International multidisciplinary consensus recommendations for the screening and assessment of post-stroke spatial neglect using an online Delphi method

Design: Online Delphi method with five survey rounds and one virtual meeting to achieve international multidisciplinary recommendations for the screening and assessment of spatial neglect in clinical practice.

Participants: 175 experts with ≥5 publications in spatial neglect were invited.

Main Measures: Surveys were developed from a published review. Working definitions were provided for clarity: screening (as applicable for all stroke survivors), and assessment (conducted if positive screen). Participants rated the importance of screening and assessment of each spatial neglect subtype, and preferences for measurement tools. Consensus was predefined as ≥75% agreement. Participants could also provide explanatory free text responses. After each round, participants received summarised results to inform subsequent rounds. A final meeting focused on assessment items without consensus.

Results: 66 participated in Round 1, representing 15 countries and 6 disciplines; with 29 in the final 5th Round and 9 attended the meeting. There was consensus that: all survivors should be screened for spatial neglect within 2-weeks post stroke; and those screening positive should have a comprehensive assessment of all subtypes of spatial neglect. Several tools reached consensus with shortlists for some subtypes.

Conclusion: This work presents international, multidisciplinary recommendations on screening and assessment, developed by experts from 15 countries and six disciplines; however, attrition across rounds and small consensus meeting (n=9) may limit the representativeness of some tool-specific decisions. Implementing these findings may improve the detection of spatial neglect in clinical practice. Further research exploring psychometrics (validity, reliability, sensitivity, specificity) of shortlisted tools will support a full clinical protocol.