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. 2011 Apr 13;2011(4):CD007039. doi: 10.1002/14651858.CD007039.pub2

Mazer 2003

Methods Setting: rehabilitation hospital Sites: 1 Countries: Canada Trial design: parallel Recruitment dates: start and end not reported
Participants Numbers: 97 randomised, 86 analysed Definition of stroke: medical (hospital) records (personal communication) Time since stroke: mean 78 days: experimental group mean (SD) 91 days (52); controls 67 days (28) Time since rehabilitation: mean ≈ 52 days Comorbidities affecting disability reported: yes Excluded: yes: standard contraindications to driving, plus bilateral lesion, cerebellar or brainstem stroke, and severe cognitive, perceptual, comprehension or motor deficit Tools used to define perceptual disorders: this test battery, which has been described elsewhere, included the Complex Reaction Timer, Motor‐Free Visual Perception Test33 (MVPT), Single and Double Letter Cancellation Test, 34 Money Road Map Test of Direction Sense, 35 Trail Making Test (TMT) Parts A and B, 36 Bells test, 37 and Charron test 38. Collectively, these tests provide information on overall visuoperceptual skills, including visual scanning ability, reaction time to visual stimuli, figure ground discrimination, spatial relations, visual memory, visual processing time, and direction sense Severity of perceptual disorders: exclusion criteria included "severe perceptual deficit", yet "severe visual processing dysfunction" was one of the randomisation strata Experimental group: 28% mild, 51% moderate, 21% severe Control group: 28% mild, 54% moderate, 18% severe Included visuospatial neglect: not reason for exclusion. Only excluded if of such severity that driving licence revoked (personal communication) Age: mean 66 years: experimental group mean (SD) 65 years (11.4), controls 66 years (8.9) Sex: 70 (72%) male: experimental group 35 (74%), controls 35 (70%) Race/ethnicity: 67 (69%) French speakers, 30 (31%) English speakers
Interventions Described adequately to replicate: no Broad class: 2 types ‐ sensory stimulation coupled with strategy training Specific nature: the experimental intervention comprised 4 commercially available computerised software programmes (Tetris, Othello, Mastermind, Jigs@w Puzzle) commonly used by occupational therapists to retrain perceptual and cognitive functions. The OT selected the simplest level then increased complexity, provided verbal suggestions and taught appropriate problem‐solving strategies The control intervention comprised a computerised treatment using the 'Useful Field of View' (UFOV) that targeted visual processing speed, visual divided attention and visual selective attention Frequency: 2 to 4 sessions per week (each 30 to 60 minutes) Duration (from first to last treatment): scheduled 20 sessions at 3 per week Profession of 'therapist': occupational therapist Co‐interventions reported: in addition to the interventions described above, all participants received 4 sessions of physical retraining on the Baltimore Therapeutic Equipment work simulator Excluded: no
Outcomes Reported:

  • 6‐month ADL: no

  • End of intervention ADL: no scale reported or measured, but driving evaluation

  • 6‐month perception impairment: no

  • End of intervention perception impairment: yes

  • 6‐month QoL: no

  • 6‐month effect on carer: no

  • Discharge destination: no


Adverse events:

  • Death: no

  • Fatigue: no

  • Falls: no

  • Accidents: no

  • Others: yes


Specified primary outcome(s): pass/fail of on‐road driving evaluation Time points for outcomes: end of intervention Total number of outcomes: 31 ‐ Driving evaluation, 21 visuoperception scores, 9 tests of everyday attention (TEA) Possible ceiling/floor effects: possible in visuoperception scores Assessed by: third party, independent occupational therapist for impairment, plus driving instructor for on‐road evaluation
Notes Barbara Mazer provided additional information and clarification (September 2009). Has another study prepared for submission, see 'Characteristics of ongoing studies'.
Risk of bias
Bias Authors' judgement Support for judgement
Adequate sequence generation? Low risk Computer‐generated random number tables in stratified blocks
Allocation concealment? Low risk No description of process. From personal communication, statistician (third party) prepared sequential envelopes independently
Blinding? All outcomes High risk Intended blinded assessment, but correctly identified for 79% of participants
Incomplete outcome data addressed? All outcomes Low risk Explicit reasons given for missing outcome evaluation in 13 (13%) participants. None clearly related to intervention: decided not to return to driving (5); became medically unfit (3); died (3); moved (1); not legally able to drive (1)
Free of selective reporting? Low risk Does not appear selective
Free of other bias? Low risk

ADL: activities of daily living CT: computerised tomography CVA: cerebrovascular accident PCMF: Percept‐concept‐motor function QoL: quality of life RMA: Rivermead Motor Assessment RPAB: Rivermead Perceptual Assessment Battery SD: standard deviation