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

Background Visuospatial 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. Methods PsycInfo, 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. Results A 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 ( ß =0.275, p <0.05). Conclusions Most 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. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement Nele Demeyere (Advanced Fellowship NIHR302224) is funded by the National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes * BIT : Behavioural Inattention Task JBI : Joanna Briggs Institute