta-analysis, we extracted data on sample sizes, means, and standard deviations. When both pre- and post-treatment outcomes were reported, effect sizes were calculated based on the difference in change scores between the treatment and control groups. If only post-treatment values were available, we computed standardized mean differences (SMDs) based on post-intervention group comparisons. In cases where studies reported standard errors instead of standard deviations, we converted them using the formula: SD\u0026thinsp;=\u0026thinsp;SE \u0026times; \u0026radic;n. When necessary, we contacted corresponding authors to obtain missing data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Quality assessment\u003c/h2\u003e\u003cp\u003eInterventions were assessed for level of evidence and methodology quality and strength. Also in this case, two authors independently evaluated the characteristics and the quality of the previously included studies, with conflicts resolved by discussion between all the authors until consensus was reached. The methodological quality was assessed using the PEDro scale and the Cochrane Collaboration\u0026rsquo;s tool for assessing risk of bias [\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e], as reported above. A grade for the level of evidence was assigned to each study according to the mSS [\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e], following a method used in previous reviews [\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e].\u003c/p\u003e\u003cp\u003eThe PEDro scale is an 11-item scale designed for rating the quality of clinical trials. This scale has been used to rate the quality in several systematic reviews [\u003csup\u003e\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e]. Each satisfied yes/no item (except for item 1, which, unlike other scale items, pertains to external validity) contributes one point to the total PEDro score (range 0\u0026ndash;10 points). Individual item level and total PEDro scores showed good agreement between raters [\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e]. Moreover, Foley et al. [\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e] have arbitrarily defined the following criteria for rating the methodologic quality of a study: 9 to 10, excellent; 6 to 8, good; 4 to 5, fair; and \u0026lt;\u0026thinsp;4, poor.\u003c/p\u003e\u003cp\u003eIn the Cochrane Collaboration\u0026rsquo;s tool for assessing risk of bias in randomised trials, bias is assessed as a judgement (high, low, or unclear) for individual elements from five domains (selection, performance, attribution, detection, reporting) and others (Higgins et al 2011).\u003c/p\u003e\u003cp\u003eThe mSS, with 5 levels of evidence, was used to determine the strength of evidence for each intervention [\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e]. The modified scale was created to simplify the 10 subcategories present in the Sackett scale into a system with 5 levels. Level 1 included RCT with a PEDro score greater than or equal to 6, whereas RCTs with scores lower than 6 were given level 2(a) evidence. Prospective controlled trials and cohort studies were also included in level 2(b) evidence. Level 3 evidence consisted only of case control trials. Pre-post studies, post-test, and case series were considered level 4 evidence. Lastly, level 5 evidence consisted of observational studies, clinical consensus, and case reports.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Meta-Analytic Procedure and Statistical Model\u003c/h2\u003e\u003cp\u003eAll statistical analyses were conducted using the \u003cem\u003eComprehensive Meta-Analysis\u003c/em\u003e software, Version 4 [\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e]. Hedges\u0026rsquo; g was chosen as the effect size index, as it corrects for small sample bias and allows comparison across heterogeneous study designs. A random-effects model was employed to account for expected variability in intervention modalities, participant characteristics, and settings.\u003c/p\u003e\u003cp\u003eHeterogeneity across studies was evaluated using the Q-statistic and I\u0026sup2;. In addition to standard heterogeneity indices, we calculated a 95% prediction interval to estimate the likely range of true effect sizes across future studies in similar contexts.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Assessment of Publication Bias and Sensitivity Analyses\u003c/h2\u003e\u003cp\u003eTo evaluate the presence and impact of potential publication bias, we employed multiple procedures: visual inspection of funnel plots [\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e], Egger\u0026rsquo;s regression test for small-study effects, and Duval \u0026amp; Tweedie\u0026rsquo;s Trim and Fill method [\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e]. Adjusted estimates were computed under both fixed-effect and random-effects assumptions, and results are presented as sensitivity analyses rather than definitive corrections.\u003c/p\u003e\u003cp\u003eRisk of Bias and Certainty Assessment Risk of bias was assessed using the GRADE framework (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gradepro.org\u003c/span\u003e\u003cspan address=\"https://www.gradepro.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003e3.1. \u003cstrong\u003eStudy selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter removal of duplicates, the initial search identified 5434 articles that were evaluated according to the inclusion criteria. Screening of citations and references provided seven additional studies for review. Following screening of titles and abstracts, 176 articles were selected for full-text review. Of the 176 articles assessed in the full-text screening, 149 were excluded. The reasons for exclusion were the following: theoretical/non-empirical studies (54 excluded), reviews (34), papers not published in peer-reviewed journals (22), primary objective different from memory rehabilitation (11), articles not in English (6), single case reports (5), studies with no quantitative assessment of memory through validated neuropsychological tests (8), studies including patients with brain tumors or patients with neurodegenerative disease, therefore \u0026ldquo;progressive\u0026rdquo; diseases (6), studies where the intervention was pharmacological or a general stimulation of cognitive abilities (3). Ultimately, 27 articles met the full inclusion criteria and were used for this review. \u0026nbsp;Figure 1 shows a flowchart of the selection process.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026mdash;Insert Figure 1 about here\u0026mdash;\u003c/p\u003e\n\u003cp\u003e3.2. \u003cstrong\u003eStudy Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetails of the studies included in this review are shown in Tables 1 and 2. Of the 27 studies selected according to the inclusion criteria, 14 were RCT [\u003csup\u003e32\u0026ndash;41\u003c/sup\u003e], seven were nRCT [\u003csup\u003e42\u0026ndash;48\u003c/sup\u003e], four had a pre- and post-measurement design [\u003csup\u003e49\u0026ndash;52\u003c/sup\u003e], and two involved case series [\u003csup\u003e53,54\u003c/sup\u003e]. Of the 14 RCT studies, 13 employed a between-subjects design and only one used a crossover within-subjects design [\u003csup\u003e38\u003c/sup\u003e]. Regarding nRCT studies, seven used a between-subjects design, four a within-subjects design and one a wait-list-based control.\u003c/p\u003e\n\u003cp\u003eA total of 1405 participants were involved in the included records. Sample sizes ranged from 4 [\u003csup\u003e54\u003c/sup\u003e] to 328 [\u003csup\u003e33\u003c/sup\u003e], with a mean sample size of 52 (SD=65). The patients\u0026rsquo; mean age ranged from 27,5 to 65, with the majority being in their early 30s or 40s. All participants had suffered an ABI (the lesion interval ranges from an average of approximately 38 days to around 80 months). Inspection of etiological factors indicated that 58,8% (n=826) had a diagnosis of TBI, 28,8% (n=404) of stroke, 0,6% of hypoxia (n=8), 0,1% of encephalitis or encephalopathy (n=2) and 11,7% (n=165) of other ABI (arteriovenous malformation, hydrocephalus, systemic lupus erythematosus, cyst or not specified).