Lincoln 1985

Methods	Setting: Rivermead Rehabilitation Centre Sites: 1 Countries: UK Trial design: parallel Recruitment dates: June 1981 to end November 1982
Participants	Number: 33 analysed Definition of stroke: unspecified; included 21 (64%) with stroke, 6 (18%) each with head injury and subarachnoid haemorrhage Time since stroke: 2.7 months, SD ≈ 1.8 (Table 4), mean (SD) in experimental group 2.4 (1.0) months, control group 3.1 (2.4) months Comorbidities affecting disability: not reported Excluded: no Tools used to define perceptual disorders: Rivermead Perceptual Assessment Battery (RPAB) Severity of perceptual disorders: 3 or more subtests on which performance was > 2 SDs from mean for normal non‐brain damaged adult score Included visuospatial neglect: yes probably: frequency/severity: not stated, but they did not exclude people with neglect Age: mean 50 years, range 17 to 69 years; mean (SD) in experimental group 49 (14.6) years, control group 51 (16.0) years Sex: 17 (52%) male: experimental group 9 (53%), control group 8 (50%)
Interventions	Described adequately to replicate: no Broad class: sensory stimulation Specific nature: the experimental group practiced various perceptual tasks (e.g. stick length sorting, picture lotto, colour matching squares, shape recognition games) of the type commonly used in occupational therapy departments The control group received the same amount of therapy time but carried out activities that were designed to improve physical rather than perceptual abilities (e.g. games, craft work, gardening) Frequency: 4 hours per week Duration (from first to last treatment): 4 weeks Profession of 'therapist': not explicitly stated but 'Acknowledgements' section suggests that occupational therapists carried out the experimental intervention and also provided activities for the control group Co‐interventions reported: any occupational therapy provided in addition to the 4 study hours per week was aimed at gross motor performance and provided to both groups Excluded: no
Outcomes	Reported: 6‐month ADL: no End of intervention ADL: yes 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: no Specified primary outcome(s): no, 16 tests of RPAB and ADL presented with no apparent hierarchy Time points for outcomes: end of intervention Total number of outcomes: 17, includes 16 measures of perception in RPAB but no overall score Possible ceiling/floor effects: evident from presented means and SD for some subtests of the RPAB Assessed by: third party "unaware of the treatment group"
Notes	Personal communication
Risk of bias
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Unclear risk	No detail beyond "patients were randomly allocated"
Allocation concealment?	Unclear risk	No information on process
Blinding? All outcomes	High risk	Intended blinded outcome assessment, but not reported success
Incomplete outcome data addressed? All outcomes	Low risk	No suggestion of loss to follow‐up
Free of selective reporting?	Low risk	No suggestion of unreported outcomes
Free of other bias?	Unclear risk	Original eligibility criteria restricted entry to right‐hemisphere stroke patients. Later extended to head injury, subarachnoid haemorrhage and left hemisphere stroke "to obtain reasonable numbers within the time". Not clear what interim analyses were undertaken, and possible consequences for interpretation of the final data