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

  1. Dawn A Skelton1,*,
  2. Tracey E Howe2,
  3. Claire Ballinger3,
  4. Fiona Neil4,
  5. Shelagh Palmer5,
  6. Lyle Gray6

Editorial Group: Cochrane Eyes and Vision Group

Published Online: 5 JUN 2013

Assessed as up-to-date: 9 NOV 2012

DOI: 10.1002/14651858.CD009233.pub2


How to Cite

Skelton DA, Howe TE, Ballinger C, Neil F, Palmer S, Gray L. Environmental and behavioural interventions for reducing physical activity limitation in community-dwelling visually impaired older people. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009233. DOI: 10.1002/14651858.CD009233.pub2.

Author Information

  1. 1

    Glasgow Caledonian University, School of Health & Life Sciences, Institute of Allied Health Research, Glasgow, UK

  2. 2

    Glasgow City of Science, Glasgow, Scotland, UK

  3. 3

    Faculty of Medicine, University of Southampton, Research Design Service South Central, Southampton, UK

  4. 4

    Greater Glasgow and Clyde NHS, Community Falls Prevention Programme, Glasgow, Scotland, UK

  5. 5

    Visibility, Glasgow, UK

  6. 6

    Glasgow Caledonian University, Life Sceince, Glasgow, UK

*Dawn A Skelton, School of Health & Life Sciences, Institute of Allied Health Research, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK. dawn.skelton@gcu.ac.uk.

Publication History

  1. Publication Status: New
  2. Published Online: 5 JUN 2013

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Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Balliet 1985Although an RCT, not a behavioural/environmental intervention (visual field training) and no physical activity outcome measures.

Campbell 2005bAlthough an RCT, aim of intervention was not to decrease physical activity limitation and no physical activity outcome measures. Falls as secondary outcome measure. La Grow 2006 is an article about implementing this RCT.

Cheung 2008Although an RCT, aim of intervention was not to decrease physical activity limitation and no physical activity outcome measures. Balance measures assessed. Although one aim was to increase confidence in safe ambulation this was not assessed.

Conrod 1986Although an RCT, not a behavioural/environmental intervention (residual vision training) and no physical activity outcome measures.

Cumming 2007Although an RCT, aim of intervention was not to decrease physical activity limitation and no physical activity outcome measures. Falls as secondary outcome measure. Most had change in glasses, with only a few having an occupational therapy Intervention.

Dahlin-Ivanoff 2002Although an RCT, outcome measure was perceived security in the performance of daily occupations rather than a subjective or objective measure of physical activity or change in physical activity.

Day 2002Although an RCT, aim of intervention was not to decrease physical activity limitation and no physical activity outcome measures. Falls as secondary outcome measure.

Deremeik 2007Although an RCT, aim of intervention was not to decrease physical activity limitation and no physical activity outcome measures. Outcomes were rehabilitation goals and visual correction. Residents were based in a nursing home.

Eklund 2007Although an RCT, aim of intervention was changing associations between assistive living devices and ADL dependence. No physical activity outcome measures.

Eklund 2008Although an RCT, aim of intervention was ADL dependence and self-reported health problems. No physical activity outcome measures.

Engel 2000Not an RCT or quasi-RCT. Physical activity outcomes not well reported and not validated.

Girdler 2010Although an RCT, aimed to increase participation in life situations but no physical activity outcome measures.

Gutman 2002Not an RCT or quasi-RCT and no physical activity outcome measures.

Kuyk 2008Not an RCT or quasi-RCT and no physical activity outcome measures.

Kuyk 2010Although an RCT, not a behavioural/environmental intervention (computerised vision training) and no physical activity outcome measures.

La Grow 2004Not an RCT or quasi-RCT and no physical activity outcome measures.

McCabe 2000Not an RCT or quasi-RCT and no physical activity outcome measures.

Overbury 1996Although an RCT, not a behavioural/environmental intervention (perceptual learning training - paper-based) and no physical activity outcome measures.