\u003c/p\u003e\n\u003cp\u003eTwenty-two group studies reported results for PM rehabilitation (or LTM including PM) [\u003csup\u003e32\u0026ndash;53\u003c/sup\u003e]. Five other studies [\u003csup\u003e54\u0026ndash;58\u003c/sup\u003el reported results for both PM and STM/WM rehabilitation, covering a variety of neuropsychological approaches, including internal or external memory strategies, individual-based or group-based psychoeducational intervention, computer-based cognitive training, cognitive training with mobile technologies, internet-based cognitive training, virtual reality memory training and holistic rehabilitation approach. Regarding the duration of treatment, a high variability was generally observed between the different studies in terms of both dose (range from 5 hours to over 1000 hours) and intensity (ranged from 5-9 one-hour sessions within 8 weeks at several hours per day, three to four times a week for months or even years) (see Supplementary Tables S1, S2, S3, S4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3\u0026nbsp;Methodological quality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 14 RCTs, 12 obtained a PEDro score \u0026gt;6 and hence were considered \u0026ldquo;high-quality\u0026rdquo; (mSS Level 1). Specifically, only one study obtained a PEDro score of 10, two studies a PEDro score of 9, three of 8, four of 7 and two of 6. The remaining two RCTs obtained a PEDro score of 5 and were considered as \u0026ldquo;fair-quality\u0026rdquo; RCTs (mSS Level 2a). Among the 13 studies using nRCT designs, eight studies were ranked as Level 2b and five as Level 4 at the mSS. The results of the assessment performed using the Cochrane Collaboration\u0026apos;s tool for assessing risk of bias are shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u0026mdash;-Insert Table 1 about here--\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Qualitative summary and synthesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3.4.1. PM rehabilitation techniques in RCT.\u0026nbsp; Restitution-oriented therapies were applied in four out of the fourteen studies [\u003csup\u003e41,55\u0026ndash;57\u003c/sup\u003e]. Eight studies were based on compensation techniques [\u003csup\u003e32,34\u0026ndash;40\u003c/sup\u003e]. Das Nair et al. [\u003csup\u003e33\u003c/sup\u003e] used mixed techniques. Finally, Withiel et al. [\u003csup\u003e58\u003c/sup\u003e] compared a compensatory memory skills group with a restorative computerized group focused on functional goal attainment.\u003c/p\u003e\n\u003cp\u003eThe treatment was delivered either individually [\u003csup\u003e34\u0026ndash;36,38,39,41,55\u0026ndash;57\u003c/sup\u003e], or in group [\u003csup\u003e32,33,40\u003c/sup\u003e], with two further studies comparing the effectiveness of group versus individual interventions [\u003csup\u003e37,58\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003eDifferent computerized interventions were used, such as a personal digital assistant [\u003csup\u003e35\u003c/sup\u003e], Google Calendar as a memory external aid [\u003csup\u003e38\u003c/sup\u003e], and other software such as VILAT-G [\u003csup\u003e55\u003c/sup\u003e] that trains semantic structuring of verbal information and spaced retrieval, or the computerized and adaptive cognitive training Lumosity\u003csup\u003eTM\u003c/sup\u003e [\u003csup\u003e58\u003c/sup\u003e]. A virtual reality program was used by Yip \u0026amp; Man [\u003csup\u003e41\u003c/sup\u003e], where a virtual store was developed for PM training. Furthermore, telerehabilitation was applied by Lemoncello et al.[\u003csup\u003e36\u003c/sup\u003e]: the authors employed a Television Assisted Prompting system, which provides audiovisual reminders at scheduled times, directly at home on the patient\u0026rsquo;s television.\u003c/p\u003e\n\u003cp\u003eInterventions varied in number of sessions (range 4-21), with a frequency of 1-6 days per week, and in duration of each session (30 - 120 minutes).\u003c/p\u003e\n\u003cp\u003eThe etiology of the samples differed among the studies: three out of the fourteen included chronic TBI [\u003csup\u003e33,39,40\u003c/sup\u003e]. One more study included patients at 1-month post-discharge [\u003csup\u003e34\u003c/sup\u003e]. Two studies included only stroke patients [\u003csup\u003e32,58\u003c/sup\u003e]. The remaining studies included mixed ABI patients (TBI, encephalitis and cerebrovascular accidents).\u003c/p\u003e\n\u003cp\u003eA follow-up was conducted in half of the studies and varied from 1 week to 12 months post-intervention [\u003csup\u003e32\u0026ndash;35,37,40,58\u003c/sup\u003e]. Other studies only run an immediate post-training assessment [\u003csup\u003e38,39,41,55\u0026ndash;57\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003e3.4.2 Treatment outcome\u003c/p\u003e\n\u003cp\u003ePM and LTM outcome measures improved in many studies. When individual vs. group training were compared, contrasting results were obtained. Leśniak et al. [\u003csup\u003e37\u003c/sup\u003e] found a significant improvement after the individual training but not after the group training, in the delayed recall of Pattern Recognition Memory test (PRM), in the Rapid Visual Information Processing (RVP) and in the Spatial Span (SSP) test from the Cambridge Neuropsychological Test Automated Battery (CANTAB-PRM).\u0026nbsp;However, patients allocated to the individual rehabilitation program performed some exercises that could be considered as remedial methods (for instance, some memory and attention exercises delivered from Rehacom or Cogniplus computer software); crucially, they showed greater gains when the assessment was based on computer-assisted tests. Therefore, the comparison between individual and group training should be interpreted with caution.\u003c/p\u003e\n\u003cp\u003eTwo studies reported a gain at the Cambridge Prospective Memory Test (CAMPROMPT), after a compensatory training in TBI patients [\u003csup\u003e39\u003c/sup\u003e], and after a virtual reality training in a group of patients with mixed etiologies [\u003csup\u003e41\u003c/sup\u003e]. In the latter study, there was also an improvement in immediate recall in PM tasks. A similar improvement was reported in a study by Fleming et al. [\u003csup\u003e34\u003c/sup\u003e], in which TBI patients performed a Compensatory strategy training associated to Metacognitive skills training (COMP-MST); nevertheless, a positive trend over time was observed also in patients who did COMP training alone and in the waitlist control group. Storzbach et al. [\u003csup\u003e40\u003c/sup\u003e] employed a manualized group-based compensatory cognitive training (CCT), which consisted in the use of daily strategies and external aids (calendar systems and assistive devices) to veterans who suffered from mild TBI. The authors found a significant post-treatment decrease of self-reported difficulties in memory (Prospective-Retrospective Memory Questionnaire, PRMQ), attention and planning problems (Multiple Sclerosis Neuropsychological Screening Questionnaire - Patient Version, MSNQ); furthermore, the use of cognitive strategies increased (Portland Cognitive Strategies Scale 2.0, PCSS).\u003c/p\u003e\n\u003cp\u003eAn improvement of PM in terms of completing intentions was described by using an active memory aid, namely Google Calendar, considered more effective than a standard diary [\u003csup\u003e38\u003c/sup\u003e]; activities remembered and completed in time were verified by a family member, and ABI participants appreciated Google Calendar more than common diaries as memory aids.\u003c/p\u003e\n\u003cp\u003eLemoncello et al. [\u003csup\u003e36\u003c/sup\u003e] found significant advantage of PM prompting using the Television Assisted Prompting system (72% completion of daily tasks) over no prompting (43%). Motivation played an important role in success.\u003c/p\u003e\n\u003cp\u003eHildebrandt et al. [\u003csup\u003e55\u003c/sup\u003e] stressed that rehabilitation can improve retrieval processes (not encoding and consolidation) by explaining strategies: VILAT-G computer training, compared to a group training, increased memory performance on the CVLT and story recall. During the sessions, patients were supported by a neuropsychologist, who taught the strategy of semantic structuring and spaced retrieval and in handling the program. Nevertheless, no generalization was found to PM measures.\u003c/p\u003e\n\u003cp\u003eWithiel et al. [\u003csup\u003e58\u003c/sup\u003e] demonstrated that participants allocated to the Memory skills group (MSG) had greater improvement in PM at post-intervention, with significant reduction of everyday memory complaints, than those who did computerized cognitive training (CCT), but this effect was not maintained at follow-up.