Goal Management Training for rehabilitation of executive functions: a systematic review of effectivness in patients with acquired brain injury

Agata Krasny‐Pacini; Chevignard, Mathilde; Evans, Jonathan J. · 2013 · OpenAlex-citations

DOI: 10.3109/09638288.2013.777807

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Summary

This systematic review evaluates the effectiveness of Goal Management Training (GMT) for rehabilitating executive functions in patients with acquired brain injury (ABI). The study addresses the challenge of transferring cognitive strategies from clinical settings to daily life, a persistent issue in ABI rehabilitation. While metacognitive approaches are considered the most evidence-based interventions for executive dysfunction, it remains unclear which specific formats are most effective, what the optimal treatment dose is, and whether GMT improves underlying impairments or functional participation. The authors aimed to determine if GMT improves executive function impairments and/or increases participation in everyday activities, while also identifying the best candidates and delivery formats. The researchers conducted a systematic search of databases including MEDLINE, PsycINFO, and PROQUEST for studies published up to December 2011. After screening 429 papers, twelve studies met the inclusion criteria: four "proof-of-principle" studies testing specific GMT components and eight "rehabilitation" studies assessing full multi-session interventions. The review classified studies based on whether they tested GMT alone or in combination with other methods, such as Problem Solving Therapy or mindfulness. Methodological quality was appraised using CONSORT guidelines for group studies and Single-Case Experimental Design (SCED) criteria for single-case studies, with effect sizes calculated using Hedge’s g. The findings indicate that GMT alone has limited effectiveness. Proof-of-principle studies showed contradictory results, with content-free cueing showing variable efficacy. Rehabilitation studies using GMT alone demonstrated improvements on specific neuropsychological tests but failed to show significant effects on self-rated or proxy-rated daily life functioning. In contrast, comprehensive interventions combining GMT with other strategies, such as Problem Solving Therapy, ecological activities, and goal setting, yielded medium to large effect sizes on participation measures. These combined approaches significantly improved performance on ecological tasks, such as the Multiple Errands Task, and enhanced role resumption in daily life domains. However, even these effective interventions did not produce statistically significant improvements on classical neuropsychological tests measuring underlying impairments, suggesting that GMT primarily facilitates functional adaptation rather than correcting cognitive deficits. The study concludes that GMT is most effective when integrated into a multifaceted rehabilitation program that includes ecological activities and goal setting, rather than when delivered in isolation. The evidence suggests that GMT aids in the generalization of strategies to daily life and improves participation, but it does not significantly alter underlying executive function impairments as measured by standard neuropsychological tests. The review highlights the importance of ecological validity in outcome measures and suggests that future research should focus on identifying which patient characteristics, such as severity of injury or level of self-awareness, predict better outcomes. Ultimately, the paper supports the use of GMT as a component of broader metacognitive training to enhance independence in ABI patients.

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• cognitive impairment