Characteristics and Trends of Randomized Controlled Trials on Post-Stroke Unilateral Spatial Neglect Rehabilitation: A Systematic Review

Abstract

Background

Unilateral spatial neglect (USN) is a common post-stroke deficit that adversely affects activities of daily living and functional independence. Despite advancements in stroke rehabilitation research, USN-specific rehabilitation studies remain relatively limited, contributing to a gap in evidence-based clinical practice.

Objective

To characterize randomized controlled trials (RCTs) evaluating post-stroke USN rehabilitation interventions and to provide an overview of the intervention types studied and gaps in the current literature.

Methods

Systematic searches of MEDLINE, Embase, Scopus, CINAHL, and PsycINFO were conducted from inception to December 31, 2024. The methodological quality of included RCTs was assessed using the PEDro scale.

Results

A total of 123 RCTs were included, collectively enrolling 3,419 participants. The annual number of trials has remained stable in recent years. The mean sample size was 27.8, and the majority of RCTs (60.2%) were conducted in the subacute phase post-stroke. A total of 44 unique types of intervention were examined across the 123 RCTs. Top-down interventions were evaluated in 49 RCTs (39.8%), while bottom-up therapies were examined in 82 RCTs (66.6%), and pharmacological interventions were used in only 6 studies (4.9%).

Conclusions

Future RCTs on neglect should recruit larger sample sizes, evaluate the efficacy of combined interventions, and implement time-sensitive treatment strategies to maximize gains in the earlier post stroke phase. Additionally, RCTs are needed to specifically address the impact of treatment timing on outcomes, and the long-term effects.