| Methods |
RCT
Setting: UK |
| Participants |
42 (see Notes) stroke patients with visual neglect from those with general perceptual problems admitted to an inpatient SU
Experimental n = 24, control n = 18
Mean age (SD): experimental 69.17 years (11.35), control 66.61years (14.5)
Sex (male/female): experimental 10/14, control 8/10
Mean time post‐onset: 37 days
Inclusion: a subset of those with neglect from those with general perceptual problems from those consecutive admissions to a stroke unit trial. SU trial criteria were: medically stable, able to transfer with maximum 2 nurses, no discharge date planned, able to tolerate 30‐minute treatments, able to carry out some independent ADLs pre‐stroke |
| Interventions |
ToT approach to treat the 'cause of the perceptual problem'. The underlying assumption is that practising a perceptual task will treat the underlying impairment and if successful will improve performance of other tasks which depend on the skills. Personal communication suggested that cueing and feedback were used to teach participants to compensate versus FA to treat the 'symptom rather than the cause' and involved practising ADL tasks
Both groups received 2.5 hours per week for 6 weeks in addition to standard OT
(NB: ToT is coded as experimental in this review)
For analysis of bottom‐up and top‐down rehabilitation approaches this review coded the experimental condition as top‐down |
| Outcomes |
The broader study of perceptual problems completed the following measures by different assessors immediately after the 6 weeks treatment: an independent blinded assessor completed the BI, Edmans ADL Scale, and RPAB. This assessor completed the ADL scales following interviews with unblinded nursing staff. The unblinded ward OT also completed the BI and Edmans ADL Scale. An unblinded physiotherapist completed the RMA gross motor score. Additionally assessments by other clinical staff were analysed: speech and language therapists, psychologists, physiotherapists
For comparability with other studies this review used only the RPAB letter cancellation subtest score (number correctly cancelled) and the blinded assessor's BI |
| Notes |
Personal communication supplied further data and clarification of method. Authors provided unpublished data on 42 neglect patients from a larger RCT of 80 left and right (35) hemisphere strokes with perceptual problems which was itself taken from the stroke unit admission arm (n = 158) of a RCT of stroke unit versus general medical care. No pre‐randomisation differences between groups except that the ToT group were a little longer post‐stroke (40/33 days) than the FA group |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Allocation concealment (selection bias) |
Low risk |
The researcher used random number tables to prepare sequentially numbered opaque sealed envelopes. The random number tables were then returned and due to the large number randomised (80 to the full perception trial) it was unlikely that the sequence would be remembered. The envelopes were only opened in the presence of a witness. Random number tables. Concealment was highly likely to have been achieved, although it could not be guaranteed |
| Blinding of outcome assessment (detection bias)
All outcomes |
Low risk |
Blinded outcome assessor |
| Incomplete outcome data (attrition bias)
All outcomes |
Low risk |
"No patients withdrew from the study but one patient (in the functional approach group) died before completing his six weeks of perceptual treatment." Data from this patient are included in analyses |
| Free of systematic differences in baseline characteristics of groups compared? |
High risk |
"There was a significant difference between groups using t‐test on time post‐stroke to entry to the study (t = 2.12, p < 0.05) with the transfer of training group patients being slightly longer post stroke that the functional group" |
| Did authors adjust for baseline differences in their analyses? |
Unclear risk |
Not stated |
