A Cochrane review [Abstract] 1 included 6 studies with a total of 338 subjects in rehabilitation settings. Four trials included only stroke patients. Time from onset varied from 2 weeks to 5 months. The perceptual problem was confirmed by neuropsychological tests. All studies provided sensory stimulation, sometimes with another intervention. Sensory stimulation typically involved practising tasks that required visuo-perceptual processing with occupational therapist assistance. Repetition was never used and only one study included functional training. Control interventions included activities aimed at reducing motor or physical disabilities or 'routine rehabilitation'. Only 3 trials provided any data suitable for analysis, no trials provided data on longer term improvement in activities of daily living (ADL) scores. There was no difference in ADL scores at the scheduled end of intervention: mean difference was 0.9 (95%CI -1.6 to 3.5) points on a self-care ADL scale in one study (n=33) and OR was 1.3 (95%CI 0.56 to 3.1) for passing a driving test in the other (n=97), both in favour of active intervention. The trial comparing two active interventions did not find evidence of difference in any of the review outcomes.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, lack of blinding), inconsistency (heterogeneity in patients, interventions and outcomes), indirectness (differences in outcomes) and imprecise results (limited study size for each comparison).
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