\u003c/p\u003e\n\u003cp\u003e3.4.3. Evidence of transfer\u003c/p\u003e\n\u003cp\u003eEvidence of transfer was detected with restitution-oriented techniques, using virtual reality to improve everyday PM\u003csup\u003e41\u003c/sup\u003e. A significant improvement was also reported in a behavioral checklist of PM tasks in the real environment and on a self-efficacy questionnaire, while \u0026ldquo;traditional\u0026rdquo; internal-external strategies did not significantly change relatives\u0026rsquo; ratings of PM failures and of psychosocial reintegration of patients\u003csup\u003e39\u003c/sup\u003e. A working memory training combined with semantic structuring and verbal fluency generalized to ability of remembering future events\u003csup\u003e56\u003c/sup\u003e, as measured by RMBT (Names, Belongings, Appointment), but not to Cognitive Failures Questionnaire (CFQ). The same author found far transfer effects on Everyday Memory Test (EMT), combining working memory and recollection training\u003csup\u003e57\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eFocusing on studies that used compensation techniques, namely internal/external strategies and psychoeducation, Leśniak et al. [\u003csup\u003e37\u003c/sup\u003e] found an extended effect of training, showing an enhancement not only in neuropsychological tests, but also in objective tests of everyday memory, such as RBMT; however, they also found gains in a control group (no therapy) without detecting a specific effect of training. A significant improvement in Memory Self-Efficacy and in Quality of Life (QoL) was especially found in younger (\u0026lt; 65 years old) participants[\u003csup\u003e32\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003eUsing mixed techniques (internal and external strategies, psychoeducation) there were fewer memory failures on Goal Attainment Scale (GAS) [\u003csup\u003e35\u003c/sup\u003e], or there were improvements in everyday memory functioning measures, such as the Everyday Memory Questionnaire (EMQ) [\u003csup\u003e33\u003c/sup\u003e]. Accordingly, caregivers reported a reduced amount of forgetting at the Memory Functioning Questionnaire (MFQ) [\u003csup\u003e35\u003c/sup\u003e] and a decrease of memory failures at the EMQ in group treatment as compared to individual therapy [\u003csup\u003e33\u003c/sup\u003e]. The remaining studies did not find any evidence of transfer.\u003c/p\u003e\n\u003cp\u003e3.4.4. Maintenance over time\u003c/p\u003e\n\u003cp\u003eEffectiveness of interventions over a longer time was assessed in six studies. Improvement was sustained after 6 months in Aben et al.\u003csup\u003e32\u003c/sup\u003e; this result, together with an improved quality of life, was higher in people under 65, and remained stable over 12 months. Das Nair et al. [\u003csup\u003e33\u003c/sup\u003e] detected a maintenance of memory rehabilitation effects at 6 months, but not at 12 months. Leśniak et al. [\u003csup\u003e37\u003c/sup\u003e] found that with group training, improvement in RBMT continued at 4-month follow-up. Storzbach et al. [\u003csup\u003e40\u003c/sup\u003e] planned a 5-week follow-up that confirmed the results found at the post-treatment assessment: a reduction of cognitive complaints and an increased number of compensatory strategies in daily activities. In Withiel\u0026rsquo; et al. (2019)\u0026rsquo;s study [\u003csup\u003e58\u003c/sup\u003e], gains in functional goal attainment and internal strategies after MSG were maintained for 6 weeks after training. Lastly, Fleming et al. [\u003csup\u003e34\u003c/sup\u003e] detected a clinically relevant change at 3-month follow-up on psychosocial reintegration (Sydney Psychosocial Reintegration Scale version 2, SPRS-2 Form B) and on Everyday PM failure (Brief Assessment of Prospective Memory, BAPM) as reported by participants\u0026rsquo; caregivers, without finding significant differences between COMP-MST and COMP group.\u003c/p\u003e\n\u003cp\u003eSome studies did not include a follow-up [\u003csup\u003e38,39,41\u003c/sup\u003e]. Finally, in Lannin et al. [\u003csup\u003e35\u003c/sup\u003e] this was limited to 8 weeks with no evidence of maintenance.\u003c/p\u003e\n\u003cp\u003e3.4.5. Neurological and demographic factors associated with rehabilitation effectiveness\u003c/p\u003e\n\u003cp\u003eTwo RCT studies included only stroke patients [\u003csup\u003e32,58\u003c/sup\u003e] and four studies only TBI [\u003csup\u003e33,34,39,40\u003c/sup\u003e]. Finally, two studies between those including patients with mixed etiologies [\u003csup\u003e37,38\u003c/sup\u003e] considered neurological factors as associated with outcome. The remaining RCT studies did not explore specific effects of treatment based on these variables.\u003c/p\u003e\n\u003cp\u003eConcerning stroke, as already reported, a psychoeducational intervention was more useful for younger people [\u003csup\u003e32\u003c/sup\u003e]; nevertheless, older patients were mainly men, having lower memory scores, that could explain this result. There is a limited number of studies on early intervention after stroke, as spontaneous recovery can mask the effects of treatment.\u003c/p\u003e\n\u003cp\u003eConcerning TBI, since patients are often unaware of their PM deficits, a combined training, consisting in a compensatory intervention preceded by a self-awareness training has been considered the best option [\u003csup\u003e34,39\u003c/sup\u003e] but the superiority of combined training on compensatory strategy training alone was not confirmed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn additional variable that could affect treatment effectiveness is time since the event, but results are inconsistent: Das Nair et al. [\u003csup\u003e33\u003c/sup\u003e] did not confirm this hypothesis with an heterogeneous sample in terms of clinical and demographic features, while in Leśniak et al. (2018)\u0026rsquo;s study [\u003csup\u003e37\u003c/sup\u003e], a significant improvement between pre- and post-assessment was found only in late recovery (\u0026gt;6 months from ABI).\u003c/p\u003e\n\u003cp\u003eFinally, considering ABI patients in general, severity of memory and executive deficits affects the effectiveness of memory aids; moreover, patients with milder deficits benefited more from the use of Google Calendar than diary [\u003csup\u003e38\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003e3.4.6 PM rehabilitation techniques in nRCT\u003c/p\u003e\n\u003cp\u003eThirteen nRCTs studies focusing on PM rehabilitation were included: seven addressed TBI, five considered stroke and one studied ABI patients in general.\u003c/p\u003e\n\u003cp\u003eConcerning TBI studies, compensatory methods were the preferred approach. Only two studies employed a restorative approach with patients who suffered a TBI at least 1 year before treatment: in detail, Raskin and Sohlberg [\u003csup\u003e47\u003c/sup\u003e] found a significant improvement in intentional memory (Assessment of Intentional Memory - total score), that increased at 1-year follow-up, and a reduction of the total number of PM failures; moreover, there was a generalization to the Everyday Memory Questionnaire (EMQ) and to the efficiency in accomplishing 10 everyday PM tasks that were identified and entered in a diary by the patient and the examiner at the beginning of the training period. The training started after assessing the baseline PM performance that lasted less than 10 minutes for all participants. PM tasks started with a delay of 1 minute longer than the individual patient\u0026rsquo;s baseline, increasing the delay (1 minute at a time) as the subject became skilled at that delay; the sessions lasted 1 hour and were delivered 2 times per week for 6 months. A similar approach was used by Raskin et al. [\u003csup\u003e48\u003c/sup\u003e] with moderate-severe TBI patients, combining visual imagery of events with rote repetition. Even this treatment was effective on memory for future intentions (performance on Memory for Intentions Test - MIST) and the positive effect generalized to attention and executive functions; in addition, like previous results, the use of diaries generalized and EMQ performance improved; all these gains were stable at 1-year assessment.\u003c/p\u003e\n\u003cp\u003eFurther studies on TBI patients, using a compensatory approach, applied various techniques: three studies used external aids, such as an internet-based calendar compared to an internet-based diary training, in which a therapist delivered the cognitive treatment through an online instant messaging system, as a telerehabilitation method [\u003csup\u003e42\u003c/sup\u003e] for a total of 60 sessions; compensatory strategies increased, especially in participants that already used them. In addition, patients\u0026apos; relatives reported improved memory and mood after completion of all sessions.\u003c/p\u003e\n\u003cp\u003eAn internet-based calendar to compensate PM difficulties was used also by Evald [\u003csup\u003e50\u003c/sup\u003e]. The treatment consisted in learning to use a smartphone (Windows Phone - version 7.5) to remember appointments and to compensate for memory difficulties. The treatment lasted 6 weeks, for a total of 9 hours (1 individual session and 5 group sessions). Post-treatment scores at the Prospective Memory Questionnaire (PMQ) and at the Prospective and Retrospective Memory Questionnaire (PRMQ) showed perceived reduced memory deficit. At 2-month follow-up a significant decrease of self-reported memory problems emerged. No effects were found on target behaviors that participants completed at home, on emotional complaints assessed using the Hospital Anxiety and Depression Scale (HADS), or quality of life measured by the World Health Organization Quality-of-Life Scale (WHO-QOL BREF).