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Longley V, Woodward-Nutt K, Turton AJ, Stocking K, Checketts M, Bamford A, Douglass E, Taylor J, Woodley J, Moule P, Vail A, Bowen A. A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial. Clin Rehabil 2023; 37:381-393. [PMID: 36285484 PMCID: PMC9912302 DOI: 10.1177/02692155221134060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Investigate feasibility and acceptability of prism adaptation training for people with inattention (spatial neglect), early after stroke, during usual care. DESIGN Phase II feasibility randomised controlled trial with 3:1 stratified allocation to standard occupational therapy with or without intervention, and nested process evaluation. SETTING Ten hospital sites providing in-patient stroke services. PARTICIPANTS Screened positive for inattention more than one-week post-stroke; informal carers. Occupational therapists participated in qualitative interviews. INTERVENTION Adjunctive prism adaptation training at the start of standard occupational therapy sessions for three weeks. MAIN MEASURES Feasibility measures included recruitment and retention rates, intervention fidelity and attrition. Outcomes collected at baseline, 3 weeks and 12 weeks tested measures including Nottingham Extended Activities of Daily Living Scale. Acceptability was explored through qualitative interviews and structured questions. RESULTS Eighty (31%) patients were eligible, 57 (71%) consented, 54 randomised (40:13, +1 exclusion) and 39 (74%) completed 12-week outcomes. Treatment fidelity was good: participants received median eight intervention sessions (IQR: 5, 12) lasting 4.7 min (IQR: 4.1, 5.0). All six serious adverse events were unrelated. There was no signal that patients allocated to intervention did better than controls. Twenty five of 35 recruited carers provided outcomes with excellent data completeness. Therapists, patients and carers found prism adaptation training acceptable. CONCLUSIONS It is feasible and acceptable to conduct a high-quality definitive trial of prism adaptation training within occupational therapy early after stroke in usual care setting, but difficult to justify given no sign of benefit over standard occupational therapy. CLINICAL TRIAL REGISTRATION https://www.isrctn.com/ Ref ISRCTN88395268.
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Affiliation(s)
- Verity Longley
- Faculty of Health and Education, Manchester Metropolitan
University, Manchester, UK
- Verity Longley, Faculty of Health and
Education, Manchester Metropolitan University, Manchester, UK.
| | - Kate Woodward-Nutt
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
| | - Ailie J. Turton
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Katie Stocking
- Centre for Biostatistics, The Manchester Academic Health Science
Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Matthew Checketts
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
| | - Ann Bamford
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
| | - Emma Douglass
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Julie Taylor
- Dorothy House Hospice Care, Bradford-on-Avon, UK
| | - Julie Woodley
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Pam Moule
- School for Health and Social Wellbeing, University of the West of
England, Bristol, UK
| | - Andy Vail
- Centre for Biostatistics, The Manchester Academic Health Science
Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Audrey Bowen
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic
Health Science Centre, Northern Care Alliance & University of Manchester,
Manchester, UK
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Moore M, Milosevich E, Beisteiner R, Bowen A, Checketts M, Demeyere N, Fordell H, Godefroy O, Laczó J, Rich T, Williams L, Woodward-Nutt K, Husain M. Rapid screening for neglect following stroke: A systematic search and European Academy of Neurology recommendations. Eur J Neurol 2022; 29:2596-2606. [PMID: 35510782 PMCID: PMC9544365 DOI: 10.1111/ene.15381] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Unilateral neglect is a common cognitive disorder following stroke. Neglect has a significant impact on functional outcomes, so it is important to detect. However, there is no consensus on which are the best screening tests to administer to detect neglect in time‐limited clinical environments. Methods Members of the European Academy of Neurology Scientific Panel on Higher Cortical Functions, neuropsychologists, occupational therapists, and researchers produced recommendations for primary and secondary tests for bedside neglect testing based on a rigorous literature review, data extraction, online consensus meeting, and subsequent iterations. Results A total of 512 articles were screened, and 42 were included. These reported data from 3367 stroke survivors assessed using 62 neglect screens. Tests were grouped into cancellation, line bisection, copying, reading/writing, and behavioral. Cancellation tasks were most frequently used (97.6% of studies), followed by bisection, copying, behavioral, and reading/writing assessments. The panel recommended a cancellation test as the primary screening test if there is time to administer only one test. One of several cancellation tests might be used, depending on availability. If time permits, one or more of line bisection, figure copying, and baking tray task were recommended as secondary tests. Finally, if a functional and ecological test is feasible, the Catherine Bergego Scale was recommended. Overall, the literature suggests that no single test on its own is sufficient to exclude a diagnosis of neglect. Therefore, the panel recommended that multiple neglect tests should be used whenever possible. Conclusions This study provides consensus recommendations for rapid bedside detection of neglect in real‐world, clinical environments.
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Affiliation(s)
- Margaret Moore
- Dept Experimental Psychology, University of Oxford, Oxford, UK.,Queensland Brain Institute, University of Brisbane, Brisbane, Australia
| | | | | | - Audrey Bowen
- Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK
| | - Matthew Checketts
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, MAHSC, UK
| | - Nele Demeyere
- Dept Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Olivier Godefroy
- Department of Neurology and Laboratoire de Neurosciences Fonctionnelles et Pathologies, Amiens University Medical Center, Jules Verne University of Picardy, Amiens, France
| | - Jan Laczó
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Timothy Rich
- Kessler Foundation, West Orange, New Jersey, USA & Rutgers University, Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Lindy Williams
- Cognitive Aging and Impairment Neurosciences Lab, University of South Australia, Adelaide, Australia
| | - Kate Woodward-Nutt
- Research and Innovation, Northern Care Alliance NHS Group, Salford, United Kingdom
| | - Masud Husain
- Dept Experimental Psychology, University of Oxford, Oxford, UK.,Nuffield Dept Clinical Neurosciences, University of Oxford, Oxford, UK
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