From evidence to action: Italian recommendations for the diagnosis and treatment of spatial neglect in stroke patients

BACKGROUND: Spatial neglect is a common and disabling cognitive consequence of stroke, associated with reduced functional independence, prolonged hospitalization, and increased healthcare and societal burden. OBJECTIVE: The aim of this paper is to describe the development of a Clinical Practice Guideline (CPG) for the diagnosis and treatment of spatial neglect in stroke patients. METHODS: The guideline was developed by an interdisciplinary expert Panel following the GRADE approach, supported by systematic reviews of the literature. Four clinical questions addressed the effectiveness of prism adaptation therapy (PAT) and visuospatial training (VST), optimal timing of treatment initiation, and the accuracy of neglect-specific versus generic ADL assessment tools. RESULTS: Evidence from randomized controlled trials indicates that both PAT and VST yield small, short-term improvements in ADL performance and neglect severity; however, overall certainty of evidence remains very low due to methodological limitations. Based on this evidence, the Panel developed two conditional recommendations in favor of using PAT and VST for the rehabilitation of patients with peri-personal neglect. No studies examined optimal timing, leading the Panel to issue Good Practice Statements recommending initiation within 4-7 days post-stroke. Observational evidence supports the use of neglect-specific tools, particularly the Catherine Bergego Scale (KF-NAP version) and the semi-structured Zoccolotti scale, which outperform generic ADL measures. CONCLUSIONS: This CPG represents the first coordinated national effort in Italy to standardize the diagnosis and rehabilitation of post-stroke spatial neglect within the National Health Service. The CPG provides two conditional recommendations for treatments along with practical indications to support implementation and future research.