\u003c/p\u003e\n\u003cp\u003eSimilar compensation of PM deficits with external memory aids was found in Dowds et al. (2011)\u0026rsquo;s study [\u003csup\u003e43\u003c/sup\u003e]. By applying a multiple cross-over design, the authors compared how many time-related personalized tasks were completed in four different conditions, that randomly changed every week for each participant: in a first condition, participants used their spontaneous memory strategies, in a second condition they used a paper-based memory aid and in two additional conditions they used different palmtop computers as PDA memory aids, namely the Palm OS and the Microsoft\u0026rsquo;s Pocket PC OS. The completion of tasks was checked calling back participants to the research Centre whenever a task was accomplished. The PDA Palm version produced better results with respect to the alternative conditions.\u003c/p\u003e\n\u003cp\u003eTwo studies, instead, trained internal strategies, such as errorless learning and metacognitive strategies in a group treatment [\u003csup\u003e52\u003c/sup\u003e]. In detail, participants trained internal memory strategies (I-MEMS), consisting in semantic association, processing and chaining, visual-auditory imagery; however, in this study, additional external memory aids, already used by patients, were continued. This treatment led to an improvement in verbal LTM, with a transfer to everyday memory effectiveness (RBMT-II). The results of the immediate post-treatment assessment were maintained and slightly increased 1 month later, mainly in patients with mild to moderate TBI. Finally, Potvin et al. [\u003csup\u003e46\u003c/sup\u003e] studied the efficacy of visual imagery on PM, carrying out 10 weekly individual rehabilitation sessions (15 hours). PM exercises gradually increased in complexity and ecological aspects, using a spaced-retrieval technique, with the aim of applying visual imagery to everyday situations. Compared to the control group, receiving only a brief educational intervention at the end of the assessment session, patients in the rehabilitation group reached higher total scores on the Ecological Test of PM and made less intrusion errors; moreover, they recalled more actions on the time-based condition, but not on the event-based condition; self-evaluated PM failures seemed fewer at the post-test than at the initial assessment, in accordance with relatives\u0026rsquo; reports on Comprehensive Assessment of Prospective Memory (CAPM). No training transfer effects were detected.\u003c/p\u003e\n\u003cp\u003eConcerning stroke, all nRCT studies applied compensatory strategies. Miller \u0026amp; Radford, [\u003csup\u003e45\u003c/sup\u003e] delivered a mixed treatment, including psychoeducation, internal strategies and external memory aids, in groups of 8-12 participants. There was a significant improvement on learning and delayed recall that continued to improve over the 3-month follow-up. Demographic and clinical variables were relevant: both older age and lower degree of depression were associated with higher probability of completing the training; higher intelligence quotient (IQ) or education increased the number of strategies used; a shorter interval after stroke was related to more gains in PM, while a longer interval was associated to reduced improvement in PM.\u003c/p\u003e\n\u003cp\u003eVirtual reality was also effective on PM abilities [\u003csup\u003e51\u003c/sup\u003e] applying visual imagery strategies to everyday context, as in Potvin et al. (2011)\u0026rsquo;s previously described study on TBI [\u003csup\u003e46\u003c/sup\u003e]. The improvement remained stable after four weeks.\u003c/p\u003e\n\u003cp\u003eIn recent years, telerehabilitation has received increasing attention. Withiel et al., [\u003csup\u003e54\u003c/sup\u003e] investigated the effectiveness of a manualized memory skills group training in four stroke patients (4\u0026ndash;41 months since injury), inspired from a previous training, namely \u0026ldquo;Making the Most of your Memory: An Everyday Memory Skills Program\u0026rdquo;[\u003csup\u003e59\u003c/sup\u003e].\u0026nbsp;The training consisted in six weekly two-hour group sessions of psychoeducation, learning internal and external compensatory strategies, discussion everyday memory issues and homework assignments. In addition, patients\u0026rsquo; family members participated in a separate session. The result was a reduction of memory complaints during the training and participants attaining at least one specific goal after the treatment, maintained at the follow-up (EMQ-R; CAPM). Lawson et al. [\u003csup\u003e44\u003c/sup\u003e] compared a face-to-face individual training with a telehealth delivery condition conducted via Zoom in stroke survivors, recruited at least 3-month from onset. Both treatments were delivered weekly, during a 6-week period, 2-hour per session. The training consisted in a modified version of the Monash Memory Skills Group program [\u003csup\u003e58\u003c/sup\u003e]. They found significant improvements in both groups in Goal Attainment Scaling, with maintenance of gains at six-week follow-up; then, they found a reduction in everyday lapses of PM, although confirmed at follow-up only for the telehealth group. While face-to-face participants demonstrated a constant increase of internal strategies application, patients in the telehealth group showed a significant increase only until the end of the program. In contrast, external strategies did not decrease over time in the two groups. Lawson et al. [\u003csup\u003e44\u003c/sup\u003e] also explored the promising role of booster sessions with a 12-week follow-up in maintaining gains on subjective measures of everyday memory and PM. Considering demographic variables, it is noted that telehealth subjects were younger than those in the face-to-face group.\u003c/p\u003e\n\u003cp\u003eA few years later, Lawson et al. [\u003csup\u003e53\u003c/sup\u003e] proposed the same compensatory memory intervention of telerehabilitation to five chronic stroke patients with mild to moderate memory deficit. All participants reported attaining at least one of the two personally memory-related goals on Goal Attainment Scaling immediately post-training and maintained or improved their level of function in these specific areas at 6-week follow-up assessment. High rates of participant satisfaction and good adherence to treatment were observed.\u003c/p\u003e\n\u003cp\u003eThe last study, by Anaki et al. [\u003csup\u003e49\u003c/sup\u003e] concerned ABI of mixed etiologies (25 TBI and 15 non-TBI, i.e. CVA, anoxia, encephalitis, etc.) selected on average three years after the injury for a holistic and intensive rehabilitation program[\u003csup\u003e60\u003c/sup\u003e]. Internal and external techniques were trained and extended to ecological contexts. Patients are treated several hours per day, 3-4 times a week, for months or years. Training consisted in individual and group interventions, involving many actors: occupational therapists, psychologists, speech therapists, physiotherapists and caregivers. Post-treatment assessment was administered on average four years after the end of the rehabilitation program. Memory performance enhanced in RBMT-II in both the experimental and control groups (the latter received a similar program without specific memory exercises). Furthermore, more intensity produces better outcomes, mostly in non-TBI patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.\u0026nbsp;Meta-analysis results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3.5.1. Characteristics of Included Studies\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 10 randomized controlled trials [\u003csup\u003e33\u0026ndash;37,41,55\u0026ndash;58\u003c/sup\u003e], involving 477 participants, met all the inclusion criteria and were included in the quantitative synthesis. The studies utilized a variety of intervention approaches, encompassing compensatory strategies (e.g., the utilization of memory aids, metacognitive training) and restitutive methods (e.g., computerized cognitive rehabilitation, virtual reality). The assessment of prospective memory involved the use of various validated instruments, including the EMQ, CAMPROMPT, RBMT, and PRMQ.\u003c/p\u003e\n\u003cp\u003e3.5.2. Main Effects of Rehabilitation on Prospective Memory\u003c/p\u003e\n\u003cp\u003eThe pooled analysis revealed a statistically significant moderate effect of cognitive rehabilitation on PM outcomes in individuals with ABI. Specifically, the mean effect size was Hedges\u0026apos; g = 0.55, with a 95% confidence interval ranging from 0.29 to 0.80. The result obtained corresponds to a Z-value of 4.20 (p \u0026lt; .001), thereby indicating a robust deviation from the null hypothesis that rehabilitation has no benefit over control conditions (see Figure 2: Forest plot of PM effect size).