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C. Umeonwuka1, R. Roos1, V. Ntsiea1
1University of Witwatersrand, Department of Physiotherapy, Johannesburg, South Africa
Background: Unilateral spatial neglect (USN) is a leading cause of disability and handicap in stroke survivors affecting functional recovery. Therapist’s knowledge and practice in post-stroke unilateral spatial neglect are key to the success of rehabilitation.
Purpose: The purpose of this study was to explore the current treatment approaches for patients with post-stroke unilateral spatial neglect and to evaluate physiotherapists’ knowledge of USN, the current practice of USN management in Nigeria.
Methods: To adequately achieve the aim, this study was conducted in phases:
Phase I: A scoping review was conducted to explore the current treatment approaches for patients with post-stroke unilateral spatial neglect. A three-step search strategy using the Johanna Briggs Institute’s guideline was undertaken. PubMed, CINAHL, The Cochrane Central Register of Controlled Trial, SCOPUS, PROSPERO, JBI, Sport Discus, and Google Scholar databases were searched. The searches were limited to publications from January 1, 2008, to May 1, 2020. Critical appraisal was undertaken by two independent reviewers using a standardized critical appraisal instrument from JBI. Findings were categorized and descriptively presented.
Phase II: A cross-sectional study was undertaken among Nigerian physiotherapists practicing in stroke rehabilitation (N=94). An online structured questionnaire that assessed respondents' knowledge and current practice of USN rehabilitation was administered.
Phase I: A scoping review was conducted to explore the current treatment approaches for patients with post-stroke unilateral spatial neglect. A three-step search strategy using the Johanna Briggs Institute’s guideline was undertaken. PubMed, CINAHL, The Cochrane Central Register of Controlled Trial, SCOPUS, PROSPERO, JBI, Sport Discus, and Google Scholar databases were searched. The searches were limited to publications from January 1, 2008, to May 1, 2020. Critical appraisal was undertaken by two independent reviewers using a standardized critical appraisal instrument from JBI. Findings were categorized and descriptively presented.
Phase II: A cross-sectional study was undertaken among Nigerian physiotherapists practicing in stroke rehabilitation (N=94). An online structured questionnaire that assessed respondents' knowledge and current practice of USN rehabilitation was administered.
Results: Phase I: Of the 3,648 articles identified, 311 full-text papers were screened and 86 articles were critically appraised, with 83 articles included in the final review. Thirty-seven studies were quasi-experimental and 46 studies were randomized controlled trials. Majority of interventions targeted stroke patients at the sub-acute phase of recovery. Thirty intervention for post-stroke unilateral spatial neglect symptom amelioration was identified and studies utilizing randomized control trial study design were in preponderance. Post-stroke neglect intervention varied widely with the two most common being combination therapy and prism adaptation therapy
Phase II: The total knowledge score was 14.23±3.61(out of a maximum score of 25). Seven Physiotherapists (7.45%) demonstrated good knowledge of USN (knowledge score 20-25) Significant association between USN knowledge and physiotherapist’s educational level (F=4.10; p=0.009) and having a postgraduate certification in neurology (t=-3.228; p=0.002). Significant minimal positive correlation was observed between duration of practice as a physiotherapist (r=0.22; p=0.04), Age (r=0.21;p=0.04) with USN knowledge. Constraint-induced movement therapy (71.3%, n=67) was the most common used USN treatment while Albert's test (18.1%,n=17) was the most utilized screening tool for USN.
Phase II: The total knowledge score was 14.23±3.61(out of a maximum score of 25). Seven Physiotherapists (7.45%) demonstrated good knowledge of USN (knowledge score 20-25) Significant association between USN knowledge and physiotherapist’s educational level (F=4.10; p=0.009) and having a postgraduate certification in neurology (t=-3.228; p=0.002). Significant minimal positive correlation was observed between duration of practice as a physiotherapist (r=0.22; p=0.04), Age (r=0.21;p=0.04) with USN knowledge. Constraint-induced movement therapy (71.3%, n=67) was the most common used USN treatment while Albert's test (18.1%,n=17) was the most utilized screening tool for USN.
Conclusion(s): This study provides insight into the current interventions for post-stroke unilateral spatial neglect. A plethora of intervention studies has been explored to ameliorate neglect symptoms post-stroke. Both positive and negative results were obtained. Interventions incorporating more than one treatment were in preponderance. Very few physiotherapists had good knowledge of USN. Participants' knowledge increased as they attain higher education levels relating to neurological physiotherapy. Findings emphasize the need for specialist rehabilitation training needs of physiotherapists.
Implications: 1. Combined modality therapy and prism adaptation therapy for post-stroke unilateral spatial neglect show more promise in ameliorating neglect symptoms.
2. This study provides evidence in support of the specialist rehabilitation training needs of physiotherapists in Nigeria.
2. This study provides evidence in support of the specialist rehabilitation training needs of physiotherapists in Nigeria.
Funding, acknowledgements: This work was supported by the University of Witwatersrand Faculty of Health individual research grant [grant number001.283.8491105.5121105.000000.0000000000.4550].
Keywords: Stroke rehabilitation, Perceptual disorder, Neurology
Topic: Neurology: stroke
Did this work require ethics approval? Yes
Institution: University of the Witwatersrand
Committee: Witwatersrand Committee for Research on Human Subjects
Ethics number: NHREC/01/01/2007-30/07/2018 and M180155
All authors, affiliations and abstracts have been published as submitted.
