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Hanna K, Lomas E, Rimmer S, Rowe F. Perceptions of vision care following neurological impairment: a qualitative study. BMC Health Serv Res 2024; 24:626. [PMID: 38745300 PMCID: PMC11095032 DOI: 10.1186/s12913-024-11079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Visual impairment is a common consequence of neurological impairments, and can impact a person's ability to undertake everyday tasks, affecting their confidence and mental health. Previous qualitative research in the UK has shown inequalities to exist where patients are accessing vision care after stroke, but little is known around the experiences of accessing vision care following other neurological impairments, and a lack of national guidelines prevent standardised care planning. The aim of this qualitative study is to explore the perceptions of vision care after neurological impairment, and to identify possible inequalities and support mechanisms, where it has been possible to access vision care. METHODS University ethical approval was obtained, and adults with a visual impairment as a result of a neurological impairment were offered an in-depth interview to explore their vision care experiences. Data were collected between April and November 2021 and analysed using iterative, thematic analysis (TA), informed by a social constructionist ideology. RESULTS Seventeen participants were recruited. Three overarching themes were conceptualised in relation to the participants' perception of vision care: Making sense of the visual impairment; The responsibility of vision care; and Influential factors in care quality perception. CONCLUSION Inequalities were noted by participants, with most reporting a lack of suitable vision care offered as part of their neurological rehabilitation. Participants were thus burdened with the task of seeking their own support online, and encountered inaccurate and worrying information in the process. Participants noted changes in their identity, and the identity of their family carers, as they adjusted to their vision loss. The findings from this research highlight a need for clinicians to consider the long-term impact of vision loss after neurological impairment, and ensure patients are provided with adequate support and information, and appropriate referral pathways, alleviating this patient burden.
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Affiliation(s)
- Kerry Hanna
- School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, UK.
| | - Elizabeth Lomas
- School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, UK
| | - Stephen Rimmer
- Patient and Public Involvement Representative, Liverpool, UK
| | - Fiona Rowe
- Institute of Population Health, University of Liverpool, Liverpool, UK
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Houston KE, Keilty M, Collins C, Trehan R, Mouldovan T, Stuckart K, Engelhardt N, Nadeau M, Rovito CA, Merabet LB. Development and 5-year Evaluation of Diagnosis-Specific Protocols for Visual Neuro-Rehabilitation in a Multicenter Inpatient Rehabilitation Network. Arch Rehabil Res Clin Transl 2022; 5:100246. [PMID: 36968165 PMCID: PMC10036222 DOI: 10.1016/j.arrct.2022.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To provide a retrospective evaluation of a new eye and vision rehabilitation care pathway in a U.S. multi-site inpatient rehabilitation network involving the occupational therapy (OT) staff and a consulting doctor of optometry (OD) specializing in vision rehabilitation. Design Retrospective study. Setting Two Inpatient Rehabilitation Facilities (IRFs) and 1 Long Term Acute Care Hospital (LTACH). Participants There were 2083 records reviewed (44% women, avg. age 59 years). The most common diagnoses were hemispatial neglect (19.2%), homonymous field defects (18.5%), and oculomotor cranial nerve palsies (16.7%) (N=2083). Interventions Clinical care was reviewed where diagnosis-specific protocols were developed and training was provided to OTs in order to reinforce OD-prescribed interventions during daily treatment sessions, including (1) third, fourth, and sixth ocular cranial nerve palsies (OCNPs) with prisms fitted for full time, postural adaptation training, and oculomotor re-education using pursuits, saccades, head-rotations, and binocular vision exercises including alternate cover and vergence; (2) homonymous hemianopia with training awareness of field loss, eccentric viewing, and fitting of Peli lens for optical field expansion; and (3) prism adaptation therapy (PAT) for left hemispatial neglect. Main Outcome Measures Frequency of diagnoses. Hypothesis Diagnoses with developed protocols were most common. Secondarily, feasibility and efficacy by anonymous OT survey. Results 2083 vision consults were performed over 5 years. The most common diagnoses were hemispatial neglect (n=399, 19.2%), homonymous field defects (n=386, 18.5%), and OCNPs (n=347, 16.7%). None of the OTs reported the protocols were infeasible and 63% (IQR 38%-69%) reported their patients benefited from the interventions. The survey suggested prism for OCNPs helped in 42%, and Peli lens and PAT both helped in 38%. Conclusions Data support the feasibility of this inpatient eye and vision rehabilitation care pathway which may be used as a foundation for creating or refining similar programs elsewhere. Uniform administration of IRF-based visual neuro-rehabilitation care could provide a substrate for future clinical trials to evaluate efficacy.
