Skip to main content
. 2019 May 23;2019(5):CD008388. doi: 10.1002/14651858.CD008388.pub3

Summary of findings 3. Summary of findings: Substitutive interventions versus control.

Substitutive interventions compared with control for visual field defects in patients with stroke
Patient or population: stroke survivors with visual field defects
Settings: any rehabilitation setting
Intervention: compensative interventions
Comparison: control, placebo, or no intervention
Outcomes Relative effect
(95% CI) No of Participants
(studies) Quality of the evidence
(GRADE) Comments
Functional ability in activities of daily living
(Barthel Index)
After 4 weeks of treatment		 Wearing prisms
MD ‐4.00 (‐17.86 to 9.86)
(no significant effect)		 39
(1 study, Rossi 1990)		 ⊕⊝⊝⊝
very low Reasons for downgrades:

  • Risk of bias ‐ study judged as high risk of bias for at least one domain

  • Indirectness ‐ included data from participants with neglect

  • Imprecision ‐ small study population (n = 39)
Visual field
(change in visual field area & change in error scores, from baseline)
After intervention		 Not wearing prisms
SMD 0.12 (‐0.46 to 0.70)
Wearing prisms
SMD 1.12 (0.44 to 1.80)		 85
(2 studies, Rossi 1990; Rowe 2010)		 ⊕⊝⊝⊝
very low Reasons for downgrades:

  • Risk of bias ‐ one study judged as high risk of bias for at least one domain

  • Indirectness ‐ included data from participants with neglect

  • Indirectness ‐ studies cannot be combined due to differences in testing (wearing/not wearing prisms)
Extended activities of daily living
(Change in EADL from baseline; mobility improvement scores, in Logits)
After intervention		 Not wearing prisms
SMD 0.20 (‐0.44 to 0.85)
Wearing prisms
SMD 0.24 (‐0.26 to 0.75)		 99
(2 studies, Bowers 2014; Rowe 2010)		 ⊕⊝⊝⊝
very low Reasons for downgrades:

  • Risk of bias ‐ one study judged as high risk of bias for at least one domain

  • Indirectness ‐ one study outcome was a mobility measure, rather than a general measure of EADL

  • Indirectness ‐ included participants with diagnoses other than stroke

  • Indirectness ‐ studies cannot be combined due to differences in testing (wearing/not wearing prisms)
Reading ability Not wearing prisms
MD 2.80 (‐7.13 to 12.73)
(no significant effect)		 45
(1 study, Rowe 2010)		 ⊕⊕⊝⊝
Low Reasons for downgrades:

  • Imprecision ‐ small study population (n = 45)

  • Imprecision ‐ wide confidence intervals
Falls
(number of falls)
After intervention		 Wearing prisms
OR 1.21, (0.26 to 5.76)
(no significant difference)		 39
(1 study, Rossi 1990)		 ⊕⊝⊝⊝
very low Reasons for downgrades:

  • Risk of bias ‐ study judged as high risk of bias for at least one domain

  • Indirectness ‐ included data from participants with neglect

  • Imprecision ‐ small study population (n = 39)
Quality of life
(Visual Function Questionnaire (VFQ‐25))
After intervention		 Not wearing prisms
MD 8.40 (‐4.18 to 20.98)
(no significant effect)		 43
(1 study, Rowe 2010)		 ⊕⊕⊝⊝
Low Reasons for downgrades:

  • Imprecision ‐ small study population (n = 43)

  • Imprecision ‐ wide confidence intervals
Scanning ‐ cancellation
(line cancellation errors)
After intervention		 Wearing prisms
MD 9.80 (1.91 to 17.69)
(favours substitutive)		 39
(1 study, Rossi 1990)		 ⊕⊝⊝⊝
very low Reasons for downgrades:

  • Risk of bias ‐ study judged as high risk of bias for at least one domain

  • Indirectness ‐ included data from participants with neglect

  • Imprecision ‐ small study population (n = 39)

  • Imprecision ‐ wide confidence intervals
Adverse events
(number of participants with reported events during intervention period)		 OR 87.32 (4.87 to 1564.66)
(favours control)		 59
(1 study, Rowe 2010)		 ⊕⊕⊝⊝
Low Reason for downgrades:

  • Inconsistency ‐ large confidence intervals

  • Imprecision ‐ data from only one study
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

EADL: extended activities of daily living
MD: mean difference
OR: odds ratio
SMD: standardised mean difference
VFQ‐25: Visual function questionnaire