Does immersive VR improve diagnostic accuracy of post-stroke spatial neglect relative to conventional and digital tests?

Objective Assessing post-stroke spatial neglect in immersive Virtual Reality (iVR) may improve diagnostic accuracy due to its ability to combine experimental control with increased ecological validity. This study investigated the diagnostic accuracy of an iVR assessment relative to conventional and non-iVR digital tests. Additionally, feasibility was evaluated.

Stroke patients performed an iVR assessment, conventional pen-and-paper tests (3 Cancellation tests and a line bisection test), and non-iVR digital tests (Digital Cancellation and Posner test). A new Bayesian statistical method was developed to address the absence of a gold standard for neglect. Instead of conventional diagnostic cut-offs, we quantified the uncertainty of classifying patients as having neglect or not and incorporated this into estimating diagnostic accuracy. Feasibility was evaluated using recruitment and drop-out rates, sample characteristics, cybersickness and user experience.

54 stroke patients and 56 healthy controls completed the study. Both iVR and non-iVR digital tests had higher diagnostic accuracies than pen-and-paper tests, although differences were not statistically significant due to high diagnostic uncertainty (resulting from inconsistencies across tests). For 6 patients, the iVR assessment and Posner test indicated neglect, while pen-and-paper tests did not. The iVR assessment was feasible for most patients, with low cybersickness and positive evaluations.

The iVR assessment and Posner test identified spatial biases missed by conventional tests. Inconsistencies across tests highlight the complexity of neglect assessment, suggesting that future studies should explore crucial test characteristics needed for a precise and sensitive evaluation. Furthermore, results established good feasibility of iVR neglect assessment. Competing Interest Statement The authors have declared no competing interest. Funding Statement Author E.P. is funded by a grant of KU Leuven with number C14/21/046, awarded to authors E.V. and C.R.G. Author H.H. is supported by a postdoctoral fellowship of the Research Foundation Flanders (FWO 1249923N). Author C.R.G. is supported by an FWO research grant (G002323N) and FWO Odysseus (G0H7718N). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee Research UZ Leuven/KU Leuven (EC Research) gave ethical approval for this work (S61410 and G-2022-4775-R2(MIN)). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All preprocessed data produced are available online at https://osf.io/vuwjd/?view_only=fbb7eac1be994b329b0bfebafa996fed