Recovery of Visuospatial Neglect With Standard Treatment: A Systematic Review and Meta-Analysis

Abstract

Background: Visuospatial neglect is a common consequence of stroke and is characterized by impaired attention to contralesional space. Currently, the extent and time course of recovery from neglect are not clearly established. This systematic review and meta-analysis aimed to determine the recovery trajectory of poststroke neglect with standard treatment.

Methods: PsycInfo, Embase, and MEDLINE were searched for articles reporting recovery rates of neglect after stroke. Time since stroke was categorized into early (0-3 months), mid (3-6 months), and late (>6 months) recovery phases. Random-effects models for pooled prevalence were generated for each phase, and potential sources of heterogeneity were explored with metaregressions. Methodological quality of each study was assessed using the Joanna Briggs Institute checklist, with low-quality studies excluded in sensitivity analyses.

Results: The search captured 4130 articles including duplicates, and 111 full-text reviews were undertaken. A total of 27 studies reporting data from 839 stroke survivors with neglect were included for review. Meta-analyses indicated a recovery rate of 42% in the early phase, which increased to 53% in the mid-recovery phase. Additional recovery in the late phase was minimal, with an estimated 56% recovery rate. Heterogeneity of studies was high (I²>75%) in all 3 phases of recovery. Estimates were robust to sensitivity analyses. Metaregressions showed significantly greater recovery in studies that included patients with left-hemisphere lesions (β=0.275, P<0.05, I²=84%).

Conclusions: Most recovery from neglect occurs in the first 3 months, although additional gains can be expected up to 6 months poststroke. While a large proportion of patients recover from neglect, over 40% show persistent symptoms. Further research is needed on effective rehabilitation interventions, particularly focusing on patients most at risk of chronic visuospatial neglect.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023388763.

Keywords: cognition; cognitive dysfunction; neuropsychology; stroke; stroke rehabilitation; systematic review.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart of study selection.

Figure 2.

Recovery of visuospatial neglect with standard treatment in the early, mid, and late phases after stroke. Individual lines indicate the proportion of recovered patients at each assessment point for every study, with dot size reflecting the sample size. The Locally Estimates Scatterplot Smoothing (LOESS) line (dashed) shows the estimated smooth fit of the regression model of recovery rates predicted by time across all studies, with the 95% CI shaded in gray. Most recovery occurred in the early phase (0–3 months), with smaller increases observed in the mid-recovery phase (3–6 months). No additional recovery was observed in the late recovery phase (>6 months).

Figure 3.

Forest plots of random-effects models for neglect recovery stratified by phase.

Figure 4.

Changes in average scores over time for studies reporting Behavioural Inattention Test (BIT) performance. Individual lines indicate mean scores reported by each study. The dashed line represents the cutoff score for a diagnosis of neglect.