Impact of visuospatial neglect post-stroke on daily activities, participation and informal caregiver burden: A systematic review

• Published in: Annals of physical and rehabilitation medicine Vol. 63; no. 4; pp. 344 - 358
• Main Authors: Bosma, Martine S., Nijboer, Tanja C.W., Caljouw, Monique A.A., Achterberg, Wilco P.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Masson SAS 01-07-2020
• Subjects: Activities of daily living; Activities of Daily Living - psychology; Aged; Aged, 80 and over; Caregiver burden; Caregiver Burden - psychology; Female; Humans; Male; Middle Aged; Participation; Patient Participation - psychology; Perceptual Disorders - etiology; Perceptual Disorders - rehabilitation; Self Care - psychology; Spatial Processing; Stroke; Stroke - psychology; Stroke Rehabilitation - psychology; Unilateral neglect; Visuospatial neglect; Participation; Stroke; Caregiver burden; Activities of daily living; Unilateral neglect; Visuospatial neglect
• ISSN: 1877-0657; 1877-0665
• DOI: 10.1016/j.rehab.2019.05.006

Visuospatial neglect (VSN) is a common cognitive disorder after stroke. The primary aim of this systematic review was to provide an overview of the impact of VSN in 3 aspects: (1) activities of daily living (ADL), (2) participation, and (3) caregiver burden. The second aim was to investigate the differences in studies focusing on populations with mean age<65 versus≥65 years.
PubMed, EMBASE, Web of Science, Cochrane Library, Emcare, PsychINFO, Academic Search Premier and CENTRAL were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool.
Of the 115 included studies, 104 provided outcomes on ADL, 15 on participation (4 studies with mean age≥65), and 2 on caregiver burden (1 study with mean age≥65). Quality assessment yielded scores ranging from 0 to 100%. VSN had a negative impact on ADL (i.e., independence during ADL and performance in self-care, household tasks, reading, writing, walking, wheelchair navigation) and participation (i.e., driving, community mobility, orientation, work). The impact of VSN on fulfilling social roles was unclear. VSN had a negative effect on caregiver burden. We found no clear age-related differences.
VSN has a negative impact not only on patients’ independence but particularly on the performance of ADL. Despite the far fewer studies of VSN as compared with ADL, VSN also seems to hamper participation and increase caregiver burden, but further research is needed. Because of the large impact, VSN should be systematically and carefully assessed during rehabilitation. A considerable number of different instruments were used to diagnose VSN. Diagnosing VSN at more than one level [function (i.e., pen-and-paper test), activities, and participation] is strongly recommended. Consensus is needed on how to assess VSN and its negative impact for research and rehabilitation practice.
PROSPERPO Registration No. CRD42018087483.