The natural recovery of visuospatial neglect: a systematic review and meta-analysis

BackgroundVisuospatial neglect is a common consequence of stroke and is characterised by impaired attention to contralesional space. Currently, the extent and time course of recovery from neglect are not clearly established. This systematic review and meta-analysis aimed to determine the natural recovery trajectory of post-stroke neglect. MethodsPsycInfo, Embase, and MEDLINE were searched for articles reporting recovery rates of neglect after stroke. Time since stroke was categorised into early (0-3 months), mid (3-6 months), or late (>6 months) recovery phases. Random-effects models for pooled prevalence were generated for each phase, and potential sources of heterogeneity were explored with meta-regressions. Methodological quality of each study was assessed using the Joanna Briggs Institute checklist, with low-quality studies excluded in sensitivity analyses. ResultsA total of 27 studies reporting data from 839 stroke survivors with neglect were included. Meta-analyses indicated a recovery rate of 42% in the early phase, which increased to 53% in the mid-recovery phase. Additional recovery in the late phase was minimal, with an estimated 56% recovery rate. Estimates were robust to sensitivity analyses. Meta-regressions showed significantly greater recovery in studies which included patients with left-hemisphere lesions ({beta}=0.275, p<0.05). ConclusionsMost natural recovery from neglect occurs in the first three months, although additional gains can be expected up to 6 months post-stroke. Whilst a large proportion of patients recover from neglect, over 40% show persistent symptoms. Further research is needed on effective rehabilitation interventions, particularly focusing on patients most at risk of chronic visuospatial neglect.