Rehabilitation needs and activity limitations of adults with a visual impairment entering a low vision rehabilitation service in England

Abstract

Citation information: Macnaughton J, Latham K & Vianya-Estopa M. Rehabilitation needs and activity limitations of adults with a visual impairment entering a low vision rehabilitation service in England. AbstractPurpose: To evaluate outcome measures of the Participation and Activity Inventory (PAI) in a sample of adults with acquired visual impairment entering vision rehabilitation. Both Priority Scores, indicating level of rehabilitative need, and Person Measures, indicating goal difficulty, were considered. Methods: Participants were newly registered adults with visual impairment within Leicestershire, United Kingdom. The importance and difficulty of 48 goals of the PAI were assessed, as were demographic factors, clinical visual function (visual acuity, contrast sensitivity, reading function) and psychosocial function (adjustment to visual loss, depression, anxiety and fear of falling). Priority scores were calculated as the product of importance and difficulty of each goal. All questionnaires were Rasch analysed, and person and item measures of perceived difficulty with goals were derived. Results: Sixty people (mean age AE S.D. = 75.8 AE 13.8 years) took part. PAI goals with greatest rehabilitative need were reading (6.82 AE 2.91), mobility outdoors (6.55 AE 3.92), mobility indoors within an unfamiliar environment (5.52 AE 3.93) and writing (5.27 AE 3.02). Greater rehabilitative need was associated with younger age (b = À0.46, p < 0.001), and with higher depressive symptomatology (b = 0.35, p < 0.01; model R 2 34%). Goals with greatest difficulty were mending clothing (À1.95 AE 0.35 logits) and hobbies and crafts (À1.32 AE 0.23 logits). Greater difficulty was associated with higher depressive symptomatology (b = 0.39, p < 0.001), lower visual acuity (b = 0.42, p < 0.001) and lower adjustment of visual loss (b = 0.31, p < 0.01; model R 2 53%). Conclusions: Key rehabilitation needs for adults at entry to services require both optical and non-optical interventions. As rehabilitative need was not associated with the level of visual impairment, eyecare professionals should not wait until the end of medical treatment before referral for support. Similarly, rehabilitative need was associated with younger age, indicating the importance to refer younger people with sight loss at an early stage. The use of structured assessment, such as the PAI, ensures goals that have an impact upon quality of life are specifically identified. Depression screening on entry to rehabilitation is relevant as it predicts both perceived difficulty and rehabilitative need.

U.S. Optometrists' Reported Practices and Perceived Barriers for Low Vision Care for Mild Visual Loss

“…Barriers to the provision of low vision rehabilitation services are not unique to the United States, because this issue has been previously reported by investigators from other countries 6,9,[13][14][15] ; therefore, it will be important to develop global collaborative efforts and interventional programs to address this issue. Additional studies are still needed to fully understand which low vision rehabilitation interventions (e.g., magnifiers or high add powers ≥4 D) are preferred by patients with mild vision loss and most effective to improve their near visual ability and reading.…”

“…4,5 Patients with mild vision loss, defined here as best corrected acuity ranging from 20/25 to 20/70 or 0.1 to 0.54 logMAR, binocular distance visual acuity, can experience difficulty with near-reading tasks and other activities of daily living. 3,6 In addition, many rate the quality of their vision as fair or poor. 3 Although these patients do not meet the visual criteria for the International Classification of Diseases, 10th Revision, classification for category 1 low vision, they should be referred for low vision rehabilitation care if they experience any functional limitation(s) due to their visual deficit, according to the standard of care described both by the American Optometric Association's Clinical Practice Guidelines for care of the patient with visual impairment and in the Preferred Practice Patterns guidelines of the American Academy of Ophthalmology.…”

A holistic model of low vision care for improving vision‐related quality of life

“…Understanding the disease process, providing current available treatments and ensuring that the physical factors are being managed well, where possible, is paramount in halting or slowing disease progression, and hence vision loss. Macnaughton et al2019 recommend that service referral should not wait until completion of treatment but rather should occur earlier in the management process to address rehabilitative needs. In order to provide a more patient‐centred model of low vision care, the discrepancies in the definition of vision impairment also need to be reconciled.…”

Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study

“…Depression can worsen the prognosis of a chronic condition, 7 increase the need for rehabilitative care 8 and result in an increased cost to both healthcare and society 9,10 . It is therefore important that depression is detected and addressed.…”