Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK.
Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK.
Health Technol Assess. 2024 Oct;28(69):1-141. doi: 10.3310/WGJT3471.
Stroke often affects recognition and interpretation of information from our senses, resulting in perceptual disorders. Evidence to inform treatment is unclear.
To determine the breadth and effectiveness of interventions for stroke-related perceptual disorders and identify priority research questions.
We undertook a scoping review and then Cochrane systematic review. Definitions, outcome prioritisation, data interpretation and research prioritisation were coproduced with people who had perceptual disorders post stroke and healthcare professionals. We systematically searched electronic databases (including MEDLINE, EMBASE, inception to August 2021) and grey literature. We included studies (any design) of interventions for people with hearing, smell, somatosensation, taste, touch or visual perception disorders following stroke. Abstracts and full texts were independently dual reviewed. Data were tabulated, synthesised narratively and mapped by availability, sense and interventions. Research quality was not evaluated. Our Cochrane review synthesised the randomised controlled trial data, evaluated risk of bias (including randomisation, blinding, reporting) and meta-analysed intervention comparisons (vs. controls or no treatment) using RevMan 5.4. We judged certainty of evidence using grading of recommendations, assessment, development and evaluation. Activities of daily living after treatment was our primary outcome. Extended activities of daily living, quality of life, mental health and psychological well-being perceptual functional and adverse event data were also extracted.
We included 80 studies ( = 893): case studies (36/80) and randomised controlled trials (22/80). No stroke survivor or family stakeholder involvement was reported. Studies addressed visual (42.5%, 34/80), somatosensation (35%, 28/80), auditory (8.7%, 7/80) and tactile (7.5%, 6/80) perceptual disorders; some studies focused on 'mixed perceptual disorders' (6.2%, 5/80 such as taste-smell disorders). We identified 93 pharmacological, non-invasive brain stimulation or rehabilitation (restitution, substitution, compensation or mixed) interventions. Details were limited. Studies commonly measured perceptual (75%, 60/80), motor-sensorimotor (40%, 32/80) activities of daily living (22.5%, 18/80) or sensory function (15%, 12/80) outcomes.
We included 18 randomised controlled trials ( = 541) addressing tactile (3 randomised controlled trials; = 70), somatosensory (7 randomised controlled trials; = 196), visual (7 randomised controlled trials; = 225) and mixed tactile-somatosensory (1 randomised controlled trial; = 50) disorders. None addressed hearing, taste or smell disorders. One non-invasive brain stimulation, one compensation, 25 restitution and 4 mixed interventions were described. Risk of bias was low for random sequence generation (13/18), attrition (14/18) and outcome reporting (16/18). Perception was the most commonly measured outcome (11 randomised controlled trials); only 7 randomised controlled trials measured activities of daily living. Limited data provided insufficient evidence to determine the effectiveness of any intervention. Confidence in the evidence was low-very low. Our clinical ( = 4) and lived experience ( = 5) experts contributed throughout the project, coproducing a list of clinical implications and research priorities. Top research priorities included exploring the impact of, assessment of, and interventions for post-stroke perceptual disorders.
Results are limited by the small number of studies identified and the small sample sizes, with a high proportion of single-participant studies. There was limited description of the perceptual disorders and intervention(s) evaluated. Few studies measured outcomes relating to functional impacts. There was limited investigation of hearing, smell, taste and touch perception disorders.
Evidence informing interventions for perceptual disorders after stroke is limited for all senses.
Further research, including high-quality randomised controlled trials, to inform clinical practice are required.
This study is registered as PROSPERO CRD42019160270.
This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128829) and is published in full in ; Vol. 28, No. 69. See the NIHR Funding and Awards Website for further award information.
中风常影响我们对感官信息的识别和解释，导致知觉障碍。目前尚不清楚针对这些障碍的治疗证据。
确定与中风相关知觉障碍的干预措施的广度和有效性，并确定优先研究问题。
我们进行了范围界定综述，然后是 Cochrane 系统综述。与中风后存在知觉障碍的患者和医疗保健专业人员共同制定了定义、结果优先排序、数据解释和研究优先排序。我们系统地检索了电子数据库（包括 MEDLINE、EMBASE，从开始到 2021 年 8 月）和灰色文献。我们纳入了针对中风后听力、嗅觉、躯体感觉、味觉、触觉或视觉知觉障碍患者的各种干预措施的研究（任何设计）。摘要和全文由两名独立审查员进行审查。将数据制成表格，以可用性、感觉和干预措施进行叙述性综合，并绘制图表。我们没有评估研究质量。我们的 Cochrane 综述综合了随机对照试验数据，使用 RevMan 5.4 评估了偏倚风险（包括随机化、盲法、报告），并对干预措施（与对照组或无治疗相比）进行了荟萃分析。我们使用 GRADE 评估、制定、发展和评估（Grading of Recommendations, Assessment, Development and Evaluation）来判断证据的确定性。治疗后的日常生活活动是我们的主要结局。还提取了扩展的日常生活活动、生活质量、心理健康和心理幸福感、感知功能和不良事件数据。
我们纳入了 80 项研究（=893 人）：病例研究（36/80）和随机对照试验（22/80）。没有报告中风幸存者或家庭利益相关者的参与情况。研究涉及视觉（42.5%，34/80）、躯体感觉（35%，28/80）、听觉（8.7%，7/80）和触觉（7.5%，6/80）知觉障碍；一些研究侧重于“混合知觉障碍”（6.2%，5/80，如味觉-嗅觉障碍）。我们确定了 93 种药理学、非侵入性脑刺激或康复（恢复、替代、补偿或混合）干预措施。细节有限。研究通常测量知觉（75%，60/80）、运动-感觉运动（40%，32/80）日常生活活动（22.5%，18/80）或感觉功能（15%，12/80）结局。
Cochrane 系统综述：我们纳入了 18 项随机对照试验（=541 人），涉及触觉（3 项随机对照试验；=70）、躯体感觉（7 项随机对照试验；=196）、视觉（7 项随机对照试验；=225）和混合触觉-躯体感觉（1 项随机对照试验；=50）障碍。没有涉及听力、味觉或嗅觉障碍。描述了一种非侵入性脑刺激、一种补偿、25 种恢复和 4 种混合干预措施。随机序列生成（13/18）、失访（14/18）和结果报告（16/18）的偏倚风险低。知觉是最常测量的结果（11 项随机对照试验）；只有 7 项随机对照试验测量了日常生活活动。有限的数据提供了足够的证据来确定任何干预措施的有效性。证据的置信度低-非常低。我们的临床（=4）和生活经验（=5）专家在整个项目中提供了意见，共同制定了一份临床意义和研究重点清单。优先研究重点包括探索中风后知觉障碍的影响、评估和干预措施。
研究结果受到研究数量少和样本量小的限制，其中很大一部分是单参与者研究。对知觉障碍和评估的干预措施的描述有限。很少有研究测量与功能影响相关的结局。没有对听力、嗅觉、味觉和触觉知觉障碍进行调查。
针对中风后知觉障碍的干预措施证据有限，涉及所有感觉。
需要进一步研究，包括高质量的随机对照试验，以为临床实践提供信息。
本研究是由英国国家卫生与保健优化研究所（NIHR）健康技术评估计划资助（NIHR 奖 REF：NIHR128829），并全文发表于 ; Vol. 28, No. 69。有关该奖项的更多信息，请访问 NIHR 资助和奖项网站。