Pankow 2004Although an RCT, aimed to improve wellbeing. No physical activity outcome measures.

Reeves 2004Although an RCT, aimed to improve quality of life. No physical activity outcome measures.

Rumrill 1999Although an RCT, not a behavioural/environmental intervention (skills at requesting accommodation from employers for employees so few older people) and no physical activity outcome measures.

Scanlan 2004Although an RCT, not a behavioural/environmental intervention (microscopes) to extend reading time) and no physical activity outcome measures.

Smith 2009Although an RCT, not a behavioural/environmental intervention (educational programme on self care, food preparation, home and financial management) and no physical activity outcome measures.

Stelmack 2005Abstract only. Protocol for an RCT study and no activity outcome measures. Relates to Stelmack 2008a; Stelmack 2008b and Stelmack 2008c.

Vukicevic 2009Although an RCT, not a behavioural/environmental intervention (eccentric viewing computerised training) and no physical activity outcome measures.

West 2004Abstract only. Protocol for an RCT study and no activity outcome measures. Contacted author. Residents are based in a nursing home.

 
Characteristics of ongoing studies [ordered by study ID]
ACTRN12607000399493

Trial name or titleA randomised controlled trial of a low vision self management programme on quality of life in people with low vision.

MethodsRandomised controlled trial Parallel

ParticipantsAge 55 years and older, male and female

Inclusion criteria: Participants are clients of Vision Australia centres who have received a low vision assessment within the last 12 months and meet the following inclusion criteria:

i. visual acuity of < 6/12 and > 6/480 in the better eye with habitual correction;

ii. age 55 years or older;

iii. living independently (not in a nursing home);

iv. English-speaking;

v. no cognitive impairment as assessed by the six-item cognitive impairment test (Brooke & Bullock, 1999);

vi. adequate hearing to respond to normal conversation.

Exclusion criteria: Nil

InterventionsParticipants are randomised to receive either the new low vision self-management programme 'Living with Low Vision' or continued access to usual low vision rehabilitation services.

The 'Living with Low Vision' programme has been developed specifically for this study. It consists of eight 3-hour weekly facilitated group sessions. The programme is structured and a facilitator manual clearly outlines the content and delivery. As well as providing information, the topics in the programme are covered by exploring participants' experiences, difficulties and solutions. Participants are encouraged to draw on their extensive life experience and coping mechanisms and to develop new skills and strategies and apply these new techniques in their daily life. Participants are given the option to bring a relative, friend or carer to the programme with them.

OutcomesPrimary:

The Impact of Vision Impairment Questionnaire (IVI) is used to assess the restriction of participation in daily activities in people with low vision (Lamoureux, Pallant, Pesudovs, Hassell, & Keeffe, 2006). The 28-item IVI has been extensively validated and has been shown to be sensitive to rehabilitation-induced changes in people with low vision.

The Depression Anxiety Stress Scale (DASS) is used to assess psychological wellbeing (Henry & Crawford, 2005; Lovibond & Lovibond, 2004). This is a 21-item self-report measure that provides three 7-item subscales of negative affect: depression, anxiety and stress.

Secondary:

Adaptation to Age-related Vision Loss Scale (AVL-12) is used to assess psychosocial adaptation to vision loss, including acceptance of limitations, attitudes towards rehabilitation and appropriate help from family and friends (Horowitz & Reinhardt, 2006).

The General Self-Efficacy Scale (GSES) is used to assess general self-efficacy (Jerusalem & Schwarzer, 1992).

The Health Education Impact Questionnaire (HEIQ) scales: 'Skill and technique acquisition' (five items) and 'Positive and active engagement in life' (five items) are used to determine the direct impact of the programme on strategies to manage low vision and engagement in life (Nolte, Elsworth, Sinclair, & Osborne, 2006).

The Positive and Negative Affect Schedule (PANAS) is used to assess the both positive and negative mood (Watson, Clark, & Tellegen, 1988).

