Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 34196963 · doi:10.1002/14651858.CD003586.pub4
What was done
A systematic review and meta-analysis evaluated randomized controlled trials (RCTs) of non-pharmacological interventions for spatial neglect following stroke or non-progressive brain injury across multiple databases up to October 2020. Interventions were grouped into eight types: visual interventions, prism adaptation, body awareness, mental function, movement interventions, non-invasive brain stimulation (NIBS), electrical stimulation, and acupuncture. The primary outcome was persisting functional ability in activities of daily living (ADL). Quality of evidence was assessed using GRADE.
What was found
The review included 65 RCTs (1,951 stroke participants). Only 16 trials reported persisting ADL outcomes. Persisting ADL results included: visual interventions vs. control (2 studies, 55 participants; SMD -0.04, 95% CI -0.57 to 0.49), prism adaptation vs. control (2 studies, 39 participants; SMD -0.29, 95% CI -0.93 to 0.35), body awareness vs. control (5 studies, 125 participants; SMD 0.61, 95% CI 0.24 to 0.97), and NIBS vs. control (3 studies, 92 participants; SMD 0.35, 95% CI -0.08 to 0.77). Zero trials reported persisting ADL for mental function, movement, electrical stimulation, or acupuncture. Across all categories and outcomes, evidence was rated very uncertain.
Why it matters
Current RCT evidence is insufficient to support or refute any non-pharmacological rehabilitation technique for spatial neglect, highlighting an urgent need for adequately powered, high-quality clinical trials measuring functional independence.
Limits
All included trials were small (<50 participants per group) and only two were at low risk of bias; no phase 3 trials existed. Persisting ADL outcomes were absent in 49 of 65 studies, and falls, balance, and quality of life were entirely unmeasured. All participants had stroke, leaving other non-progressive brain injuries unrepresented.
Cited by
- supports In stroke patients suffering from visual neglect syndrome, attention training improves performance on the trained task but does not generalize to other tasks.