\u003c/p\u003e\n\u003cp\u003e3.5.3. Heterogeneity and Prediction Interval\u003c/p\u003e\n\u003cp\u003eThe analysis identified moderate heterogeneity across studies. The Q-statistic was 16.73 with 9 degrees of freedom (p = 0.05), and the I\u0026sup2; statistic was 46%, suggesting that nearly half of the variance in observed effects is attributable to true between-study differences rather than sampling error.\u003c/p\u003e\n\u003cp\u003eAssuming a normal distribution of the true effects, the 95% prediction interval ranged from \u0026ndash;0.15 to 1.26, implying that while the average effect is beneficial, future studies may observe effects ranging from negligible to large, depending on context and implementation.\u003c/p\u003e\n\u003cp\u003e3.5.4. Publication Bias and Sensitivity Analyses\u003c/p\u003e\n\u003cp\u003eMultiple indicators pointed to the possible presence of publication bias. Egger\u0026rsquo;s regression test yielded an intercept of 2.98 (p = 0.040), suggesting asymmetry in the funnel plot (Figure 3) and a tendency for smaller studies to report larger effect sizes. The classic fail-safe N was calculated at 76, indicating that 76 unpublished null studies would be required to overturn the statistical significance of the observed effect publication bias report. Using the Trim and Fill method, three studies were imputed to the left of the mean (see Figure 3), yielding an adjusted effect size of Hedges\u0026rsquo; g = 0.347 (95% CI: 0.054, 0.640) under a random-effects model. This adjustment reduced the pooled estimate but preserved statistical significance, affirming the overall robustness of the findings.\u003c/p\u003e\n\u003cp\u003eThe certainty of the evidence was evaluated by considering factors such as the risk of bias, inconsistency, indirectness, imprecision, and publication bias. The GRADE assessment for PM outcomes was rated as moderate, primarily due to concerns regarding blinding (Table 2).\u003c/p\u003e\n\u003cp\u003eWhile moderator analyses could have offered valuable insights into the differential impact of intervention types or outcome measures, the limited number of included studies did not permit their reliable execution. As a result, planned exploratory comparisons\u0026mdash;such as those contrasting compensatory versus restitutive approaches, or performance-based versus self-reported measures of prospective memory\u0026mdash;were not pursued in the present analysis.\u003c/p\u003e\n\u003cp\u003e\u0026mdash;Insert Figure 2 and Figure 3, about here\u0026mdash;\u003c/p\u003e\n\u003cp\u003e\u0026mdash;Insert Table 2 about here\u0026mdash;\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eWe systematically reviewed the literature on the effectiveness of PM rehabilitation, in adult patients after stroke or TBI. Very few additional different etiologies (such as infective diseases) were considered. We did not include patients with epilepsy (see Joplin et al.\u003csup\u003e61\u003c/sup\u003e for a review on memory rehabilitation in this group of patients), multiple sclerosis (see Mazo et al.\u003csup\u003e62\u003c/sup\u003e, although limited to WM), and neurodegenerative diseases. More specifically, we were interested in highlighting whether new treatments, such as NIBS, virtual reality or computer-based rehabilitation are employed with success in combination or alone, compared to more \u0026ldquo;traditional\u0026rdquo; techniques (a summary of the different techniques adopted in the reviewed studies can be found in Table 3). We evaluated the methodology of studies, the outcomes, the level of generalization and maintenance over time. Furthermore, we verified the effects of demographic variables on results. Finally, we performed a meta-analysis on the effects of treatment on PM, and we also assessed the level of evidence with the GRADE methodology for RCT studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026mdash;insert Table 3 about here\u0026mdash;\u003c/p\u003e\n\u003cp\u003eBefore discussing the results, it is important to outline several limitations of the reviewed articles.\u003c/p\u003e\n\u003cp\u003eFirst, terminology is inconsistent across studies: long-term memory (LTM) tests have been used both for baseline and outcome assessments, even though the primary target of training is prospective memory (PM).\u003c/p\u003e\n\u003cp\u003eSecond, patients with mixed etiologies are often grouped together, which hinders the ability to analyze the effects of specific etiologies. This is a significant limitation, as recently highlighted in a voxel-based lesion-symptom mapping study[\u003csup\u003e63\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003eThird, neuropsychological batteries and outcome measures vary widely. In many cases, it appears that parallel forms of the tests were not used, and outcomes were not evaluated by independent, blinded examiners.\u003c/p\u003e\n\u003cp\u003eFourth, we identified a limited number of studies comparing paper-and-pencil aids with digital tools, and, unexpectedly, none of these employed non-invasive brain stimulation (NIBS). This can be partially explained by the fact that most structures involved in memory systems are not reachable for stimulation. However, PM deficits could possibly benefit from NIBS applied over the dorsolateral prefrontal cortex[\u003csup\u003e64\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003eFinally, outcome measures related to everyday functioning are typically based on scales or questionnaires, which are rarely reported in detail (see for instance\u003csup\u003e33,37,48,57\u003c/sup\u003e).\u003c/p\u003e\n\u003cp\u003eWe included 14 RCT. Both, restorative and compensation treatments were used, balanced between individual and group treatment, or both. Computer rehabilitation training programs were applied, as well as virtual reality programs (see for example Yip \u0026amp; Man\u003csup\u003e41\u003c/sup\u003e) or technical devices of which the most fruitful appeared to be Google Calendar\u003csup\u003e38\u003c/sup\u003e. It must be noted, however, that this study received a PEDro score \u0026lt;6 and high risk of selection, performance, detection and reporting bias according to the Cochrane scale, therefore the results must be considered with caution. Individual vs. group treatment does not seem to produce significant differences but, again, the observation is speculative and limited by the scarce number of confrontations. Similarly, when asked, caregivers reported a decrease of memory failure, but data are limited to two studies\u003csup\u003e33,35\u003c/sup\u003e. Also in these cases, the meta-analysis revealed a positive effect of treatment but, again, given the limited number of studies, we did not differentiate among treatments. Moreover, the level of improvement was very different, ranging from very mild effects to moderate ones. More studies are required to confirm these results. However, the level of evidence as assessed with the GRADE methodology, was moderate.\u003c/p\u003e\n\u003cp\u003eInformation about maintenance is scarce. A follow-up to a maximum of 12 months has been conducted only in seven RCTs. There was limited evidence that age affects recovery when the etiology is stroke\u003csup\u003e32\u003c/sup\u003e while time since TBI did not prove to affect treatment.\u003c/p\u003e\n\u003cp\u003eFinally, we considered a group of five studies treating both WM and PM. Four of these were RCTs and, among them, three studies employed restitution-oriented therapies while the remaining one compared restorative vs. compensatory methods. The nRCT study used compensatory methods instead. No clear results were obtained, nor was evidence of transfer assessed with ecological measures. Improvements were maintained only for WM.\u003c/p\u003e\n\u003cp\u003eThe results of the meta-analysis, however, are encouraging and suggest that, at least in the case of PM, rehabilitation should be recommended, but more evidence is required to confirm this positive result, and it would be relevant to differentiate the outcomes of different treatments.\u003c/p\u003e\n\u003cp\u003e4.4. Limitations of this review\u003c/p\u003e\n\u003cp\u003eWe must acknowledge the limitations of this review that were in part due, as reported, to the number and quality of the examined studies.\u003c/p\u003e\n\u003cp\u003eStandardized tests were not always used and differed in almost every study. Techniques are highly variable, as well as the software employed. The review was limited to studies published in English.\u003c/p\u003e\n\u003cp\u003e4.5. Directions of future research\u003c/p\u003e\n\u003cp\u003eSumming up, our findings add new data to the existing literature, including new techniques such as Virtual Reality. Moreover, with respect to previous reviews, we did not focus only on traumatic brain injuries. The level of evidence was assessed using the GRADE methodology.