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Affiliation(s)
- Kevin E. Houston
- Spaulding Rehabilitation Hospital Cape Cod, Sandwich, MA
- Spaulding Hospital for Continuing Medical Care Cambridge, Cambridge, MA
- Spaulding Rehabilitation Hospital, Boston, MA
- Massachusetts Eye and Ear, Optometry and Vision Rehabilitation Service, Boston, MA
- Harvard Medical School, Department of Ophthalmology, Boston, MA
- Schepens Eye Research Institute, Boston, MA
- Corresponding author Kevin E. Houston, OD, MSc, Massachusetts Eye and Ear, 243 Charles St. Boston, MA 02114.
| | - Matthew Keilty
- Spaulding Rehabilitation Hospital Cape Cod, Sandwich, MA
| | | | - Ritika Trehan
- Spaulding Hospital for Continuing Medical Care Cambridge, Cambridge, MA
| | | | | | | | - Melanie Nadeau
- Massachusetts Eye and Ear, Optometry and Vision Rehabilitation Service, Boston, MA
- Harvard Medical School, Department of Ophthalmology, Boston, MA
- Schepens Eye Research Institute, Boston, MA
| | - Craig A. Rovito
- Spaulding Rehabilitation Hospital, Boston, MA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA
| | - Lotfi B. Merabet
- Spaulding Rehabilitation Hospital, Boston, MA
- Massachusetts Eye and Ear, Optometry and Vision Rehabilitation Service, Boston, MA
- Harvard Medical School, Department of Ophthalmology, Boston, MA
- Schepens Eye Research Institute, Boston, MA
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Keilty M, Houston KE, Collins C, Trehan R, Chen YT, Merabet L, Watts A, Pundlik S, Luo G. Inpatient Virtual Vision Clinic Improves Access to Vision Rehabilitation Before and During the COVID-19 Pandemic. Arch Rehabil Res Clin Transl 2021; 3:100100. [PMID: 33363279 PMCID: PMC7749728 DOI: 10.1016/j.arrct.2020.100100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe and evaluate a secure video call system combined with a suite of iPad vision testing apps to improve access to vision rehabilitation assessment for inpatients. DESIGN Retrospective. SETTING Two acute care inpatient rehabilitation hospitals and 1 long-term acute care (LTAC) hospital. PARTICIPANTS Records of inpatients seen by the vision service. INTERVENTIONS Records from a 1-year telemedicine pilot performed at acute rehabilitation (AR) hospital 1 and then expanded to AR hospital 2 and LTAC hospital during coronavirus disease 2019 (COVID-19) were reviewed. In the virtual visits, an occupational therapist measured the patients' vision with the iPad applications and forwarded results to the off-site Doctor of Optometry (OD) for review prior to a video visit. The OD provided diagnosis and education, press-on prism application supervision, strategies and modifications, and follow-up recommendations. Providers completed the telehealth usability questionnaire (10-point scale). MAIN OUTCOME MEASURES Vision examinations per month at AR hospital 1 before and with telemedicine. RESULTS With telemedicine at AR hospital 1, mean visits per month significantly increased from 10.7±5 to 14.9±5 (P=.002). Prism was trialed in 40% of cases of which 83% were successful, similar to previously reported in-person success rates. COVID-19 caused only a marginal decrease in visits per month (P=.08) at AR1, whereas the site without an established program (AR hospital 2) had a 3-4 week gap in care while the program was initiated. Cases at the LTAC hospital tended to be more complex and difficult to manage virtually. The telehealth usability questionnaire median category scores were 7 for Ease of Use, 8 for Interface Quality, 6 for Reliability, and 9 for Satisfaction and Future Use. CONCLUSIONS The virtual vision clinic process improved inpatient access to eye and visual neurorehabilitation assessment before and during the COVID-19 quarantine and was well accepted by providers and patients.
