A Cochrane review [Abstract] 1 included 23 studies with a total of 628 subjects. Most studies measured outcomes using standardised neglect assessments: 15 studies measured effect on activities of daily living (ADL) immediately after the end of the intervention period, but only six reported persisting effects on ADL. One study (n=30) reported discharge destination and one study (n=8) reported the number of falls. Eighteen of the 23 included trials compared cognitive rehabilitation with any control intervention (placebo, attention or no treatment). Meta-analyses demonstrated no statistically significant effect of cognitive rehabilitation, compared with control, for persisting effects on either ADL (five studies, n=143) or standardised neglect assessments (8 studies, n=172), or for immediate effects on ADL (10 studies, n=343). In contrast, we found a statistically significant effect in favour of cognitive rehabilitation compared with control, for immediate effects on standardised neglect assessments (SMD 0.35, 95% CI 0.09 to 0.62; 16 studies, n=437). Additionally, 5 of the 23 trials compared one cognitive rehabilitation intervention with another. These included 3 studies comparing a visual scanning intervention with another cognitive rehabilitation intervention, and two studies (3 comparison groups) comparing a visual scanning intervention plus another cognitive rehabilitation intervention with a visual scanning intervention alone. Subgroup analyses exploring the effect of having an attention control demonstrated some evidence of a statistically significant difference between those comparing rehabilitation with attention control and those with another control or no treatment group, for immediate effects on standardised neglect assessments (test for subgroup differences, p=0.04).
Comment: The quality of evidence is downgraded by limitations in study quality (inadequate allocation concealment) and by inconsistency (heterogeneity in interventions and outcomes).
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