The Effectiveness of Low Vision Rehabilitation on Occupational Performance and Quality of Life among

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The Effectiveness of Low Vision Rehabilitation on
Occupational Performance and Quality of Life
among Older Adults with Low Vision

• Faculty Investigators Shirley J. Jackson, MS,
  OTR/L, FAOTA Anne L. Morris, Ed.D.,OTR/L, SCEM,
  FAOTA, CAPS
• Student Investigators Sonya Finklin, MSOT
  Candidate Christina Popoola, MSOT Candidate

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Purpose

• The purpose of this study was to investigate the
  effectiveness of occupational therapy low vision
  rehabilitation for older adults with low vision.
• The objective of this research was to determine
  if the participants occupational performance and
  quality of life has been enhanced or weakened
  following low vision rehabilitation.

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Background

• In the United States, vision impairment affects
  approximately 21 of adults 65 years of age and
  older (7.3 million persons), including low
  vision, (Lighthouse International, 2001).
• The aging population in the U.S. and documented
  annual rise in low vision incidence indicates
  that the number of older adults with low vision
  impairments will continue to increase over the
  next half century (Leat, Fryer, Rumney, 2004).

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Significance

• In this study a vision-specific quality of life
  assessment was used in a clinical setting to
  evaluate low-vision rehabilitation strategies and
  management. Original research involved one
  hundred fifty patients with low vision who
  completed the low-vision questionnaire before and
  after their rehabilitation.
• Those results showed that the assessment
  quantified the quality of life of those clients
  with low vision indicating an improvement in the
  patients after receiving low-vision
  rehabilitation (Wolffsohn, 2000).

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Significance(continued)

• Girdler et al (2008) conducted a study that
  examined the impact of age-related vision loss,
  identified the factors that influence adaptation,
  and described the perceived problem areas in the
  daily lives of older adults.
• Findings showed that the importance of occupation
  is adaptation to vision loss and how their
  vision loss was perceived that served as a
  significant marker and pivotal point in their
  lives.

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Significance(continued)

• Conversely, others have reported that extended
  education in the use of low vision aids resulted
  in significantly improved ability to read,
  increased perception of quality of life, higher
  satisfaction with service, and more frequent use
  of low vision aids (Shuttleworth, Dunlop,
  Collins, James, 1995).

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Operational Definitions

• Occupational Performance is operationally defined
  as improved activity potential in areas of
  distance vision, mobility, level of lighting for
  use in reading and fine work, and activities of
  daily living.
• Quality of Life is defined as the satisfaction
  achieved from exploring yourself, living to your
  potential and finding balance in your everyday
  life through personal and professional
  activities.

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Operational Definition(cont.)

• Low Vision is a level of visual impairment
  where functional limitations of the eye(s)
  manifest as reduced visual acuity or contrast
  sensitivity, visual field loss, visual
  distortion, or altered visual perception.
• It is defined as permanent visual impairment
  that is not correctable with spectacles, contact
  lenses, or surgical intervention and interferes
  with normal everyday activities.

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Research Question Hypotheses

• Research Question
• What is the impact of occupational therapy low
  vision rehabilitation on the occupational
  performance of older adults with low vision?
• Hypothesis1 Older adults with low vision who
  receive occupational therapy low vision
  rehabilitation will demonstrate more independence
  in their occupational performance skills, such as
  mobility, reading and writing, and activities of
  daily living.
• Hypothesis2 Older adults with low vision who
  receive occupational therapy low vision
  rehabilitation will report improvements in their
  quality of life as measured by the Low Vision
  Quality of Life (LVQOL) questionnaire.

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Research Design

• An ABA single case study design was used to
  determine the effectiveness of low vision
  training on occupational performance among older
  adults with low vision.
• This pretest-posttest design with low vision
  rehabilitation intervention occurred 1 time per
  week for 4 weeks.
• This design was used to (1) establish the level
  of functioning before low vision training, (2) to
  monitor and make adaptations during low vision
  training, (3) and to track the change in function
  after the intervention was completed.

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Participants

• A convenience sample of 6 participants diagnosed
  with low-vision disorders were recruited from
  Howard University Hospital, Department of
  Ophthalmology, Low Vision Clinic for this study.
  