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Key Words
- AR, acute rehabilitation
- COVID-19, coronavirus disease 2019
- EOM, extraocular movement
- IQR, interquartile range
- IRF, inpatient rehabilitation facility
- LTAC, long-term acute care
- OD, Doctor of Optometry
- OT, occupational therapist
- Pandemics
- Rehabilitation
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- Telemedicine
- Vision, ocular
- app, application
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Affiliation(s)
- Matthew Keilty
- Spaulding Rehabilitation Hospital Cape Cod, East Sandwich, Massachusetts
| | - Kevin E. Houston
- Spaulding Rehabilitation Hospital Cape Cod, East Sandwich, Massachusetts
- Spaulding Rehabilitation Hospital, Cambridge, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Optometry and Vision Rehabilitation Service, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Schepens Eye Research Institute, Boston, Massachusetts
| | - Caroline Collins
- Spaulding Rehabilitation Hospital Cape Cod, East Sandwich, Massachusetts
| | - Ritika Trehan
- Spaulding Rehabilitation Hospital, Cambridge, Massachusetts
| | - Ya-Ting Chen
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lotfi Merabet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Optometry and Vision Rehabilitation Service, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Schepens Eye Research Institute, Boston, Massachusetts
| | - Amy Watts
- Optometry and Vision Rehabilitation Service, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Shrinivas Pundlik
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Schepens Eye Research Institute, Boston, Massachusetts
| | - Gang Luo
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Schepens Eye Research Institute, Boston, Massachusetts
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Boey DS, Warren M. Implementing an Occupational Therapy Low Vision Rehabilitation Program in Singapore. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x19877265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: This article describes the development, implementation, and evaluation of an occupational therapy (OT) low vision rehabilitation program established in a large hospital in Singapore in 2013. Methods: A logic model was used to develop a blueprint to guide program development and evaluation of the program. The targeted short-term outcomes for the first 2 years are to demonstrate program growth through an increase in referrals and meeting of clients’ needs through expressed client satisfaction and improvement in performance of daily activities. The long-term outcomes are to expand the program’s referral base and contribute to education and research in low vision rehabilitation. The steps of the logic model are described along with program evaluation results from the first 2 years of implementation. Results: The short-term outcome for program growth was met with the increase of referrals in the first 2 years. Program evaluation, however, revealed that there was limited support from some referral sources and underutilization of OT services, which need to be addressed to ensure sustainability of the program. It was difficult to establish whether the short-term outcomes for meeting clients’ needs were met due to limited outcome measures completed. Discussion: The logic model guided the steps of developing and evaluating an outpatient low vision rehabilitation program in a hospital in Singapore to determine whether the targeted outcomes were met for the first 2 years of the program. Use of this process enabled the program providers to identify weaknesses in the program and institute steps to move the program toward achievement of its long-term goals. Implications for practitioners: This blueprint can be used to guide occupational therapists developing medically based low vision rehabilitation programs for older adults.
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Affiliation(s)
| | - Mary Warren
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Choi D, Choi W, Lee S. Influence of Nintendo Wii Fit Balance Game on Visual Perception, Postural Balance, and Walking in Stroke Survivors: A Pilot Randomized Clinical Trial. Games Health J 2018. [DOI: 10.1089/g4h.2017.0126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Donmo Choi
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
| | - Wonjae Choi
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
- Institute of Rehabilitation Science, Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Institute of Rehabilitation Science, Sahmyook University, Seoul, Korea
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Grider SL, Yuen HK, Vogtle LK, Warren M. Visual concerns that interfere with daily activities in patients on rehabilitation units: a descriptive study. Occup Ther Health Care 2014; 28:362-70. [PMID: 25050649 DOI: 10.3109/07380577.2014.933946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to estimate the prevalence of patients with visual concerns that interfere with their activities of daily living (ADL) performance in physical rehabilitation units through occupational therapy assessment. Over the two-month study period, 215 adult inpatients from a physical rehabilitation hospital were evaluated using the Brief Vision Screen (BVS) through ADL. The BVS assessed four areas of visual concerns, namely left visual field, focusing, and near- and low-contrast acuity, while patients engaged in ADL. The occupational therapists identified 33% of patients who had at least one area of visual concern, with the largest proportion diagnosed with stroke (55%), followed by pulmonary disease (40%) and joint replacement (35%). When comparing the four areas of visual concerns in the BVS between the two major diagnostic groups (acquired brain injury, ABI and non-acquired brain injury, non-ABI), a significantly higher proportion of patients with ABI were identified as having left hemianopsia concerns compared to patients with non-ABI. No significant difference was observed in other areas of visual concern between the two groups. Findings indicated that visual concerns that interfere with ADL performance among older patients in rehabilitation units are common. The high proportion of patients with pulmonary disease identified as having visual concerns warranted further confirmation and investigation. Preliminary evidence to support the psychometric properties of the BVS for identifying visual concerns in patients on rehabilitation units was established.
