Current clinical practice in the screening and diagnosis of spatial neglect post-stroke: Findings from a multidisciplinary international survey

Figures & data

Figure 1. Flowchart depicting respondents’ pathway through the survey.

Table 1. Characteristics of respondents.

	Demographics (N = 454)	Occupational Therapy (n = 179, 39%)	Psychology (n = 84, 19%)	Medicine (n = 70, 15%)	Physiotherapy (n = 55, 12%)	Other (n = 66, 15%)	Total
Country	UK	63	21	19	27	42	172 (38%)
	USA	71	1	5	11	11	99 (22%)
	Italy	11	47	14	0	4	76 (17%)
	Other Europe	10	15	23	7	3	58 (13%)
	Other Non-Europe, Non-USA	24	0	9	10	6	49 (11%
Length of service	Median months of experience (Min, Max)	96 (1, 408)	120 (12, 420)	204 (25, 600)	125 (4, 406)	120 (6, 420)	120 (1, 600)
Patients with neglect in past 12 mo	1 to 6	62	27	14	25	22	150
	7+	117	57	56	30	44	304
Clinical setting	Inpatient	138	62	63	41	54	358
	Not inpatient	41	22	7	14	12	96
	Outpatient	41	47	43	13	42	186
	Not outpatient	138	37	27	42	24	268
	Community	26	13	3	9	15	66
	Not community	153	71	67	46	51	388
Research involvement	None	140	37	34	47	50	308
	Investigator	14	36	26	6	7	89
	Recruitment	25	11	10	2	9	57

NB: one respondent from the psychology group, one from the medicine group, and one from the “other” group did not provide months of experience. For clinical setting, respondents were allowed to select more than one response. Underlined categorical groups served as reference categories for logistic regression analyses.

Figure 2. Percentage of respondents from each professional group who use each category of neglect assessment.

Figure 3. Number of respondents from each country who indicate their use of each category of neglect assessment.

Figure 4. Forest plots depicting logistic regression results for selection of each assessment category. Note: x-axes are on a logarithmic scale. Logistic regression results are presented as odds ratios with 95% confidence intervals.

Figure 5. Cognitive assessment selections by professional group (5A) and by country (5B).

Figure 6. Functional assessment selections by professional group (6A) and by country (6B).

Figure 7. Neurological assessment selections by professional group (7A) and by country (7B).

Figure 8. Reported neuroimaging/neuromodulation techniques by professional group (8A) and by country (8B).

Figure 9. Proportions of “use” responses according to reason for selection – institutional policy or professional choice.

Table 2. Self-reported “ideal” screening assessments as reported by 176 respondents.

Theme	No. of Respondents	Examples
Cognitive assessments	75	BIT Cancellation Tests Hearts test (from OCS) OCS
Combinatorial approaches	41	Cognitive plus functional assessments Custom combinations based on individual cases Custom approaches based on individual cases requiring particular intervention (e.g., cancellation tasks and visual scanning training) Custom combinations of individual assessments taken from batteries that are easier to administer
Functional assessments	32	CBS CBS via the KF-NAP Functional observation ADL performance
Neurological assessments	18	Neurological examination with a focus on contralesional function NIHSS Extinction tests Visual field testing fMRI
Desire for further information	12	Responses focus primarily on uncertainty surrounding range of available screening assessments Some report use of non-standardized assessments if free/accessible assessments aren’t available
Sources other than the patient	8	Information gathering from family members Information gathering from other clinicians involved in patient’s care

Column 1 shows themes emerging from free-text responses, column 2 shows the number of respondents contributing to each theme, and column 3 shows examples of each theme.

Table 3. Self-reported “ideal” diagnostic assessments as reported by 176 respondents.

Theme	No. of respondents	Examples
Combinatorial approaches	43	31 responses contained at least one cognitive element: usually combinations of cognitive assessment Cancellation/bisection/symmetry judgement combined with tests of representational neglect Cognitive and functional assessment Cognitive assessment and neuroimaging reports Cognitive and functional assessment with neuroimaging reports Cognitive assessment and reaction time measurement
Functional assessments	35	CBS CBS via the KF-NAP Functional observation ADL performance
Neurological assessments	20	Neurological examination MRI Visual scanning Visual acuity
Desire for further information	26	Any best-practice assessment as stipulated by best-practice guidelines Desire to integrate comprehensive diagnostic assessment if staffing and financial resource allowed Expertise of multidisciplinary team Several responses contained a single word: “unknown”

Table 4. Additional comments on the screening and diagnosis of neglect as provided by 100 respondents.

Theme	No. of respondents	Examples
Desire for further training	27	Little to no training in neglect screening/diagnosis at degree level Professional differences in amount of neglect-specific training Increased awareness of impact of neglect in order to generate resources for more comprehensive screening/diagnosis
Under-use of existing assessments	21	Limited understanding of how to score cognitive assessments appropriately Subjectivity in assessment scoring and interpretation fosters invalidity of assessments Dislike of large test batteries that can take too much time and are less acceptable to patients (desire for research into new, short comprehensive batteries linked to this) Lack of any assessment with clinicians’ ideal psychometric properties (high sensitivity and specificity) Incorrect combinations of assessments may also be sub-optimal
Clinician factors	26	Different clinicians prefer different approaches; beauty of a multidisciplinary team Some clinicians more dynamic in their approach than others (e.g., tailoring assessment to neglect presentation) Some clinicians experience scarcer resources than others – impact on time spent with neglect patients Pooling of neglect-specific and non-specific assessment results from different professionals within multidisciplinary team