Mary Warren

Preliminary Validation of a Vision-Dependent Activities of Daily Living Instrument on Adults With Homonymous Hemianopia

OBJECTIVE This study sought to validate the use of the Self-Report Assessment of Functional Visual Performance (SRAFVP) as a measure of the severity of activity of daily living (ADL) limitations in people with homonymous hemianopia (HH). METHOD Thirty adults with HH from stroke rated their level of difficulty in completing the SRAFVP. RESULTS The Cronbachs αs of the SRAFVP and its three subscales (Reading, Eye-Hand Coordination, and Functional Mobility) ranged from .73 to .99. All three subscales were significantly correlated with each other and with the total SRAFVP score. Paired t tests revealed that Functional Mobility was significantly less difficult for participants to complete than Reading or Eye-Hand Coordination. Participants with complete HH reported greater difficulty in completing the Reading tasks than those with macular sparing. CONCLUSION The SRAFVP demonstrated acceptable reliability and validity in evaluating the severity of ADL impairment in people with HH.

Results from a survey of occupational therapy practitioners in low vision rehabilitation.

The purpose of this study was to provide practitioners working in low vision rehabilitation with a means for comparing service provision, including assessment, intervention, and program evaluation strategies, across a range of treatment facilities in the United States. Occupational therapy practitioners providing low vision services (N = 34) completed an online survey to address: (1) practitioner backgrounds in occupational therapy and low vision, (2) design, type, and location of practice, (3) client diagnoses and demographics, (4) referrals to and from occupational therapy, (5) types of assessments used, (6) types of interventions provided, and (7) follow-up and program evaluation procedures. Descriptive statistics were calculated for all items. Results suggest that practitioners seek adequate continuing education; use a combination of self-designed and standardized assessment procedures, and both remedial and compensatory intervention strategies; frequently refer to other low vision professionals; and provide services primarily to older adults through a medical rehabilitation model.

Client and therapist perspectives on the influence of low vision and chronic conditions on performance and occupational therapy intervention.

OBJECTIVE We explored how vision loss and comorbid chronic conditions influence occupational therapy intervention by gathering perspectives from occupational therapists treating clients with low vision and from older adults with low vision. METHOD We surveyed 59 occupational therapists on the frequency of comorbidities in their clients and their influence on low vision intervention. Eight older adults with low vision participated in in-depth interviews and observations on the influence of low vision and comorbidities on their occupational performance. Conclusions reflect data analysis from both methods. RESULTS The occupational therapists modified low vision interventions to address the added effect of each comorbidity. Modifications included more treatment sessions, home visits, referrals to other professions, and provision of strategies to address comorbidities. The older adults viewed vision loss as a stronger influence than comorbidities on independence in daily occupations. CONCLUSION Both vision loss and comorbidities influence occupational performance, supporting the need for interventions to address both conditions.

Clinical Application of Low Vision Rehabilitation Strategies After Completion of a Computer-Based Training Module

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.

Visual Concerns that Interfere with Daily Activities in Patients on Rehabilitation Units: A Descriptive Study

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.

Low Vision Rehabilitation Curriculum: A Design Using the AOTA Standards for Continuing Competence.

This paper describes development of a comprehensive Web-based distance education occupational therapy (OT) curriculum leading to a graduate certificate in low vision rehabilitation. The program was designed as post-professional education to develop continuing professional competence in OT practitioners in this specialty area of practice. The AOTA Standards of Continuing Competence were used as part of the framework for curriculum development. The rationale for using the standards as a curriculum framework is discussed with examples of the way in which it was used to guide development of course content and instructional materials. Outcome evaluation results indicate that the curriculum adds positive value to the practice of occupational therapists completing the program.

