One session of prism adaptation training does not increase immediate engagement in occupational therapy in people with spatial neglect early after stroke: a proof-of-concept study nested within a phase II RCT

Checketts, M. , Turton, A., Woodward-Nutt, K., Longley, V., Stocking, K., Vail, A., Bamford, A. and Bowen, A. (2023) One session of prism adaptation training does not increase immediate engagement in occupational therapy in people with spatial neglect early after stroke: a proof-of-concept study nested within a phase II RCT. medRxiv, (doi: 10.1101/2023.07.17.23292600) (PMID:PPR693195)

Abstract

Objectives: Spatial neglect, a debilitating cognitive syndrome and predictor of poor functional outcome, affects attention and awareness after stroke. Early rehabilitation is essential but neglect itself may impede participation in therapy. In a proof-of-concept study nested within an RCT, we investigated whether the oft-reported immediate effects of prism adaptation training (PAT) might enable engagement if introduced at the start of an occupational therapy session. Methods: Early after stroke we video-recorded in-patients carrying out a standardised activity in their first RCT occupational therapy session, before and after PAT (or a control therapy activity). Level of engagement was later scored by a video-rater, experienced in therapy, blind to arm allocation (intervention/control) and whether randomly presented videos were recorded pre-or post-therapy. The rater recorded engagement scores on a 100mm visual analogue scale. Treating therapists also reported, on a 3-point Likert scale, whether or not engagement changed. Results: 49 of the RCT’s 53 patients were recruited (37 PAT, 12 control), 43 of whom consented to be video-recorded. Regression analysis did not suggest improvement in engagement following one session of PAT, using the blinded expert video scoring method: mean difference (95% CI) = −0.5 (−7.4 to 6.4) mm; p=0.89). Similarly, post-hoc re-rating of engagement scores (the video-rater viewed paired pre- and post-therapy recordings but remained blind to arm allocation) excluded any material difference in engagement following PAT: mean difference (95% CI) = 1.2 (−2.5 to 4.9) mm; p=.52). Impressions of level of engagement provided by the treating occupational therapists also suggested no change: OR (95% CI) = 1.3 (0.13 to 13); p=0.81). Conclusions: Despite the need to enable neglect patients to engage in the therapy they are offered, we are confident that a single session of PAT at the start of a therapy session does not enhance immediate engagement in occupational therapy early after stroke. Our study does not address the alternative definition of engagement as a longitudinal, rapport-building process which could meaningfully be explored.

• Item Type: Articles
• Additional Information: This independent research was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0816-20016). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Authors also acknowledge funding from The University of Manchester Research Impact Scholarship (MC) and Stroke Association, UK (AB; grant number TSA LECT 2015/01 – SCOPE: Strategies to COPE with cognitive difficulties after stroke). Funders had no role in study design, execution, analysis or results interpretation.
• Status: Published
• Refereed: No
• Glasgow Author(s) Enlighten ID: Checketts, Dr Matthew
• Authors: Checketts, M., Turton, A., Woodward-Nutt, K., Longley, V., Stocking, K., Vail, A., Bamford, A., and Bowen, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: medRxiv
• Copyright Holders: Copyright © The Author(s) 2023
• First Published: First published in medRxiv 2023
• Publisher Policy: Reproduced under a Creative Commons license