The recommendations are graded by their level (I, II) and strength (A, B, C+, C, D, D+, D-) of evidence. Definitions for the level and strength of the recommendations are presented at the end of the "Major Recommendations" field.
Clinical Practice Guidelines for Sensory Interventions
Feedback of eye movement versus control, level I (randomized controlled trial [RCT]): Grade C for proportion of eye movements and visual attention (Behavioral Inattention Test – behavioral subtests) at end of treatment, 4 weeks (no benefit demonstrated); and grade D for visual attention (Behavioral Inattention Test – conventional subtests) at end of treatment, 4 weeks (no benefits demonstrated but favoring control). Patients with subacute stroke.
Passive vestibular stimulation versus control, level II (controlled clinical trial [CCT]): Grade C+ for mobility at end of treatment, 2 weeks (clinically important benefit demonstrated without statistical significance). Patients with subacute and post-acute stroke.
Tape-recorded imagery versus control, level I (RCT): Grade C for motor function at end of treatment, 4 weeks (no benefit demonstrated). Patients with chronic post-stroke.
Sensory function training for the hand versus control, level II (CCT): Grade A for sensory function (change in location of touch, change in two-point discrimination, change in sense of elbow position, and change in stereognosis) at end of treatment, 6 weeks (clinically important benefit demonstrated). Patients with chronic post-stroke.
Sensory motor integrative intervention using the affected upper extremity versus functional intervention using compensation techniques, level I (RCT): Grade C for functional ability-meal preparation at end of treatment, 4 weeks and 8 weeks (no benefit demonstrated); and grade D for functional status (Barthel Index) at end of treatment, 4 weeks and 8 weeks (no benefits demonstrated but favoring control). Patients with subacute stroke.
Perceptual learning exercise versus control, level I (RCT): Grade C+ for total locus length eyes open and enveloped area eyes open at end of treatment, 2 weeks (clinically important benefit demonstrated without statistical significance); and grade C for total locus length eyes closed, enveloped area eyes closed, rectangular area eyes open and eyes closed at end of treatment, 2 weeks (no benefit demonstrated). Patients with post-acute stroke.
Rocking chair stimulation versus control, level I (RCT): Grade A for Brunnstrom-Fugl-Meyer and Action Research Arm Test at follow-up, 43 weeks and 5 years, Brunnstrom-Fugl-Meyer log at follow-up 17 weeks, number of patients improved more than 10% on Brunnstrom-Fugl-Meyer log at follow-up, 17 weeks and 43 weeks (clinically important benefit demonstrated); grade C for Brunnstrom-Fugl-Meyer log at end of treatment, 3 weeks and 6 weeks, and follow-up, 43 weeks (no benefit demonstrated); grade D+ for Barthel Index at follow-up, 43 weeks and 5 years (clinically important benefits favoring control demonstrated without statistical significance). Patients with subacute stroke.
Visual attention training versus visuoperception training, level I (RCT): Grade A for reaction time at end of treatment 5–10 weeks (clinically important benefit demonstrated); and grade C for visual perception skills, visual scanning/visual attention (Single Letter Cancellation Test and Double Letter Cancellation Test), right/left directional orientation, visual conceptual/visuomotor tracking (Trail Making Test A and Trail Making Test B), selective attention/visual scanning, and visual attention processing at end of treatment, 5 to 10 weeks (no benefit demonstrated). Patients with post-acute stroke.
Definitions:
Level of Evidence
Level I: Randomized controlled trials
Level II: Nonrandomized studies
Grade of Recommendation
Grade A: Evidence from one or more randomized controlled trials (RCTs) of a statistically significant, clinically important benefit (>15%)
Grade B: Statistically significant, clinically important benefit (>15%), if the evidence was from observational studies or controlled clinical trials (CCTs)
Grade C+: Evidence of clinical importance (>15%) but not statistical significance
Grade C: Interventions where an appropriate outcome was measured in a study that met the inclusion criteria, but no clinically important difference and no statistical significance were shown
Grade D: Evidence from one or more randomized controlled trials of a statistically significant benefit favoring the control group (<0%: favors controls)
Grade D+: Evidence of clinical importance (<-15% for controls) without statistical significance
Grade D-: Evidence from one or more randomized controlled trials of a clinically important benefit (<-15% for controls) that was statistically significant, where the number of participants in the study is equal to or higher than 100