Home-based cognitive telerehabilitation in multiple sclerosis: differential cognitive trajectories according to baseline impairment severity.

BACKGROUND: Although cognitive impairment (CI) is common in multiple sclerosis (MS), conventional cognitive rehabilitation is often limited by accessibility and adherence challenges. Telerehabilitation offers an accessible alternative, but its efficacy across different CI severity levels remains unclear. The present prospective, single-center, single-arm interventional study with repeated measures aimed to identify changes in cognitive and psychosocial outcomes following a home-based cognitive telerehabilitation program with weekly synchronous coaching in MS patients with mild versus moderate CI, and to explore whether baseline impairment severity was associated with differences in change over time. METHODS: Sixty-six MS patients (34 mild CI; 32 moderate CI) completed a 12-week home-based cognitive telerehabilitation program (five sessions/week), supported by weekly Skype coaching. Outcomes were assessed at baseline (T0), post-intervention (T1), and 3-month follow-up (T2). Cognitive and emotional-behavioral functioning were investigated using standardized, validated instruments in the MS population. Changes over time and between-group differences were analyzed using linear models. RESULTS: At T1, both groups improved in attention, verbal memory, and subjective cognitive perception (all p < 0.05). Processing speed improved only in mild CI (p < 0.001), whereas executive function improved only in moderate CI (p = 0.007). At T2, mild CI further improved in attention and verbal memory (p = 0.003-0.035), while moderate CI improved only in processing speed (p = 0.006). Emotional-behavioral outcomes improved in both groups at T1 (anxiety p = 0.002; depression p = 0.023; fatigue p < 0.001) and were largely maintained at T2, with no statistically significant between group differences. Mental quality of life improved over time, whereas physical quality of life remained unchanged. CONCLUSION: Following the intervention, both groups showed improvements in cognitive and emotional-behavioral outcomes, with larger and more sustained changes in mild CI. These findings should be confirmed in randomized controlled studies.