\u003c/p\u003e\n\u003cp\u003eFinally, we suggest directions for future research. Namely, the selection of patients should be more homogeneous concerning the demographic variables: for example, in many studies participants ranged between 18 and 70 years, and this could have affected the use of new technologies, in which younger people are certainly more familiar; younger people can be more motivated than older people; the cerebrovascular response to cognitive stimulation differs depending on age\u003csup\u003e65\u003c/sup\u003e. Etiology must be considered, ecological outcomes should be constantly evaluated: too frequently, the success of a treatment is based on the test score even when no parallel forms of the same test are adopted. Another crucial point is to have an examiner assessing the post-treatment performance, different from the person who conducted the treatment; this is not specified in most of the papers we analyzed, and this was not considered in previous reviews.\u003c/p\u003e\n\u003cp\u003eA final remark is that the treatment of PM is still very tentative due to the lack of systematic studies. Probably, memory treatment could benefit from a multicentric consortium of memory centers, employing comparable assessment methods, treatment techniques and specific outcome evaluation, distinguishing patients with different etiology and demographic variables. Only in this way, enough homogeneous patients can be recruited to develop effective guidelines for the treatment of such a disabling deficit.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis work was supported by a grant from the Italian Ministry of Health (RF 19) to CP.\u003c/p\u003e\u003cp\u003eCompeting Interests: The authors declare no competing financial or non-financial interests.\u003c/p\u003e\u003cp\u003eData Availability: This study is a systematic review and meta-analysis. The data analyzed were extracted from previously published studies. As such, the original data are not owned by the authors. However, the dataset compiled and used for the meta-analysis is available from the corresponding author upon reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.S., L.B., E.B., E.Ba., S.T., and L.Z. conceived the study and developed the review and meta-analysis protocol. All authors participated at different stages in literature screening and data extraction. M.S., L.B., E.B., E.Ba., S.T., and L.Z. conducted data extraction and quality assessment for the systematic review and contributed to the preparation of all tables, except those related to the meta-analysis. M.B. performed data extraction for the meta-analysis, carried out all statistical analyses, and produced the corresponding figures and tables. C.P. supervised the project, drafted the manuscript, and revised its final version. All authors contributed to data interpretation, critically reviewed the manuscript, and approved the final version for submission.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThis study is a systematic review and meta-analysis. The data analyzed were extracted from previously published studies. As such, the original data are not owned by the authors. However, the dataset compiled and used for the meta-analysis is available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVakil, E. The Effect of Moderate to Severe Traumatic Brain Injury (TBI) on Different Aspects of Memory:A Selective Review. \u003cem\u003eJ. Clin. Exp. Neuropsychol.\u003c/em\u003e \u003cstrong\u003e27\u003c/strong\u003e, 977\u0026ndash;1021 (2005).\u003c/li\u003e\n\u003cli\u003eSchaapsmeerders, P. \u003cem\u003eet al.\u003c/em\u003e Long-Term Cognitive Impairment After First-Ever Ischemic Stroke in Young Adults. \u003cem\u003eStroke\u003c/em\u003e \u003cstrong\u003e44\u003c/strong\u003e, 1621\u0026ndash;1628 (2013).\u003c/li\u003e\n\u003cli\u003eWilson, B. A. Cognitive rehabilitation in the 21st century. \u003cem\u003eNeurorehabil. Neural Repair\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 207\u0026ndash;210 (2002).\u003c/li\u003e\n\u003cli\u003eRees, L. \u003cem\u003eet al.\u003c/em\u003e Cognitive interventions post acquired brain injury. \u003cem\u003eBrain Inj.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 161\u0026ndash;200 (2007).\u003c/li\u003e\n\u003cli\u003eVelikonja, D. \u003cem\u003eet al.\u003c/em\u003e INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part V: Memory. \u003cem\u003eJ. Head Trauma Rehabil.\u003c/em\u003e \u003cstrong\u003e29\u003c/strong\u003e, 369\u0026ndash;386 (2014).\u003c/li\u003e\n\u003cli\u003eMahan, S., Rous, R. \u0026amp; Adlam, A. Systematic Review of Neuropsychological Rehabilitation for Prospective Memory Deficits as a Consequence of Acquired Brain Injury. \u003cem\u003eJ. Int. Neuropsychol. Soc. JINS\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 254\u0026ndash;265 (2017).\u003c/li\u003e\n\u003cli\u003eCicerone, K. D. \u003cem\u003eet al.\u003c/em\u003e Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. \u003cem\u003eArch. Phys. Med. Rehabil.\u003c/em\u003e \u003cstrong\u003e100\u003c/strong\u003e, 1515\u0026ndash;1533 (2019).\u003c/li\u003e\n\u003cli\u003eHudes, R. \u003cem\u003eet al.\u003c/em\u003e Evaluating the effectiveness of compensatory memory interventions in adults with acquired brain injury: A systematic review and meta-analysis of memory and everyday outcomes. \u003cem\u003eNeuropsychology\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 243\u0026ndash;265 (2022).\u003c/li\u003e\n\u003cli\u003eVelikonja, D. \u003cem\u003eet al.\u003c/em\u003e INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory. \u003cem\u003eJ. Head Trauma Rehabil.\u003c/em\u003e \u003cstrong\u003e38\u003c/strong\u003e, 83\u0026ndash;102 (2023).\u003c/li\u003e\n\u003cli\u003eLambez, B. \u0026amp; Vakil, E. The effectiveness of memory remediation strategies after traumatic brain injury: Systematic review and meta-analysis. \u003cem\u003eAnn. Phys. Rehabil. Med.\u003c/em\u003e \u003cstrong\u003e64\u003c/strong\u003e, 101530 (2021).\u003c/li\u003e\n\u003cli\u003eElliott, M. \u0026amp; Parente, F. Efficacy of memory rehabilitation therapy: a meta-analysis of TBI and stroke cognitive rehabilitation literature. \u003cem\u003eBrain Inj.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 1610\u0026ndash;1616 (2014).\u003c/li\u003e\n\u003cli\u003eSpreij, L. A., Visser-Meily, J. M. A., van Heugten, C. M. \u0026amp; Nijboer, T. C. W. Novel insights into the rehabilitation of memory post acquired brain injury: a systematic review. \u003cem\u003eFront. Hum. Neurosci.\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, 993 (2014).\u003c/li\u003e\n\u003cli\u003eTse, Z. C. K. \u003cem\u003eet al.\u003c/em\u003e Prospective Memory Training in Older Adults: A Systematic Review and Meta-Analysis. \u003cem\u003eNeuropsychol. Rev.\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 347\u0026ndash;372 (2023).\u003c/li\u003e\n\u003cli\u003eJones, W., Benge, J. \u0026amp; Scullin, M. Preserving Prospective Memory in Daily Life: A Systematic Review and Meta-Analysis of Mnemonic Strategy, Cognitive Training, External Memory Aid, and Combination Interventions. \u003cem\u003eNEUROPSYCHOLOGY\u003c/em\u003e \u003cstrong\u003e35\u003c/strong\u003e, 123\u0026ndash;140 (2021).\u003c/li\u003e\n\u003cli\u003eHara, T., Shanmugalingam, A., McIntyre, A. \u0026amp; Burhan, A. M. The effect of non-invasive brain stimulation (Nibs) on attention and memory function in stroke rehabilitation patients: A systematic review and meta-analysis. \u003cem\u003eDiagnostics\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, (2021).\u003c/li\u003e\n\u003cli\u003eHara, T., Shanmugalingam, A., McIntyre, A. \u0026amp; Burhan, A. The Effect of Non-Invasive Brain Stimulation (NIBS) on Executive Functioning, Attention and Memory in Rehabilitation Patients with Traumatic Brain Injury: A Systematic Review. \u003cem\u003eDIAGNOSTICS\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, (2021).\u003c/li\u003e\n\u003cli\u003eMoher, D. \u003cem\u003eet al.\u003c/em\u003e Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. \u003cem\u003eSyst. Rev.\u003c/em\u003e \u003cstrong\u003e4\u003c/strong\u003e, 1 (2015).\u003c/li\u003e\n\u003cli\u003eOuzzani, M., Hammady, H., Fedorowicz, Z. \u0026amp; Elmagarmid, A. Rayyan-a web and mobile app for systematic reviews. \u003cem\u003eSyst. Rev.\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 210 (2016).\u003c/li\u003e\n\u003cli\u003eHiggins, J. P. T. \u003cem\u003eet al.\u003c/em\u003e The Cochrane Collaboration\u0026rsquo;s tool for assessing risk of bias in randomised trials. \u003cem\u003eBMJ\u003c/em\u003e \u003cstrong\u003e343\u003c/strong\u003e, d5928 (2011).\u003c/li\u003e\n\u003cli\u003eSackett, D. L. \u003cem\u003eet al.\u003c/em\u003e \u003cem\u003eEvidence-Based Medicine: How to Practice and Teach EBM\u003c/em\u003e. (Churchill Livingstone, 2000).