Real-World Outcomes of a Telephone-Based Virtual Cognitive Rehabilitation Therapy Program: A Retrospective Cohort Analysis
- 1Moneta Health
Abstract
BackgroundCognitive rehabilitation (CR) is an established behavioral intervention that improves daily functioning for individuals with mild cognitive impairment (MCI) and early-stage dementia. Traditional models of in-person delivery limit access, particularly for individuals living in rural areas. This study evaluated the effectiveness of a novel fully remote, telephone-based CR model combining speech-language pathologist (SLP)-led sessions and automated voice-agent based cognitive exercise sessions.
MethodsWe conducted a retrospective observational analysis of 141 older adults referred for CR who completed treatment to discharge (58% female; mean age 71.2 {+/-} 10.8 years; MCI diagnosis rate 61.7%, dementia diagnosis rate 29.1%; Montreal Cognitive Assessment mean score 21.1 {+/-} 4.0). Changes in four outcome measures from initiation of treatment to discharge were evaluated for statistical significance: quality of life and three therapist-rated Functional Communication Measures (FCMs) of overall cognition, language expression, and language comprehension. Changes were compared to FCM averages from the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA NOMS). Models were developed to predict changes in outcome measures based on patient demographics, clinical status, program engagement and treating therapist.
ResultsAll four outcomes improved significantly over the course of treatment (p<0.05), with medium to very large effect sizes. Mean changes in FCM outcomes exceeded comparable ASHA NOMS benchmarks for in-person outpatient care. A majority of patients saw an improvement in each clinical outcome measure. Models with meaningful predictive power were identified for changes in overall cognition and language expression, and a statistically significant but weak model was identified for quality of life. No predictive model was identified for spoken language comprehension. Baseline cognitive function was the most influential and negatively correlated predictor of an improvement in overall cognitive abilities and language expression. Baseline quality of life was the dominant and negatively correlated predictor of improvement in quality of life.
ConclusionsTelephone-based virtual CR led by SLPs with automated exercises delivered by a voice agent produced clinically meaningful gains, with functional gains comparable to external benchmarks for in-person clinical practice. These results support the use of virtual CR within post-diagnostic care for older adults experiencing cognitive impairment, with greater benefit observed among patients with greater baseline impairment. These results support the expanded use of virtual CR particularly for patients in rural or underserved communities.
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BibTeX
@misc{flexman2026realworld,
title = {{Real-World Outcomes of a Telephone-Based Virtual Cognitive Rehabilitation Therapy Program: A Retrospective Cohort Analysis}},
author = {J. A. Flexman and J. Ng and E. Risinger and C. Serviente and M. Busa},
howpublished = {medRxiv},
year = {2026},
month = jul,
doi = {10.64898/2026.07.10.26357703},
url = {https://www.medrxiv.org/content/10.64898/2026.07.10.26357703v2},
note = {CC BY-ND},
}
RIS
TY - UNPB
TI - Real-World Outcomes of a Telephone-Based Virtual Cognitive Rehabilitation Therapy Program: A Retrospective Cohort Analysis
AU - J. A. Flexman
AU - J. Ng
AU - E. Risinger
AU - C. Serviente
AU - M. Busa
PY - 2026
DA - 2026/07/10
PB - medRxiv
DO - 10.64898/2026.07.10.26357703
UR - https://www.medrxiv.org/content/10.64898/2026.07.10.26357703v2
AB - BackgroundCognitive rehabilitation (CR) is an established behavioral intervention that improves daily functioning for individuals with mild cognitive impairment (MCI) and early-stage dementia. Traditional models of in-person delivery limit access, particularly for individuals living in rural areas. This study evaluated the effectiveness of a novel fully remote, telephone-based CR model combining speech-language pathologist (SLP)-led sessions and automated voice-agent based cognitive exercise sessions. MethodsWe conducted a retrospective observational analysis of 141 older adults referred for CR who completed treatment to discharge (58% female; mean age 71.2 {+/-} 10.8 years; MCI diagnosis rate 61.7%, dementia diagnosis rate 29.1%; Montreal Cognitive Assessment mean score 21.1 {+/-} 4.0). Changes in four outcome measures from initiation of treatment to discharge were evaluated for statistical significance: quality of life and three therapist-rated Functional Communication Measures (FCMs) of overall cognition, language expression, and language comprehension. Changes were compared to FCM averages from the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA NOMS). Models were developed to predict changes in outcome measures based on patient demographics, clinical status, program engagement and treating therapist. ResultsAll four outcomes improved significantly over the course of treatment (p<0.05), with medium to very large effect sizes. Mean changes in FCM outcomes exceeded comparable ASHA NOMS benchmarks for in-person outpatient care. A majority of patients saw an improvement in each clinical outcome measure. Models with meaningful predictive power were identified for changes in overall cognition and language expression, and a statistically significant but weak model was identified for quality of life. No predictive model was identified for spoken language comprehension. Baseline cognitive function was the most influential and negatively correlated predictor of an improvement in overall cognitive abilities and language expression. Baseline quality of life was the dominant and negatively correlated predictor of improvement in quality of life. ConclusionsTelephone-based virtual CR led by SLPs with automated exercises delivered by a voice agent produced clinically meaningful gains, with functional gains comparable to external benchmarks for in-person clinical practice. These results support the use of virtual CR within post-diagnostic care for older adults experiencing cognitive impairment, with greater benefit observed among patients with greater baseline impairment. These results support the expanded use of virtual CR particularly for patients in rural or underserved communities.
ER -