Nys 2008.

Methods	RCT "single‐blind randomised controlled design" Setting: Netherlands
Participants	16 participants with neglect from 3 stroke units Experimental: n = 10 , control: n = 6 Adequacy of matching at baseline? Yes Number lost to follow‐up: not clear ‐ only those who completed were included in the report. Also excluded 1 patient with deterioration of neurological condition during treatment phase , which probably should have been a loss to follow‐up rather than exclusion Mean age (mean (SD)): experimental = 63.6 (13.8), control = 61.5 (11.0) years Sex (male/female): experimental = 7/3, control = 3/3 Time post‐onset: experimental 1 = 8.8 (5.3), control = 11.2 (6.4) days Side of damage: right Method of diagnosing stroke: not stated, was based on the referral by a stroke physician on their admitting SU Method of diagnosing neglect: 2 or more subtests (out of 4): BIT subtests below cut‐off. The four tests were Star Cancellation (cut‐off ≤ 51), line bisection (cut‐off ≤ 7), figure copying (cut‐off ≤ 2) and representational drawing (cut‐off ≤ 2) Inclusion criteria: inpatient in SU with neglect, within 4 weeks post‐stroke. All participants had to demonstrate an after‐effect of at least 3 visual degrees to the left of the landing position after the first prism adaptation; this would only apply to the active treatment group, but none were excluded for this reason Exclusion criteria: ocular problems, a disturbed consciousness or a too limited attention span (participants excluded during screening) Visual sensory deficit: 2 in the experimental group had hemianopia, diagnosed by confrontation comparing cueing and non‐cueing conditions by a stroke neurologist
Interventions	Prism adaptation: "an extended version of that used by Rosetti et al 1998". While wearing goggles with prisms inducing a rightward optical shift of 10°,  participants made 100 fast pointing movements to 2 visual targets presented 10° to the left and right of the body midline. Sessions of 30 minutes were conducted 4 days in a row versus placebo ‐ as above but  wearing goggles with no optical shift. Sessions of 30 minutes were conducted 4 days in a row For analysis of bottom‐up and top‐down rehabilitation approaches this review coded the experimental condition as bottom‐up Profession of intervention provider not stated
Outcomes	Behavioural Inattention test at 1 month after treatment Modified BI at 1 month after treatment, but no indication what the modification was Schenkenberg Line Bisection, after every treatment session Letter cancellation, after every treatment session Gainotti Scene Copying after every treatment session scored retrospectively by an independent rater
Notes	Postulated mechanism of action: not clear but stated there was a "neural basis for the therapeutic effect" and treated early because the brain is most sensitive to rehabilitative treatment early after stroke
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	Insufficient details "according to a randomisation procedure in SPSS"
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Only 1 measure, scene copying, appears to have been scored retrospectively by an independent rater. Not stated if outcome assessor was blinded
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Unclear ‐ only those who completed were included in the report
Free of systematic differences in baseline characteristics of groups compared?	Unclear risk	Removed 1 person who failed to complete treatment but no indication of which group this was from
Did authors adjust for baseline differences in their analyses?	Low risk	Not necessary