\u003c/li\u003e\n\u003cli\u003eMoseley, A. M., Herbert, R. D., Sherrington, C. \u0026amp; Maher, C. G. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). \u003cem\u003eAust. J. Physiother.\u003c/em\u003e \u003cstrong\u003e48\u003c/strong\u003e, 43\u0026ndash;49 (2002).\u003c/li\u003e\n\u003cli\u003eBucur, M. \u0026amp; Papagno, C. A systematic review of noninvasive brain stimulation for post-stroke depression. \u003cem\u003eJ. Affect. Disord.\u003c/em\u003e \u003cstrong\u003e238\u003c/strong\u003e, 69\u0026ndash;78 (2018).\u003c/li\u003e\n\u003cli\u003eBucur, M. \u0026amp; Papagno, C. Are transcranial brain stimulation effects long-lasting in post-stroke aphasia? A comparative systematic review and meta-analysis on naming performance. \u003cem\u003eNeurosci. Biobehav. Rev.\u003c/em\u003e \u003cstrong\u003e102\u003c/strong\u003e, 264\u0026ndash;289 (2019).\u003c/li\u003e\n\u003cli\u003eda Silva, F. C. \u003cem\u003eet al.\u003c/em\u003e Effects of physical exercise programs on cognitive function in Parkinson\u0026rsquo;s disease patients: A systematic review of randomized controlled trials of the last 10 years. \u003cem\u003ePLoS ONE\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, e0193113 (2018).\u003c/li\u003e\n\u003cli\u003eAlashram, A. R., Annino, G., Padua, E., Romagnoli, C. \u0026amp; Mercuri, N. B. Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology. \u003cem\u003eJ. Clin. Neurosci. Off. J. Neurosurg. Soc. Australas.\u003c/em\u003e \u003cstrong\u003e66\u003c/strong\u003e, 209\u0026ndash;219 (2019).\u003c/li\u003e\n\u003cli\u003eSherrington, C., Herbert, R. D., Maher, C. G. \u0026amp; Moseley, A. M. PEDro. A database of randomized trials and systematic reviews in physiotherapy. \u003cem\u003eMan. Ther.\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 223\u0026ndash;226 (2000).\u003c/li\u003e\n\u003cli\u003eWollesen, B., Wildbredt, A., Schooten, K. V. van, Lim, M. \u0026amp; Delbaere, K. The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis. \u003cem\u003eEur. Rev. Aging Phys. Act.\u003c/em\u003e (2020) doi:10.1186/s11556-020-00240-y.\u003c/li\u003e\n\u003cli\u003eFoley, N. C., Teasell, R. W., Bhogal, S. K. \u0026amp; Speechley, M. R. Stroke Rehabilitation Evidence-Based Review: methodology. \u003cem\u003eTop. Stroke Rehabil.\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 1\u0026ndash;7 (2003).\u003c/li\u003e\n\u003cli\u003eStraus, S. E., Glasziou, P., Richardson, W. S. \u0026amp; Haynes, R. B. \u003cem\u003eEvidence-Based Medicine: Evidence-Based Medicine E-Book\u003c/em\u003e. (Elsevier Health Sciences, 2018).\u003c/li\u003e\n\u003cli\u003eBorenstein, M., Hedges, L., Higgins, J. \u0026amp; Rothstein, H. Comprehensive Meta‐Analysis Software. in 425\u0026ndash;441 (2021). doi:10.1002/9781119558378.ch49.\u003c/li\u003e\n\u003cli\u003eDuval, S. \u0026amp; Tweedie, R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. \u003cem\u003eBiometrics\u003c/em\u003e \u003cstrong\u003e56\u003c/strong\u003e, 455\u0026ndash;463 (2000).\u003c/li\u003e\n\u003cli\u003eAben, L., Heijenbrok-Kal, M. H., Ponds, R. W. H. M., Busschbach, J. J. V. \u0026amp; Ribbers, G. M. Long-lasting effects of a new memory self-efficacy training for stroke patients: a randomized controlled trial. \u003cem\u003eNeurorehabil. Neural Repair\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 199\u0026ndash;206 (2014).\u003c/li\u003e\n\u003cli\u003edas Nair, R. \u003cem\u003eet al.\u003c/em\u003e Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial. \u003cem\u003eClin. Rehabil.\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 1171\u0026ndash;1184 (2019).\u003c/li\u003e\n\u003cli\u003eFleming, J. \u003cem\u003eet al.\u003c/em\u003e Efficacy of Prospective Memory Rehabilitation Plus Metacognitive Skills Training for Adults With Traumatic Brain Injury: A Randomized Controlled Trial. \u003cem\u003eNeurorehabil. Neural Repair\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 487\u0026ndash;499 (2022).\u003c/li\u003e\n\u003cli\u003eLannin, N. \u003cem\u003eet al.\u003c/em\u003e A randomized controlled trial of the effectiveness of handheld computers for improving everyday memory functioning in patients with memory impairments after acquired brain injury. \u003cem\u003eClin. Rehabil.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 470\u0026ndash;481 (2014).\u003c/li\u003e\n\u003cli\u003eLemoncello, R., Sohlberg, M. M., Fickas, S. \u0026amp; Prideaux, J. A randomised controlled crossover trial evaluating Television Assisted Prompting (TAP) for adults with acquired brain injury. \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 825\u0026ndash;846 (2011).\u003c/li\u003e\n\u003cli\u003eLeśniak, M. M., Mazurkiewicz, P., Iwański, S., Szutkowska-Hoser, J. \u0026amp; Seni\u0026oacute;w, J. Effects of group versus individual therapy for patients with memory disorder after an acquired brain injury: A randomized, controlled study. \u003cem\u003eJ. Clin. Exp. Neuropsychol.\u003c/em\u003e \u003cstrong\u003e40\u003c/strong\u003e, 853\u0026ndash;864 (2018).\u003c/li\u003e\n\u003cli\u003eMcDonald, A. \u003cem\u003eet al.\u003c/em\u003e Google Calendar: a new memory aid to compensate for prospective memory deficits following acquired brain injury. \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 784\u0026ndash;807 (2011).\u003c/li\u003e\n\u003cli\u003eShum, D., Fleming, J., Gill, H., Gullo, M. J. \u0026amp; Strong, J. A randomized controlled trial of prospective memory rehabilitation in adults with traumatic brain injury. \u003cem\u003eJ. Rehabil. Med.\u003c/em\u003e \u003cstrong\u003e43\u003c/strong\u003e, 216\u0026ndash;223 (2011).\u003c/li\u003e\n\u003cli\u003eStorzbach, D. \u003cem\u003eet al.\u003c/em\u003e Compensatory Cognitive Training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans With Mild Traumatic Brain Injury. \u003cem\u003eJ. Head Trauma Rehabil.\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 16\u0026ndash;24 (2017).\u003c/li\u003e\n\u003cli\u003eYip, B. C. B. \u0026amp; Man, D. W. K. Virtual reality-based prospective memory training program for people with acquired brain injury. \u003cem\u003eNeuroRehabilitation\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 103\u0026ndash;115 (2013).\u003c/li\u003e\n\u003cli\u003eBergquist, T. \u003cem\u003eet al.\u003c/em\u003e The effect of internet-based cognitive rehabilitation in persons with memory impairments after severe traumatic brain injury. \u003cem\u003eBrain Inj.\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 790\u0026ndash;799 (2009).\u003c/li\u003e\n\u003cli\u003eDowds, M. M. \u003cem\u003eet al.\u003c/em\u003e Electronic reminding technology following traumatic brain injury: effects on timely task completion. \u003cem\u003eJ. Head Trauma Rehabil.\u003c/em\u003e \u003cstrong\u003e26\u003c/strong\u003e, 339\u0026ndash;347 (2011).\u003c/li\u003e\n\u003cli\u003eLawson, D. W. \u003cem\u003eet al.\u003c/em\u003e Telehealth Delivery of Memory Rehabilitation Following Stroke. \u003cem\u003eJ. Int. Neuropsychol. Soc. JINS\u003c/em\u003e \u003cstrong\u003e26\u003c/strong\u003e, 58\u0026ndash;71 (2020).\u003c/li\u003e\n\u003cli\u003eMiller, L. A. \u0026amp; Radford, K. Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients. \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 721\u0026ndash;737 (2014).\u003c/li\u003e\n\u003cli\u003ePotvin, M.-J., Rouleau, I., S\u0026eacute;n\u0026eacute;chal, G. \u0026amp; Gigu\u0026egrave;re, J.-F. Prospective memory rehabilitation based on visual imagery techniques. \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 899\u0026ndash;924 (2011).\u003c/li\u003e\n\u003cli\u003eRaskin, S. A. \u0026amp; Sohlberg, M. M. Prospective memory intervention: A review and evaluation of a pilot restorative intervention. \u003cem\u003eBrain Impair.\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 76\u0026ndash;86 (2009).\u003c/li\u003e\n\u003cli\u003eRaskin, S. A., Smith, M. P., Mills, G., Pedro, C. \u0026amp; Zamroziewicz, M. Prospective memory intervention using visual imagery in individuals with brain injury. \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e \u003cstrong\u003e29\u003c/strong\u003e, 289\u0026ndash;304 (2019).\u003c/li\u003e\n\u003cli\u003eAnaki, D., Devisheim, H., Goldenberg, R. \u0026amp; Feuerstein, R. Long-Term Effects of Intensive Rehabilitation on Memory Functions in Acquired Brain-Damaged Patients. \u003cem\u003eArch. Clin. Neuropsychol. Off. J. Natl. Acad. Neuropsychol.\u003c/em\u003e \u003cstrong\u003e39\u003c/strong\u003e, 1398\u0026ndash;1407 (2024).\u003c/li\u003e\n\u003cli\u003eEvald, L. Prospective memory rehabilitation using smartphones in patients with TBI. \u003cem\u003eDisabil. Rehabil.\u003c/em\u003e \u003cstrong\u003e40\u003c/strong\u003e, 2250\u0026ndash;2259 (2018).\u003c/li\u003e\n\u003cli\u003eMitrovic, A., Mathews, M., Ohlsson, S., Holland, J. \u0026amp; McKinlay, A. Computer-based post-stroke rehabilitation of prospective memory. \u003cem\u003eJ. Appl. Res. Mem. Cogn.