Data Extraction and Methodology
The data from the articles were extracted according to the stages proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)11,12. PRISMA establishes systematic and explicit methods to identify, select, and assess the properties of relevant studies.
Inclusion and Exclusion Criteria
The inclusion criteria for this review were articles that assessed Cognitive-Behavioral Therapy (CBT) as an intervention in the treatment of depression and its potential effects on the rehabilitation process of adult patients (≥ 18 years) affected by stroke (CVA), published in the last 20 years. This time frame is justified by preliminary research in databases, based on the search strategy defined for this study, with the earliest article on the topic published in 2003 (Figure 1).
Only randomized clinical trials and peer-reviewed articles in Portuguese, English, and Spanish were included. There were no restrictions regarding the countries of publication. Exclusion criteria included: (i) studies addressing other syndromes besides post-stroke depression and their impacts on the rehabilitation process; (ii) articles that did not evaluate the applicability and effectiveness of CBT in the outcome of post-stroke depression; (iii) articles where the population consisted of children or adolescents; and (iv) duplicates.
Search Strategy
Searches were conducted between September 2023 and August 2024 in the following electronic databases: PubMed, SciELO, BVS, Cochrane, and Web of Science. These databases were selected due to their relevance in indexing scientific articles related to the field of health. The descriptors used were selected using the Medical Subject Headings (MeSH) developed by the U.S. National Library of Medicine (https://www.ncbi.nlm.nih.gov/mesh), which allows for more effective literature searches. Descriptors were combined using Boolean operators AND and OR. The search strategy involved the following keywords: “Stroke,” “Rehabilitation,” “Depression,” and “Cognitive-Behavioral Therapy” and their variations in English and Spanish. The PICO strategy (Participants, Interventions, Comparisons, and Outcomes) was used to guide the formulation of the research question and the bibliographic search13.
Bias Assessment, Data Extraction, and Analysis
Article selection was done based on (i) screening of titles, abstracts, and keywords and (ii) reading the full text. Both authors reviewed the studies independently, and the selection of articles was done through mutual agreement, following the inclusion and exclusion criteria.
To assess the risk of bias, information was collected on the blinding of therapists, participants, and/or assessors, randomization, and stratification in sample allocation. In scientific research, there is a risk that researchers' expectations may influence the results, especially when there is a subjective aspect under evaluation, which may bias the conclusions14. Blinding, sometimes referred to as masking, is used to attempt to avoid this bias14.
The term blinding, and particularly “double-blind,” generally refers to keeping study participants, those involved in the intervention, and those collecting and analyzing clinical data unaware of the assigned treatment to prevent them from being influenced by knowledge of allocation14. It is a principle of randomized clinical trials that the treatment allocation for each patient should not be revealed until their inclusion in the trial to avoid selection bias, known as allocation concealment14.
Regarding scientometric analyses, the following information was extracted from each article: (i) year of publication; (ii) authors; (iii) country where the study was conducted; (iv) journal of publication. Additionally, information for descriptive analyses was collected, such as methodological characteristics, study design, interventions used, and the contribution of CBT to the topic of interest.
Assessment of Article Quality
The methodological quality of the studies was assessed using the PEDro scale15, widely recognized in the rehabilitation field. It consists of 11 items, each worth 1.0 point, except for the first item, which is not scored. Thus, the maximum score is 10 points and the minimum is zero. The assessment was done jointly by the two authors. In cases of disagreement, a third evaluator was consulted.
