A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial.
Verity Longley, Kate Woodward-Nutt, Ailie J Turton and 9 others
PMID 36285484WHAT IT FOUND
Adding brief prism adaptation training to routine occupational therapy for stroke patients with spatial inattention showed no benefit.
The intervention was feasible and acceptable to patients and therapists, but the authors concluded it is not worth pursuing in a larger trial.
Key findings
01The study was a feasibility trial designed to test if a larger trial was possible, not to prove if the treatment works.
02None of the outcome measures showed any sign of benefit from the prism adaptation training compared to standard care.
03The authors explicitly stated they cannot justify taking this specific prism adaptation intervention to a definitive trial.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study was a pilot/feasibility trial with a small sample size (53 participants) and was not powered to detect small but potentially real effects. Blinding of outcome assessors was largely impossible, with 87% of 3-week and 79% of 12-week assessments performed by unblinded staff, which could introduce bias. The dose of prism adaptation (median 8 sessions of ~5 minutes) may have been too low compared to other studies that suggest more intensive protocols are needed for lasting effects. One-third of the patients who screened positive for inattention were physically unable to participate in the intervention, limiting the generalisability of the findings to more severely impaired patients.
Declared interests
The authors declared no potential conflicts of interest. The research was funded by the National Institute for Health Research (NIHR), The University of Manchester, and the Stroke Association.
The easy way to misread this
Do not interpret the lack of statistical significance as proof that prism adaptation never works for any patient. The authors note that their protocol was low-dose (5 minutes) and early post-stroke, and other studies using more intensive protocols or different populations have reported different results. This paper only rules out this specific brief intervention for this specific early-stroke group.