• All participants met the inclusion criteria that
  consisted of (1) 50 years of age or older, (2)
  diagnosis of low vision impairment (worse than
  20/70 but no worse than 20/400 visual acuity in
  the better-seeing eye, (3) No evidence of severe
  cognitive deficits or dementia, (4) English
  language fluency, and (5) potential or current
  use of low vision assistive devices.
• Signed consent forms were required of all
  volunteer participants. The study protocol and
  consent forms was submitted to and approved by
  Howard University Institutional Review Board.

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Instrumentation

• A questionnaire consisting of 25 questions was
  developed by the Victorian College of Optometry.
  The 25-item Low Vision Quality of Life
  Questionnaire (LVQOL) was used to measure the
  impact of visual impairment on aspects of daily
  living, such as self care, mobility, reading and
  fine work, and quality of life.
• Each of the questions in the questionnaire were
  written in large print to address the
  participants visual impairment. Assistive
  technology for text magnification was available
  if needed.

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Instrumentation(continued)

• The LVQOL addresses issues related to quality of
  life reduction in those with low vision and is
  able to quantify the benefit of low-vision
  rehabilitation (Wolffsohn, 2000).
• The Low Vision Quality of Life Questionnaire has
  a high internal consistency (? 0.88) and good
  reliability (0.72).

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Procedures

• Participants were recruited through clinic
  referrals from the Howard University Hospital,
  Departments of Ophthalmology and Optometry,
  Washington, DC to their Department of
  Ophthalmology Low Vision Rehabilitation Clinic.
• Under the direct supervision of a registered
  occupational therapist, the student researchers
  introduced and explained the purpose of the
  study, and administered the questionnaire before
  and after the intervention.

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Procedures included
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Data Collection

• An initial evaluation was performed using the
  Columbia Lighthouse for the Blind evaluation
  form, which is specifically geared toward persons
  with low vision.
• The LVQOL was administered to the participants in
  low vision clinic before their rehabilitation and
  a second LVQOL was administered upon discharge
  from low vision rehabilitation services.
• Six participants completed the initial pre test
  assessment one person did not complete the post
  test and was removed from the study. The overall
  response rate was high, 83, supporting the
  importance of low vision rehab.

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Data Analysis

• A t-test design was used to analyze the data and
  determine if there was a statistically
  significant difference in occupational
  performance and quality of life means before and
  after the intervention.
• Analysis of the occupational performance and
  quality of life data was performed using the
  Statistical Package for the Social Science (SPSS)
  17 software (SPSS Inc., Chicago, Illinois). For
  the purposes of validation and reliability, the
  data was entered twice to lower the error rate of
  the recorded survey information.

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Results

• A total of 5 participants (3 females and 2
  males) were a part of this study. The majority of
  the participants were between the ages of 50-60
  years of age (60), the remaining participants
  were between the ages of 61-70 years of age
  (40). Of the participants, 20 have had low
  vision for 6 months 2years, 40 for 2-7 years,
  and 40 for 7 years or more. Of the participants,
  2 participants work full-time jobs, 1 participant
  works part-time, and 2 participants are retired
  and do not work outside the home.

Figure 1. represents the percentages of the study
participates and their visual diagnoses
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Results
Visual difficulty with distance vision,
mobility, and lighting show improvement between
the pre and post for all 5 participants. Note
that all 5 participants reported some
tangibleimprovement in distance vision, mobility
or lighting post treatment. This is a critical
area because it creates the backdrop for all
other areas of functioning.
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Results
Reading and fine work showed a mean increase from
pretest to posttest for all participants.
Occupational performance showed the greatest
improvement in performance per participant.
Increases made for participants 1, 2 and 3 were
significant at plt.05.
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Results
Occupational performance in activities of daily
living showed a mean increase between the pre and
posttest for all participants. Significance was
shown only for Person 2. This area is of great
significance in occupational performance because
it is the foundation of occupational therapy.
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Results
All 5 participants reported a better quality of
life as a result of low vision rehab
intervention. While persons 4 and 5 showed the
lowest minimum increase between pretest and
posttest, the other 3 participants reported a
significantly more positive difference in their
quality of life following low vision
rehabilitation.
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Discussion

• Appropriate hypotheses research questions were
  pursued. Occupational performance and quality of
  life improvements suggest outcomes were a result
  of clients participation in occupational therapy
  low vision rehabilitation services.
• Opportunities for future research could include
• Exploration of other models of low vision
  rehabilitation research.
• Elements of rehabilitation programs, such as
  number of clinic visits, remain critical in order
  to explore strategies that improve the quality of
  life.

