Change in rehabilitation needs and activity limitations over time of adults with acquired visual impairment following entry to a low vision rehabilitation service in England

Abstract

Longitudinal changes in priority rehabilitation needs, vision-related activity limitation and importance of visual goals were evaluated in a sample of people with a visual impairment over a year following entry to low vision rehabilitation services in England. Methods: Participants were adults with newly registered visual impairment within Leicestershire. Priority scores, indicating the level of rehabilitative need, were determined from the importance and difficulty scores of the 48 goals of the Participation and Activity Inventory (PAI). Rasch analysis of the difficulty and importance scores examined activity limitation and importance separately. PAI outcome measures were assessed on entry to rehabilitation services and at 4 and 12 months thereafter.Results: Forty-eight participants (mean age 74.2, SD 14.1 years) completed three visits. Overall, there was a statistically significant reduction in the perceived need for rehabilitation over time (p < 0.001, η p 2 = 0.29), driven by reduced perceived difficulty (p < 0.001, η p 2 = 0.32) but stable importance (p = 0.73) of goals, with most change occurring between baseline and 4 months. PAI goals with greatest rehabilitative need at study entry were reading, mobility and writing, and these remained of highest priority over time. The greatest priority score decrease was for the goal 'Hobbies and crafts'. The largest decrease in importance was for 'Mobility outdoors', whereas 'Relationship with loved ones' increased most.Conclusions: Despite a decline in the perceived need for rehabilitation over the study period, there remains a need for continued support and intervention at 12 months following registration with rehabilitation services, particularly for the key goals of reading, writing and mobility. Early identification and support for individuals' important but difficult goals could prevent such goals being relinquished.Goals concerning relationships and communication became more important over time, indicating that re-evaluation of needs at follow-up is necessary to inform ongoing service provision.

Outcomes of Telerehabilitation Versus In-Office Training With Magnification Devices for Low Vision: A Randomized Controlled Trial

“…Simple and multiple linear regressions checked for significant differences between randomized groups or other potentially influential factors (covariates) that were previously related to visual ability measured with the Activity Inventory. 28 – 31 Multiple logistic regressions evaluated whether there were any significant factors related to the odds of trial completion versus withdrawal, or the odds of proficiency with the magnifier at the initial telerehabilitation session. Proficiency with the magnifier was determined by the vision rehabilitation provider who observed whether they were using it correctly while performing the reading tasks during the telerehabilitation session; key reasons for nonproficiency are listed in Table 1 .…”