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Affiliation(s)
- Stacy L Grider
- 1Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA
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Roche S, Vogtle L, Warren M, O’Connor KA. Assessment of the Visual Status of Older Adults on an Orthopedic Unit. Am J Occup Ther 2014; 68:465-71. [DOI: 10.5014/ajot.2014.010231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
PURPOSE. To examine the visual status of a cohort of older adults on an orthopedic unit to determine their level of available vision to complete everyday activities in the hospital setting.
METHOD. A convenience sample of 50 people was recruited. A visual history was obtained, and participants’ glasses were inspected. Distance acuity, reading acuity, and contrast sensitivity were assessed using standardized screening charts.
RESULTS. Of participants, 26% did not have their glasses with them until prompted, and 85% had glasses in poor condition. When tested wearing their habitual correction, 6% had low vision, 2% were blind, 41% had reading acuities worse than 20/25, and 28% had contrast sensitivity deficits.
CONCLUSION. Visual impairment is prevalent in older adults, yet visual function is not routinely screened in hospitals. Occupational therapists should routinely inquire about patients’ visual status, inspect their glasses, and encourage regular eye examinations. Failure to address vision could lead to inaccurate evaluation results.
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Affiliation(s)
- Sheila Roche
- Sheila Roche, MS, BSc. (Cur. Occ.), is Senior Occupational Therapist, South Infirmary–Victoria University Hospital, Old Blackrock Road, Cork, Ireland;
| | - Laura Vogtle
- Laura Vogtle, PhD, OTR/L, FAOTA, is Professor, University of Alabama at Birmingham
| | - Mary Warren
- Mary Warren, PhD, OTR/L, SCLV, FAOTA, is Associate Professor, University of Alabama at Birmingham
| | - Kieran A. O’Connor
- Kieran A. O’Connor, MSc, MB, FRCPI, is Consultant Physician in Geriatric Medicine, Mercy University Hospital, Cork, Ireland
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Nipp CM, Vogtle LK, Warren M. Clinical application of low vision rehabilitation strategies after completion of a computer-based training module. Occup Ther Health Care 2014; 28:296-305. [PMID: 24971896 DOI: 10.3109/07380577.2014.908335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study evaluated changes in occupational therapists' practice behaviors after completion of an online continuing education (CE) program delivered over a hospital Intranet system. The setting was a large rural medical system covering parts of two southeastern states. A convenience sample of 28 occupational therapists and occupational therapy assistants was recruited from the facility therapy staff. A CE module on low vision assessment and treatment was delivered using the hospital Intranet and a follow-up survey assessing practice change was carried out 8 weeks later. Most participants reported an increase in their comfort level when treating clients with low vision after course completion. Fifty percent of participants reported screening for vision impairments, increased use of environmental modifications, and more referrals to other vision specialists. Outcomes suggest that Internet-delivered CE programs can improve knowledge and affect practice.
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Affiliation(s)
- Cheri M Nipp
- 1Department of Occupational Therapy, North Mississippi Medical Center at Baldwyn Outpatient Rehab , 830 Gloster Street, Tupelo , USA
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Christy B, Keeffe JE, Nirmalan PK, Rao GN. A randomized controlled trial assessing the effectiveness of strategies delivering low vision rehabilitation: design and baseline characteristics of study participants. Ophthalmic Epidemiol 2010; 17:203-10. [PMID: 20642342 DOI: 10.3109/09286586.2010.483752] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To design a randomized controlled trial (RCT) to compare the effectiveness of four different strategies to deliver low vision rehabilitation services. METHODS The four arms of the RCT comprised-center based rehabilitation, home based rehabilitation, a mix of center based and home based rehabilitation, and center based rehabilitation with home based non interventional supplementary visits by rehabilitation workers. Outcomes were assessed 9 months after baseline and included measuring changes in adaptation to age-related vision loss, quality of life, impact of vision impairment and effectiveness of low vision rehabilitation training. The socio-demographic and vision characteristics of the sample in each of the 4 arms were compared to ensure that outcomes are not associated with differences between the groups. RESULTS Four hundred and thirty six individuals were enrolled in the study; 393 individuals completed the study. One-fifth of participants were children aged 8 to 16 years. At baseline, socio-demographic and clinical characteristics were similar between individuals in the four arms of the trial. Socio-demographic and clinical characteristics did not differ significantly, except for age, between the 393 individuals who completed the trial and the 43 individuals who dropped out of the study. Twenty six (60.46%) of the forty three drop outs were from the center based arm of the trial. CONCLUSIONS Information from this trial has the potential to shape policy and practice pertaining to low vision rehabilitation services.
