Environmental and behavioural interventions for reducing physical activity limitation in community-dwelling visually impaired older people.

BACKGROUND: Impairment of vision is associated with a loss of function in activities of daily living. Avoidance of physical activity and consequent reduced functional capacity is common in older people with visual impairment and an important risk factor for falls. Indeed, the rate of falls and fractures is higher in older people with visual impairment than age-matched visually normal older people. Depression and anxiety is common in older people with vision impairment and leads to further restriction of activity, reduced social contact and reduced quality of life. Possible mechanisms to reduce activity restriction and therefore improve mobility and activity include environmental and behavioural interventions delivered by a number of health professionals, including occupational therapists. OBJECTIVES: The objective of this review was to assess the effectiveness of environmental and behavioural interventions in reducing activity limitation and improving quality of life amongst visually impaired older people. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to November 2012), EMBASE (January 1980 to November 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to November 2012), Allied and Complementary Medicine Database (AMED) (January 1985 to November 2012), OT Seeker (inception to November 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 9 November 2012. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-randomised controlled trials (Q-RCTs) that compared environmental interventions, behavioural interventions or both, versus control (placebo control or no intervention or usual care), and trials comparing different types of environmental or behavioural interventions, in older people (aged 60 and over) with irreversible visual impairment living independently or in residential settings. To be eligible for inclusion the primary aim of studies must be reducing physical activity limitation and must include a measure of physical activity. Secondary outcome measures included falls, fear of falling, quality of life. DATA COLLECTION AND ANALYSIS: Two authors independently read abstracts retrieved by the search to identify eligibility and study quality. We contacted study authors for additional information. MAIN RESULTS: Our searches found no RCTs or Q-RCTs that met the eligibility criteria for this review. AUTHORS' CONCLUSIONS: We are unable to reach any conclusion about the effectiveness of environmental or behavioural interventions for reducing physical activity limitation in community-dwelling visually impaired older people, as no eligible studies were found. However a number of studies reviewed included only the secondary outcome measures of this review. Although behavioural interventions delivered by occupational therapists have been shown to reduce the rate of falls, we are unable to conclude if this is due to reduced activity restriction (increased mobility) or reduced activity (lessening exposure to risk). There are inconclusive and conflicting results from trials evaluating the effectiveness of behavioural and environmental interventions aimed at improving quality of life. Further research is necessary (such as ongoing Dutch and UK trials considering the effectiveness of orientation and mobility training on activity restriction, physical activity, falls, fear of falling and quality of life in older adults with low vision, and the effect of an occupational therapist delivering home safety modification, coping strategies and exercise with older people with low vision) before any conclusions can be reached.

Effective rehabilitation of reading by training in the technique of eccentric viewing: evaluation of a 4-year programme of service delivery.

BACKGROUND/AIMS: Central visual loss caused by conditions such as age-related macular degeneration (ARMD) is the commonest cause of blindness in the UK. Eccentric viewing training aims to teach patients how to utilise the functioning areas of macula or adjacent retina and establish a 'pseudofovea'. This technique has yet to gain acceptance in the UK despite evidence of success. Subjects with ARMD in Glasgow, UK, have received such training, and the outcome of training for this group is described. METHODS: Retrospective analysis auditing the outcome of eccentric viewing training to read was carried out in 300 subjects with ARMD. RESULTS: The data for 300 patients were reviewed. Fifty-eight subjects were excluded due to incomplete final data. Reading speed, font size, degree of comprehension, duration of reading, and age and number of lessons were recorded before and after training. The mean age was 75.4 (SD 12). The mean number of 1-h lessons required was 3.8 (SD 1.6). The starting mean number of corrected words per min (WPM) reading speed was 48 (SD 35) and this increased to 71.9 (SD 30.5) (p=0.000). The starting Arial font size that could be read fluently was 14.3 (SD 7.6) and this improved to 11.5 (SD 2.4). The starting mean duration of comfortable reading was 1.7 (SD 2.0) min. This increased to 15.8 (SD 14.6) min. The mean percentage of material read that was understood by the patients was 73.7 (SD 36.9)%. This improved to 92.7 (SD 16.2)% (p=0.000). Overall, the majority of patients exhibited improvement in one or more of the vision-related tasks measured. CONCLUSION: Eccentric viewing training is successful in improving the reading ability of individuals with a central scotoma. This paper shows evidence of the success of training provided by the voluntary sector and funded by adult literacy funding. The results are comparable with those reported in the literature.