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A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia.

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Title: A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia.
Authors: Rowe, F. J., Conroy, E. J., Bedson, E., Cwiklinski, E., Drummond, A., García‐Fiñana, M., Howard, C., Pollock, A., Shipman, T., Dodridge, C., MacIntosh, C., Johnson, S., Noonan, C., Barton, G., Sackley, C.
Source: Acta Neurologica Scandinavica. Oct2017, Vol. 136 Issue 4, p310-321. 12p.
Subjects: Hemianopsia, Visual training, Visual acuity, Randomized controlled trials, Diagnosis, Therapeutics
Abstract: Objective Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only). Methods Prospective, multicentre, parallel, single-blind, three-arm RCT across fifteen UK acute stroke units. Participants Stroke survivors with homonymous hemianopia. Interventions Arm a (Fresnel prisms) for minimum 2 hours, 5 days per week over 6 weeks. Arm b (visual search training) for minimum 30 minutes, 5 days per week over 6 weeks. Arm c (standard care-information only). Inclusion criteria Adult stroke survivors (>18 years), stable hemianopia, visual acuity better than 0.5 logMAR, refractive error within ±5 dioptres, ability to read/understand English and provide consent. Outcomes Primary outcomes were change in visual field area from baseline to 26 weeks and calculation of sample size for a definitive trial. Secondary measures included Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual, Short Form-12 questionnaires and Radner reading ability. Measures were post-randomization at baseline and 6, 12 and 26 weeks. Randomization Randomization block lists stratified by site and partial/complete hemianopia. Blinding Allocations disclosed to patients. Primary outcome assessor blind to treatment allocation. Results Eighty-seven patients were recruited: 27-Fresnel prisms, 30-visual search training and 30-standard care; 69% male; mean age 69 years (SD 12). At 26 weeks, full results for 24, 24 and 22 patients, respectively, were compared to baseline. Sample size calculation for a definitive trial determined as 269 participants per arm for a 200 degree2 visual field area change at 90% power. Non-significant relative change in area of visual field was 5%, 8% and 3.5%, respectively, for the three groups. Visual Function Questionnaire responses improved significantly from baseline to 26 weeks with visual search training (60 [SD 19] to 68.4 [SD 20]) compared to Fresnel prisms (68.5 [SD 16.4] to 68.2 [18.4]: 7% difference) and standard care (63.7 [SD 19.4] to 59.8 [SD 22.7]: 10% difference), P=.05. Related adverse events were common with Fresnel prisms (69.2%; typically headaches). Conclusions No significant change occurred for area of visual field area across arms over follow-up. Visual search training had significant improvement in vision-related quality of life. Prism therapy produced adverse events in 69%. Visual search training results warrant further investigation. [ABSTRACT FROM AUTHOR]
Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia.
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  Data: <searchLink fieldCode="AR" term="%22Rowe%2C+F%2E+J%2E%22">Rowe, F. J.</searchLink><br /><searchLink fieldCode="AR" term="%22Conroy%2C+E%2E+J%2E%22">Conroy, E. J.</searchLink><br /><searchLink fieldCode="AR" term="%22Bedson%2C+E%2E%22">Bedson, E.</searchLink><br /><searchLink fieldCode="AR" term="%22Cwiklinski%2C+E%2E%22">Cwiklinski, E.</searchLink><br /><searchLink fieldCode="AR" term="%22Drummond%2C+A%2E%22">Drummond, A.</searchLink><br /><searchLink fieldCode="AR" term="%22García‐Fiñana%2C+M%2E%22">García‐Fiñana, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Howard%2C+C%2E%22">Howard, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Pollock%2C+A%2E%22">Pollock, A.</searchLink><br /><searchLink fieldCode="AR" term="%22Shipman%2C+T%2E%22">Shipman, T.</searchLink><br /><searchLink fieldCode="AR" term="%22Dodridge%2C+C%2E%22">Dodridge, C.</searchLink><br /><searchLink fieldCode="AR" term="%22MacIntosh%2C+C%2E%22">MacIntosh, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Johnson%2C+S%2E%22">Johnson, S.</searchLink><br /><searchLink fieldCode="AR" term="%22Noonan%2C+C%2E%22">Noonan, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Barton%2C+G%2E%22">Barton, G.</searchLink><br /><searchLink fieldCode="AR" term="%22Sackley%2C+C%2E%22">Sackley, C.</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Hemianopsia%22">Hemianopsia</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+training%22">Visual training</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+acuity%22">Visual acuity</searchLink><br /><searchLink fieldCode="DE" term="%22Randomized+controlled+trials%22">Randomized controlled trials</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnosis%22">Diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Therapeutics%22">Therapeutics</searchLink>
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  Data: Objective Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only). Methods Prospective, multicentre, parallel, single-blind, three-arm RCT across fifteen UK acute stroke units. Participants Stroke survivors with homonymous hemianopia. Interventions Arm a (Fresnel prisms) for minimum 2 hours, 5 days per week over 6 weeks. Arm b (visual search training) for minimum 30 minutes, 5 days per week over 6 weeks. Arm c (standard care-information only). Inclusion criteria Adult stroke survivors (>18 years), stable hemianopia, visual acuity better than 0.5 logMAR, refractive error within ±5 dioptres, ability to read/understand English and provide consent. Outcomes Primary outcomes were change in visual field area from baseline to 26 weeks and calculation of sample size for a definitive trial. Secondary measures included Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual, Short Form-12 questionnaires and Radner reading ability. Measures were post-randomization at baseline and 6, 12 and 26 weeks. Randomization Randomization block lists stratified by site and partial/complete hemianopia. Blinding Allocations disclosed to patients. Primary outcome assessor blind to treatment allocation. Results Eighty-seven patients were recruited: 27-Fresnel prisms, 30-visual search training and 30-standard care; 69% male; mean age 69 years (SD 12). At 26 weeks, full results for 24, 24 and 22 patients, respectively, were compared to baseline. Sample size calculation for a definitive trial determined as 269 participants per arm for a 200 degree2 visual field area change at 90% power. Non-significant relative change in area of visual field was 5%, 8% and 3.5%, respectively, for the three groups. Visual Function Questionnaire responses improved significantly from baseline to 26 weeks with visual search training (60 [SD 19] to 68.4 [SD 20]) compared to Fresnel prisms (68.5 [SD 16.4] to 68.2 [18.4]: 7% difference) and standard care (63.7 [SD 19.4] to 59.8 [SD 22.7]: 10% difference), P=.05. Related adverse events were common with Fresnel prisms (69.2%; typically headaches). Conclusions No significant change occurred for area of visual field area across arms over follow-up. Visual search training had significant improvement in vision-related quality of life. Prism therapy produced adverse events in 69%. Visual search training results warrant further investigation. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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