We investigated the effects of offline anosognosia for hemispatial neglect on neglect severity, functional ability, mobility, and motor recovery in left hemispatial neglect (HN) patients with right hemisphere injury.Eighty-five patients were included in this retrospective study. All patients had undergone a routine neglect rehabilitation programme. Neglect and anosognosia severities were determined by the Catherine Bergego Scale. Functional Independence Measure (FIM) scores, Functional Ambulation Classification (FAC) levels, and Brunnstrom motor recovery stages were noted.The prevalence of anosognosia for HN was 81.2% (69 of 85 patients). Neglect and neglect anosognosia severities were strongly correlated (r = 0.85, p < 0.001). Patients with anosognosia had more severe hemispatial neglect. There was no difference in median FIM score between those with and without anosognosia. The severity of anosognosia negatively correlated with FIM and FAC scores. Linear mixed model analysis revealed a significant decrease in neglect scores in patients with anosognosia than in those without. Anosognosia severity also decreased through rehabilitation and the decrease in anosognosia significantly predicted neglect improvement.Our study emphasizes that neglect anosognosia is related to severe hemispatial neglect, poor functional ability, and limited mobility. Addressing neglect anosognosia may be a valuable component of neglect rehabilitation.