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Limitations to this Study

• Very small sample size
• Limited access to assistive devices for use at
  home by clients followed their discharge from
  clinic setting.
• Exploration of grant availability is underway
  that might facilitate purchase of assistive
  products found useful by clients who are seen in
  this clinic.

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References

• Babbie, E. (2004). The Practice of Social
  Research, Tenth Edition. Belmont
  CaliforniaThomson / Wadsworth Learning.
• Copolillo, A. T. (2005). Aquisition and
  integration of low vision assistive devices
  Understanding the decision-making process of
  older adults with low vision. American Journal of
  Occupational Therapy, 59, 305-313.
•  
• Culham, L. R. (2002). Low vision services for
  vision rehabilitation in the United Kingdom.
  British Journal of Ophthamology, 86, 743-747.

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References(continued)

• Girdler, S. P. (2008). The Impact of Age-Related
  Vision Loss.
• Occupational Therapy Journal ofResearch,
  110-120.
•  
• Hinds, A. S. (2003). Impact of an
  interdisciplinary low vision service on the
  quality of life of low vision patients. British
  Journal of Ophthamology, 87, 1391-1396.
•  
• International, L. (2001). The Lighthouse National
  survey on vision loss The experience, attitudes
  knowledge of middle-aged and older Americans.
  Retrieved November 7, 2008, from
  http//www.lighthouse.org/pubs_lhsurvey_findings.h
  tm
•  
• La Grow, S. (2004). The effectiveness of
  comprehensive low vision services for older
  persons with visual impairments. Journal of
  Vision Impair Blindness, 98(11), 679-692.

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References (Continued)

• Leat, S. (2004). Outcome of low vision aid
  provision the effectiveness of a low vision
  clinic. Optometry Vision Science, 71, 199-206.
• Mogk, L. (2007). Eye conditions that cause low
  vision in adults. In G. Goodrich, Low Vision
  Self-paced Clinical Course (pp. 25-43). New York
  Ballantine.
• Shuttleworth, G. (2005). How effective is an
  integrated approach to low vision rehabilitation?
  British Journal of Ophthalmology, 79, 19-23.
•  
• Stelmack, J. (2008). Outcomes of the Veterans
  Affairs Low Vision Intervention Trial (LOVIT).
  Archives of Opthamology, 126, 608-617.

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References(continued)

• Tielsch, J. (2000). The epidemiology of vision
  impairment. In B. L. Silverstone, The lighthouse
  handbook on vision impairment vision
  rehabilitation (pp. 5-17). New York Oxford
  University Press.
• Warren, M. (2006). Employing occupational
  therpists to assist the low-vision population.
  American Journal of Occupational Therapy, 72-73.
• Wolffsohn, J. C. (2000, June). Design of the low
  vision quality of life questionnaire (LVQOL) and
  measuring the outcome of low-vision
  rehabilitation. American Journal of
  Ophthalmology, 793-802.
•  
• Wormald, R. W. (1992). Visual problems in the
  elderly population and implications for services.
  British Medical Journal, 304, 1226-1228.
•  

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Acknowledgements

• Robert A.Copeland Jr., M.D., Chair, Howard
  University Hospital (HUH), Opthamology Dept.
• Heidi Bowie, O.D., Optometrist , HUH Low Vision
  Rehabilitation Services Coordinator
• Mrs. Shirley J. Jackson, MS, OTR/L, FAOTA, Howard
  University Faculty, Student Research Advisor
• Anne Morris, Ed.D., OTR/L, FAOTA, Howard
  University Faculty, OT Supervisor, HUH Low Vision
  Rehabilitation Clinic
• Felecia Banks, Ph.D. OTR/L, Howard University,
  Chair, Occupational Therapy Department

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Questions or Comments???