\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 204\u0026ndash;214 (2016).\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Neil-Pirozzi, T. M. \u003cem\u003eet al.\u003c/em\u003e A controlled treatment study of internal memory strategies (I-MEMS) following traumatic brain injury. \u003cem\u003eJ. Head Trauma Rehabil.\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 43\u0026ndash;51 (2010).\u003c/li\u003e\n\u003cli\u003eLawson DW, Stolwyk RJ, Ponsford JL, \u0026amp; Wong D. Evaluating telehealth delivery of a compensatory memory rehabilitation programme following stroke: A single-case experimental design. \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 897\u0026ndash;921 (2022).\u003c/li\u003e\n\u003cli\u003eWithiel, T. D., Stolwyk, R. J., Ponsford, J. L., Cadilhac, D. A. \u0026amp; Wong, D. Effectiveness of a manualised group training intervention for memory dysfunction following stroke: a series of single case studies. \u003cem\u003eDisabil. Rehabil.\u003c/em\u003e \u003cstrong\u003e42\u003c/strong\u003e, 3033\u0026ndash;3042 (2020).\u003c/li\u003e\n\u003cli\u003eHildebrandt, H., Gehrmann, A., Modden, C. \u0026amp; Eling, P. Enhancing memory performance after organic brain disease relies on retrieval processes rather than encoding or consolidation. \u003cem\u003eJ. Clin. Exp. Neuropsychol.\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 257\u0026ndash;270 (2011).\u003c/li\u003e\n\u003cli\u003eRichter, K. M., M\u0026ouml;dden, C., Eling, P. \u0026amp; Hildebrandt, H. Working memory training and semantic structuring improves remembering future events, not past events. \u003cem\u003eNeurorehabil. Neural Repair\u003c/em\u003e \u003cstrong\u003e29\u003c/strong\u003e, 33\u0026ndash;40 (2015).\u003c/li\u003e\n\u003cli\u003eRichter, K. M., M\u0026ouml;dden, C., Eling, P. \u0026amp; Hildebrandt, H. Improving everyday memory performance after acquired brain injury: An RCT on recollection and working memory training. \u003cem\u003eNeuropsychology\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 586\u0026ndash;596 (2018).\u003c/li\u003e\n\u003cli\u003eWithiel, T. D. \u003cem\u003eet al.\u003c/em\u003e Comparing memory group training and computerized cognitive training for improving memory function following stroke: A phase II randomized controlled trial. \u003cem\u003eJ. Rehabil. Med.\u003c/em\u003e \u003cstrong\u003e51\u003c/strong\u003e, 343\u0026ndash;351 (2019).\u003c/li\u003e\n\u003cli\u003eRadford, K., Say, M. J., Thayer, Z. \u0026amp; Miller, L. A. \u003cem\u003eMaking the Most of Your Memory: An Everyday Memory Skills Program.\u003c/em\u003e (Sydney: ASSBI Resources., 2010).\u003c/li\u003e\n\u003cli\u003eDorfzaun-Harif, I. \u003cem\u003eet al.\u003c/em\u003e An innovative model for the dynamic neurocognitive rehabilitation for individuals with acquired brain injury. \u003cem\u003eTransylvanian Journal of Psychology\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 3\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eJoplin, S., Stewart, E., Gascoigne, M. \u0026amp; Lah, S. Memory Rehabilitation in Patients with Epilepsy: a Systematic Review. \u003cem\u003eNeuropsychol. Rev.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 88\u0026ndash;110 (2018).\u003c/li\u003e\n\u003cli\u003eMazo, G. \u003cem\u003eet al.\u003c/em\u003e Rehabilitation of working memory after acquired brain injury and multiple sclerosis: A systematic review. \u003cem\u003eNeuropsychol. Rehabil.\u003c/em\u003e \u003cstrong\u003e35\u003c/strong\u003e, 92\u0026ndash;130 (2025).\u003c/li\u003e\n\u003cli\u003evan Grinsven, E. E. \u003cem\u003eet al.\u003c/em\u003e The impact of etiology in lesion-symptom mapping - A direct comparison between tumor and stroke. \u003cem\u003eNeuroImage Clin.\u003c/em\u003e \u003cstrong\u003e37\u003c/strong\u003e, 103305 (2023).\u003c/li\u003e\n\u003cli\u003eVarastegan, S. \u003cem\u003eet al.\u003c/em\u003e Remember NIBS? tACS improves memory performance in elders with subjective memory complaints. \u003cem\u003eGeroScience\u003c/em\u003e \u003cstrong\u003e45\u003c/strong\u003e, 851\u0026ndash;869 (2023).\u003c/li\u003e\n\u003cli\u003eBeishon, L. C. \u003cem\u003eet al.\u003c/em\u003e Age-related differences in cerebrovascular responses to cognitive stimulation using a novel method. \u003cem\u003eNeuropsychol. Dev. Cogn. B Aging Neuropsychol. Cogn.\u003c/em\u003e\u003cstrong\u003e29\u003c/strong\u003e, 929\u0026ndash;942 (2022)\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prospective Memory, Neuropsychological Rehabilitation, Memory, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-7113515/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7113515/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eProspective memory (PM) - the ability to remember to carry out intended activities - is often impaired following acquired brain injury (ABI), yet its rehabilitation remains challenging. WE conducted a systematic review and meta-analysis to evaluate the effectiveness, durability, and real-life impact of PM interventions in adults with non-progressive ABI. Following PRISMA guidelines, five databases were searched for studies published between January 2008 and December 2024. Twenty-seven studies met inclusion criteria, including 14 randomized controlled trials (RCTs), seven non-randomized trials, four pre-post studies, and two case series. Ten RCTs were included in the meta-analysis. Interventions encompassed compensatory strategies (e.g., memory aids, metacognitive training) and restitutive methods (e.g., computerized training, virtual reality). PM outcomes were measured using validated tools such as the Cambridge Prospective Memory Test and Rivermead Behavioural Memory Test. The pooled analysis showed a moderate, statistically significant effect of rehabilitation on PM performance. However, evidence for long-term maintenance and generalization to daily life was limited. Risk of bias was assessed with the Cochrane tool, and overall evidence quality was rated moderate using GRADE. These findings support the clinical value of cognitive rehabilitation for PM deficits after ABI, while highlighting the need for more consistent methodologies and long-term outcome data.\u003c/p\u003e","manuscriptTitle":"Remembering to Remember: A Systematic Review and Meta-Analysis on Prospective Memory Rehabilitation in Adults with Acquired Brain Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 11:41:49","doi":"10.21203/rs.3.rs-7113515/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-14T02:34:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-25T15:36:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3653767887613006509785284243254913578","date":"2025-09-17T13:14:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329020417461605443862987381536898556443","date":"2025-09-17T02:51:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284417763553755300677500202751727293700","date":"2025-08-27T06:37:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169444374322642821860066293170806923890","date":"2025-08-25T06:29:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-24T10:06:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247665994311866378079785836072471651401","date":"2025-08-14T18:27:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140889626418974695939647553777544080051","date":"2025-07-28T11:49:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"160307215945201738672520251904108387105","date":"2025-07-23T00:49:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-22T18:49:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-22T18:38:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-22T13:16:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-17T06:00:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-07-17T05:56:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"82223935-39a6-4313-817b-6f7c66af67ef","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":51976537,"name":"Health sciences/Health care"},{"id":51976538,"name":"Health sciences/Medical research"},{"id":51976539,"name":"Health sciences/Neurology"},{"id":51976540,"name":"Biological sciences/Neuroscience"},{"id":51976541,"name":"Biological sciences/Psychology"},{"id":51976542,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-01-19T16:46:24+00:00","versionOfRecord":{"articleIdentity":"rs-7113515","link":"https://doi.org/10.1038/s41598-025-29423-2","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-01-14 16:29:06","publishedOnDateReadable":"January 14th, 2026"},"versionCreatedAt":"2025-07-25 11:41:49","video":"","vorDoi":"10.1038/s41598-025-29423-2","vorDoiUrl":"https://doi.org/10.1038/s41598-025-29423-2","workflowStages":[]},"version":"v1","identity":"rs-7113515","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7113515","identity":"rs-7113515","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}