Validation of Web-Based Star Cancellation and Line Bisection Tests in Hemiplegic Stroke
Development and Validity of Web Based Star Cancellation Test and Line Bisection Test in the Assessment of Visuospatial Neglect in Hemiplegic Stroke Patients
1 other identifier
observational
105
1 country
1
Brief Summary
The goal of this observational study is to evaluate the clinical usability and diagnostic performance of newly developed web-based Star Cancellation and Line Bisection tests in assessing visuospatial neglect in hemiplegic stroke patients. It will also compare these digital tests with conventional paper-and-pencil assessments. The main questions it aims to answer are: Can the web-based Star Cancellation and Line Bisection tests accurately distinguish between stroke patients with and without visuospatial neglect? Do digital test parameters (such as completion time, search speed, and search patterns) provide additional clinical information beyond conventional test scores? Researchers will compare the results of the web-based tests with standard paper-and-pencil tests to evaluate their diagnostic accuracy and clinical validity. Participants will: Complete conventional paper-and-pencil Star Cancellation and Line Bisection tests Perform web-based (digital) versions of the same tests using a tablet and stylus Undergo routine clinical and cognitive assessments as part of standard care Provide demographic and clinical information
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P50-P75 for all trials
Started Apr 2026
Shorter than P25 for all trials
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
April 12, 2026
CompletedStudy Start
First participant enrolled
April 15, 2026
CompletedFirst Posted
Study publicly available on registry
April 20, 2026
CompletedPrimary Completion
Last participant's last visit for primary outcome
October 15, 2026
ExpectedStudy Completion
Last participant's last visit for all outcomes
December 1, 2026
April 20, 2026
April 1, 2026
6 months
April 12, 2026
April 12, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (2)
Laterality Index of the Digital Star Cancellation Test
The laterality index is calculated as the proportion of targets identified on the left side relative to the total number of identified targets. It is used to assess spatial bias and distinguish between participants with and without visuospatial neglect.
Baseline (single assessment during study visit)
Mean Deviation in the Digital Line Bisection Test
Mean deviation represents the average distance between the participant's marked midpoint and the true midpoint of horizontal lines. It is used as a quantitative measure of spatial bias.
Baseline (single assessment during study visit)
Secondary Outcomes (7)
Omitted Targets in the Digital Star Cancellation Test
Baseline (single assessment during study visit)
Completion Time of the Digital Star Cancellation Test
Baseline (single assessment during study visit)
Search Speed in the Digital Star Cancellation Test
Baseline (single assessment during study visit)
Ineffective or Off-Target Responses in the Digital Star Cancellation Test
Baseline (single assessment during study visit)
Variability of Performance in the Digital Line Bisection Test
Baseline (single assessment during study visit)
- +2 more secondary outcomes
Other Outcomes (1)
Participant-Reported Feasibility of the Digital Tests
Baseline (single assessment immediately after test completion)
Study Arms (3)
Stroke patients with visuospatial neglect
The diagnosis of visuospatial neglect will be established using standard paper-and-pencil neuropsychological assessments routinely applied in clinical practice, including the Star Cancellation Test, Line Cancellation Test, Line Bisection Test, Letter Cancellation Test, figure copying tasks, and clock drawing test, along with the Catherine Bergego Scale. To classify a participant as having visuospatial neglect, pathological findings must be present in at least two of these assessments, with at least one being a performance-based paper-and-pencil test. These assessments are part of routine clinical evaluation in stroke patients.Digital test results will not be used for diagnostic classification.
Stroke patients without visuospatial neglect
Control Group
Age- and sex-matched healthy control individuals without a history of neurological disease
Interventions
The intervention consists of a web-based Line Bisection Test developed by the study investigators for the assessment of visuospatial neglect. This test is implemented as a browser-based application that can be accessed on standard devices without requiring software installation and is administered using a tablet and stylus pen to ensure consistent interaction. The digital Line Bisection Test follows the conventional paradigm in which participants are asked to mark the midpoint of horizontal lines. In the digital version, line positions vary across trials, and deviation from the true midpoint is calculated automatically, along with measures of variability.
The intervention consists of a web-based Star Cancellation Test developed by the study investigators for the assessment of visuospatial neglect. This test is implemented as a browser-based application that can be accessed on standard devices without requiring software installation and is administered using a tablet and stylus pen to ensure consistent interaction. The digital Star Cancellation Test is based on the conventional paper-and-pencil version and includes both target and distractor stimuli. In addition to standard scoring, it automatically records performance measures such as the number of omitted targets, laterality index, completion time, search speed, and search path characteristics.
Eligibility Criteria
The study population consists of adult patients with hemiplegic stroke who are admitted to our physical medicine and rehabilitation clinic, as well as age- and sex-matched healthy control individuals without a history of neurological disease.
You may qualify if:
- Age 18 to 80 years
- First-ever ischemic or hemorrhagic stroke
- Hemiplegia secondary to stroke
- Stroke in the subacute or chronic phase, defined as 1 to 24 months after stroke onset
- Ability to provide written informed consent
You may not qualify if:
- History of neurological or severe psychiatric disease before stroke that could significantly affect cognitive function or attention, such as brain tumor, traumatic brain injury, vasculitis, multiple sclerosis, or schizophrenia
- Severe visual field defect not attributable to visuospatial neglect, such as isolated homonymous hemianopia
- Severe upper extremity motor impairment or apraxia preventing interaction with the tablet or stylus pen
- Inability to understand test instructions, cooperate with the assessment, or complete the evaluation process
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Istanbul Medeniyet University Goztepe Prof Dr Suleyman Yalcin City Hospital
Istanbul, Kadikoy, 34722, Turkey (Türkiye)
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Central Study Contacts
Study Design
- Study Type
- observational
- Observational Model
- CASE CONTROL
- Time Perspective
- CROSS SECTIONAL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- MD
Study Record Dates
First Submitted
April 12, 2026
First Posted
April 20, 2026
Study Start
April 15, 2026
Primary Completion (Estimated)
October 15, 2026
Study Completion (Estimated)
December 1, 2026
Last Updated
April 20, 2026
Record last verified: 2026-04
Data Sharing
- IPD Sharing
- Will not share
Individual participant data will not be shared due to privacy and confidentiality considerations, and because the data were collected for a single-center academic study.