Prism Adaptation Treatment Improves Inpatient Rehabilitation Outcome in Individuals With Spatial Neglect: A Retrospective Matched Control Study

Abstract

Objective To determine whether prism adaptation treatment (PAT) integrated into the standard of care improves rehabilitation outcome in patients with spatial neglect (SN). Design Retrospective matched control study based on information extracted from June 2017-September 2019. Setting Inpatient rehabilitation. Participants Patients from 14 rehabilitation hospitals scoring >0 on the Catherine Bergego Scale (N=312). The median age was 69.5 years, including 152 (49%) female patients and 275 (88%) patients with stroke. Interventions Patients were matched 1:1 by age (±5 years), FIM score at admission (±2 points), and SN severity using the Catherine Bergego Scale (±2 points) and classified into 2 groups: treated (8-12 daily sessions of PAT) vs untreated (no PAT). Main Outcome Measures FIM and its minimal clinically important difference (MCID) were the primary outcome variables. Secondary outcome was home discharge. Results Analysis included the 312 matched patients (156 per group). FIM scores at discharge were analyzed using repeated-measures analyses of variance. The treated group showed reliably higher scores than the untreated group in Total FIM, F =5.57, P =.020, partial η 2 =0.035, and Cognitive FIM, F =19.20, P <.001, partial η 2 =0.110, but not Motor FIM, F =0.35, P =.553, partial η 2 = 0.002. We used conditional logistic regression to examine the odds ratio of reaching MCID in each FIM score and of returning home after discharge. No reliable difference was found between groups in reaching MCID or home discharge. Conclusions Patients with SN receiving PAT had better functional and cognitive outcomes, suggesting that integrating PAT into the standard of care is beneficial. However, receiving PAT may not determine home discharge.

The Implementation Process of Two Evidence-Based Protocols: A Spatial Neglect Network Initiative

“…The implementation information being tracked included de-identified patient clinical records. Patient outcomes were reported separately (36,37).…”

“…We evaluated the implementation outcomes using quantitative and qualitative information that was collected during the 4year period. The study also included collecting patient outcomes, which was reported separately (36,37).…”

“…In November 2020, we completed the collection of de-identified clinical records shared by participating sites. Note that patient outcomes (i.e., improvement in spatial neglect and rehabilitation outcomes) were reported in separate articles (36,37).…”

Impacts of Prism Adaptation Treatment on Spatial Neglect and Rehabilitation Outcome: Dosage Matters

“…To gain insight of the relationship between PAT dosage and outcomes, the present study examined data gathered through regular clinical practice (i.e., clinical records) in 16 rehabilitation hospitals that participated in a large-scale implementation project for improving SN care of patients with brain injury (for details about the overarching project, see Hreha et al) 29 It is important to note that clinical records can provide practice-based evidence, which differs from evidence generated from prospective RCTs and has inherent limitations such as no blinding (i.e., the same therapists or colleagues on the same therapy team assessing and treating the same patients), no randomization or allocation concealment procedures assigning patients to control conditions, and a great heterogeneity of the sample. Nonetheless, as demonstrated in the matched, controlled study described above, 18 data based on clinical records can help answer certain questions and generate new research questions.…”

Neural Mechanisms of Prism Adaptation in Healthy Adults and Individuals with Spatial Neglect after Unilateral Stroke: A Review of fMRI Studies

“…Spatial neglect has a significant clinical impact as it hinders rehabilitation progress and outcomes [ 13 , 14 , 15 , 16 ]. Prism adaptation treatment (PAT) is one of the interventions that can reduce symptoms of spatial neglect and improve functional outcomes [ 17 , 18 ]. However, the results of randomized sham-controlled trials in stroke patients are mixed with respect to unequivocal benefits of this treatment for all stroke patients [ 19 , 20 , 21 , 22 , 23 ].…”