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Affiliation(s)
- Beula Christy
- Dr P R K Prasad Center for Rehabilitation of the Blind and Visually Impaired, Hyderabad, India.
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Ahmadian L, Massof R. Impact of general health status on validity of visual impairment measurement. Ophthalmic Epidemiol 2008; 15:345-55. [PMID: 18850472 DOI: 10.1080/09286580802227402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the effects of bias and distortion from general health status on Rasch model-based measurements of visual function, and establish measurement equivalence across different health status groups in low vision patients. METHODS Self-reported data were obtained from 1746 low vision patients who completed the Activity Inventory (AI) and an intake health-related questionnaire prior to their first visit to the low vision rehabilitation service. Differential Item Functioning (DIF) analysis by health status and separate Rasch analyses adjusted by health status were performed on the responses to both a DIF-free scale and the full scale of the AI. RESULTS Of 48 Goal-level items, only 15 items showed significant DIF (P < 0.001). Comparing the vision-related estimates from the original full set of items with those from the DIF free scale; we found that only 25% of the person measure estimates differed by 0.5 logits or more and there was a strong intraclass correlation between the two scales in measuring the patients' vision-related functional ability (IC = 0.75). Patients' health status influenced the Rasch model based estimation of visual function by the AI (ANOVA, p = 0.005), but this effect was within accepted range of MISFIT statistics. CONCLUSION Taken together, our results indicate that despite confounding effects of general health status on vision-related ability, we can still regard visual ability to be a single theoretically constructed variable for the low vision population. It appears that self-perceived comorbidities add to vision-related disability, but do not distort its measurement.
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Affiliation(s)
- Lohrasb Ahmadian
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Riggs RV, Andrews K, Roberts P, Gilewski M. Visual Deficit Interventions in Adult Stroke and Brain Injury. Am J Phys Med Rehabil 2007; 86:853-60. [PMID: 17885320 DOI: 10.1097/phm.0b013e318151f907] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Visual deficits after cerebral injury are common. The variability in the types of injury sustained as well as their impact on function in the environment have produced multiple approaches at corrective intervention. To assess the effectiveness of these vision interventions, an extensive literature search was completed. The analysis of this review revealed some success with visual neglect disorders, but not enough evidence to comment definitively on interventions for hemianopsia, quadrantonopsia, diplopia, or convergence insufficiency. A lack of follow-up also limited efforts to assess the durability of documented gains. Additional research is necessary to clarify, quantify, and measure treatment outcomes for acquired visual dysfunction as well as to link laboratory testing to improvement in actual functioning for individuals in their environment.
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Affiliation(s)
- Richard V Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Golden SH, Hill-Briggs F, Williams K, Stolka K, Mayer RS. Management of Diabetes During Acute Stroke and Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2005; 86:2377-84. [PMID: 16344038 DOI: 10.1016/j.apmr.2005.07.306] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 05/25/2005] [Accepted: 07/20/2005] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To summarize evidence on the impact of hyperglycemia on stroke outcomes and to present therapy algorithms for inpatient management in diabetic stroke patients. DATA SOURCES Guidelines for inpatient management of diabetes were reviewed and extracted from a technical review and recommendations from 2 national diabetes and endocrine organizations. MEDLINE database searches were conducted using key words: stroke, diabetes, hyperglycemia, hypoglycemia, inpatient, hospitalized, treatment, outcomes, disability, self-management, and education. STUDY SELECTION Studies were selected that specifically addressed the impact of the following in stroke patients: hyperglycemia and diabetes on rehabilitation outcomes, management strategies for hyperglycemia and diabetes, and strategies for facilitating diabetes self-management. DATA EXTRACTION Two authors independently extracted data and management practices from selected articles and published practice guidelines. DATA SYNTHESIS Diabetes is prevalent in stroke patients and results in poorer inpatient hospital and rehabilitation outcomes. Management of diabetes in stroke patients is further complicated by impairments in mobility and vision, necessitating accommodation strategies and tools for self-management. Optimal management of hyperglycemia using insulin or oral hypoglycemic agents results in reduced morbidity and mortality among diabetic inpatients. CONCLUSIONS To achieve inpatient glycemic management targets, use of clinical management algorithms, self-management tools, and systems approaches such as diabetes management teams are useful.
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Affiliation(s)
- Sherita Hill Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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