Revised Self-Report Assessment of Functional Visual Performance (R–SRAFVP)—Part II: Construct Validation

OBJECTIVE. We describe the development and content validation of the revised Self‐Report Assessment of Functional Visual Performance (R‐SRAFVP). METHOD. The content validation process consisted of three stages: (1) three occupational therapy experts in low vision rehabilitation revised items on the 38‐item SRAFVP via written feedback and semistructured interview, (2) eight occupational therapy low vision experts evaluated items for relevance and provided feedback on the rating scale, and (3) five adults with low vision provided feedback on item clarity via cognitive interviewing. RESULTS. In Stage 1 review, 21 items were added, totaling 59 items. In Stage 2 evaluation, 9 items were eliminated, resulting in the 50‐item R‐SRAFVP with a 4‐point scale. The scale content validity index of the R‐SRAFVP was .9. Stage 3 cognitive interviewing provided no substantive changes in content. CONCLUSION. R‐SRAFVP content was relevant to evaluate the ability of adults with low vision to complete vision‐dependent daily tasks and was understandable by these participants. &NA; The R‐SRAFVP was shown to be relevant to the evaluation of the ability of adults with low vision to complete vision‐dependent ADLs.

Accessible Fall Prevention Interventions for Older Adults With Low Vision

Objectives: To assess fall prevention services and provide information on tailoring interventions for older adults with low vision. Methods: A phenomenological qualitative design was conducted using semistructured interviews of visually impaired older adults. Interviews were audio recorded and transcribed verbatim for analysis. Results: Despite frequent falls, participants received limited fall interventions. Participants described key elements of an accessible intervention including visually accessible handouts tailored for visually impaired persons, multiple delivery methods, and an accessible location. Conclusions: Participants affirmed a lack of fall prevention services and provided insight into how to design educational interventions for older adults with vision impairment.

Validation of a Reading Assessment for Persons With Homonymous Hemianopia or Quadrantanopia

OBJECTIVE To preliminarily validate the Visual Skills for Reading Test (VSRT) for assessing reading performance in persons with homonymous hemianopia (HH) or quadrantanopia. DESIGN Retrospective chart review. SETTING University-based outpatient low vision rehabilitation center. PARTICIPANTS Persons (N=38) with HH or quadrantanopia who completed the VSRT. INTERVENTIONS Validation procedures included testing for equivalence of the 3 test versions, estimation of internal consistency reliability, and known-group comparison using VSRT results from previous studies of adults with normal vision and central field loss. MAIN OUTCOME MEASURES Corrected reading rate, reading accuracy rate, type and number of reading errors, and completion time were recorded and evaluated. RESULTS Cronbach α for the VSRT across all participants was .80, which indicated good internal consistency. A known-group comparison showed that persons with a visual field deficit read significantly slower than did normally sighted adults (t580=10.13; P<.0001). Persons with quadrantanopia read significantly faster than did persons with HH (t36=2.25; P=.03) or those with central field loss (t48=3.17; P=.0027). These findings confirmed that the VSRT correctly discriminated between groups in terms of reading performance. CONCLUSIONS Preliminary validation results indicate that the VSRT demonstrates adequate evidence of reliability and validity to evaluate reading performance in adults with HH or quadrantanopia.

Health Literacy in Older Adults With and Without Low Vision

OBJECTIVE In this study, we investigated whether older adults with low vision (LV) from age-related macular degeneration (AMD) demonstrated lower functional health literacy than older adults without LV. METHOD Fifty adults with AMD were matched with adults without LV on age, gender, education, and income. We measured visual acuity, contrast sensitivity, and reading speed and administered the Test of Functional Health Literacy in Adults (TOFHLA) using two test time conditions, standard and unlimited, to measure health literacy levels. RESULTS The group with LV had considerably lower TOFHLA scores for both time conditions (p < .001) and took notably longer to complete the test (p < .001). Poorer acuity correlated with lower TOFHLA scores in the group with LV. CONCLUSION Older adults with LV may take longer to read and understand health information, which has important implications for providing health education to support self-management. Modifying components of the reading task may facilitate reading performance and understanding of health education materials.