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Published on: January 14, 2020
Significant immediate and limited long-term benefit of prism adaptation on spatial neglect: a systematic review and
YuanLiang Zhu1, Francois Quesque2, Daisuke Nishida3
1476 Neurosciences et Cognition, Université Claude Bernard Lyon 1 69675, Bron, France; INSERM U1028 CNRS UMR5292, Trajectoires team, Lyon Neuroscience Research Center (CRNL) 69500, Bron, France.
Background:
Although prism adaptation (PA) has been applied in spatial neglect (SN) for 27 years, its efficacy remains controversial and lacks consistency.
Objective:
The first aim was to assess the immediate and long-term effects of PA on SN via meta-analysis of randomized controlled trials (RCTs). The second aim was to identify potential effect modifiers of PA efficacy.
Methods:
We searched four databases up to March 2025 for RCTs comparing PA, or PA+conventional vs. shamPA, or shamPA+conventional, or only conventional in participants with SN, and assessing behavioral or neuropsychological tests (such as Catherine Bergego scale (CBS) and behavioral inattention test (BIT)). Cochrane risk-of-bias assessment tool and random-effects meta-analysis were used, and effect size was reported as Weighted Mean Difference (WMD) with 95 % CI.
Results:
Only 10 RCTs (356 participants) could be included, eight of them reporting CBS data and six for BIT. Immediate PA effects on SN showed a significant improvement for CBS between the PA group (PA/PA+conventional) and control group (shamPA/ shamPA+conventional/only conventional), all studies with prism shift ≥10°, (WMD = -2.13, 95% CI -3.93 to 0.33; P = 0.020), but non-significance for conventional BIT (BIT-C). Long-term benefit was not significant for CBS, while it was significant for BIT-C when the prism shift was ≥10° (n = 2; WMD = 12.37, 95% CI 0.53 to 24.21; P = 0.041). Linear regressions showed non-significant effect modifiers among the participant characteristics or PA intervention parameters. Subgroup analyses for CBS showed a significant immediate improvement in the larger total quantity of prism exposure (number of total trials × prism shift) subgroup (WMD = -2.73, 95% CI -5.01 to -0.44; P = 0.019), whereas the subgroup with smaller total exposure showed no significant difference.
Conclusion:
Even with stringent inclusion criteria, significant effects of PA on SN were observed in the short-term CBS (all studies with prism shift ≥10°), mainly derived from studies with total exposure ≥11250°·trials. The total quantity of prism exposure (°·trials) may be an applicable effect modifier of PA efficacy.
Trial Registration:
PROSPERO database (registration number: CRD420250650402).
