title: What are the functional outcomes of right hemisphere stroke patients with or without hemi-inattention complications? A critical narrative review and suggestions for further research.
abstract: OBJECTIVE
  There is widespread acceptance that patients demonstrating neglect/hemi-inattention (HI) following right hemisphere stroke (RHS) underachieve functionally compared to their counterparts without neglect. However, empirical evidence for this view needs examination. The purpose of this review is to critically appraise relevant studies that compared outcomes from RHS patients with/without hemi-attention and suggest more robust follow-up research.
  
  
  METHODS
  Twelve studies published in 1995-2013 were critically reviewed. Two independent reviewers appraised design features including sample representation, assessment and data analysis methods. Strengths and limitations were highlighted.
  
  
  RESULTS
  Results were largely inconsistent. Considerable heterogeneity within patient groups and across studies complicated interpretation. Evidence suggested average group disparity in scores between patients with and without HI at discharge but the cause of functional disparity could not be attributed specifically to HI from the data and modelling results available.
  
  
  CONCLUSIONS
  The relationship between HI status and functional recovery warrants further investigation in studies with stronger methodology to ensure rigour and robustness in the results. Pending further research, HI status should not be regarded as a key predictor of functional recovery or rehabilitation potential in patients with RHSs. This group should continue to receive appropriate therapeutic intervention aimed at maximising their functional recovery post-stroke. Implications for Rehabilitation Findings from this review demonstrate a paucity of evidence to support the presence of hemi-inattention as a key predictor of functional recovery in patients with right hemisphere stroke; as such, practitioners should take this into consideration when planning rehabilitation programmes of their patients. In the initial months following right hemisphere stroke, there are wide-ranging differences in the rate and amount of functional recovery in patients, with and without hemi-inattention. Practitioners should not limit the aspirations of their patients based on the presence or absence of hemi-inattention. This review has identified a number of measurement limitations in commonly employed assessment tools for hemi-inattention and overall functional recovery. As such, practitioners should take the limitations of specific measures into account when interpreting the results contextually and with respect to their patients' situation.
authors.affiliation: a Department of Clinical Sciences , Brunel University , London , UK.
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Stein
authors.affiliation: a Department of Clinical Sciences , Brunel University , London , UK.
authors.forename: Cherry
authors.initials: C
authors.lastname: Kilbride
authors.affiliation: a Department of Clinical Sciences , Brunel University , London , UK.
authors.forename: Frances Ann
authors.initials: FA
authors.lastname: Reynolds
mesh_terms: D001288:Attention; D000067290:Behavior Rating Scale; D007839:Functional Laterality; D006801:Humans; D010468:Perceptual Disorders / Q000175:diagnosis*; D020127:Recovery of Function; D012720:Severity of Illness Index; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation
keywords: Functional outcomes; hemi-inattention; modelling; neglect; right hemisphere; stroke