Starting date1/03/2007

Contact informationJill Keefe

Notes

NCT00545220

Trial name or titleProblem Solving Training and Low Vision Rehabilitation

MethodsRandomised controlled trial Parallel

ParticipantsAged 19 and over (including older people), male and female.

Inclusion Criteria:

  • +19 yrs of age;
  • Underwent a low vision rehabilitation initial eye exam;
  • No more than 2 errors on cognitive on cognitive screening measure (SPBS);
  • Must have access to telephone;
  • No significant hearing problems;
  • No significant communication problems;
  • Speaks fluent English.


Exclusion Criteria: Nil

InterventionsParticipants are randomised to:

Experimental Group - Behavioural: problem-solving training

Sham Comparator - Behavioural: Sham

OutcomesNo information

Starting dateOctober 2007

Contact informationLaura Dreer

Notes

NCT00769015

Trial name or titleLow Vision Depression Prevention Trial for Age Related Macular Degeneration (VITAL)

MethodsRandomised,controlled clinical trial

ParticipantsAged 65 years and older, male and female

Inclusion Criteria: bilateral AMD and subthreshold depressive symptoms. At least 1 vision goal that is important yet difficult to carry out.

Exclusion Criteria: healthy older people;

  • Uncontrolled glaucoma, diabetic retinopathy, corneal dystrophy, or cataracts for which surgery within six months is likely will be exclusionary conditions;
  • Current diagnosis of depression;
  • Cognitive impairment;
  • Life-threatening illness or any other health conditions that interfere with study activities;
  • Patients who have received low vision rehabilitation or home-based occupational therapy (OT) in the preceding 12 months will be excluded.

InterventionsCollaborative Low Vision Rehabilitation (LVR) (optometrist and home-based occupational therapist (OT)) or enhanced LVR (optometrist and home-based Supportive Therapy (ST)). In this study, usual care LVR is enhanced with ST, which is a standardised placebo psychological treatment that controls for attention.

In BA-LVR, a low vision OT will deliver Behavior Activation (BA), a psychological treatment to prevent depression. This will be administered in the context of the standard of low vision care for OTs as defined by the American Occupational Therapy Association (AOTA). The OTs will collaborate with low vision optometrists, who will deliver the standard of low vision care as defined by the American Optometric Association. The optometrists will evaluate remaining vision and magnification needs, prescribe optical devices, and provide the OTs with initial care plans. The OTs will subsequently meet with participants in their homes six times over 12 weeks to enhance device use, home modifications, and compensatory strategies.

OutcomesPrimary Outcome Measures: Depression
Secondary Outcome Measures: Vision Function and Quality of Life

Starting dateJune 2009

Contact informationRobin Casten

 

Notes

UKCRN ID 10883

Trial name or titleVIP2UK: Preventing falls in older people with a visual impairment

MethodsPilot randomised controlled trial

ParticipantsAged 75 years and over

  • Independent community-dwelling;
  • Able to walk around their own residence;
  • Cognitively able to participate in the programme;
  • Able to understand the study requirements.


Vision-related inclusion criteria:

  • Binocular visual acuity less than 0.6 LogMAR (Snellen equivalent 6/24), stratified into (i) 0.61.0 LogMAR (1.0 LogMar = Snellens 6/60), (ii) less than 1.0 LogMAR, and/or
  • Moderate visual field loss, defined as affecting more than 20% of the test location used in a binocular Estermann test, stratified into (i) those missing < 50% of the test locations, (ii) those missing > 50% of the test location.

InterventionsOccupational therapist delivering home safety assessment and modifications with the approval of visually-impaired older people. Occupational therapist delivering the Otago home exercise programme, with support of peer mentors (buddies) that provide additional home visits and telephone calls throughout the intervention.

OutcomesPhoneFITT physical activity questionnaire, quality of life.

Starting dateMay 2011

Contact informationH. Waterman

Notes

Zijlstra 2009

Trial name or titleEvaluation of a standardised orientation and mobility training in older adults with low vision

MethodsRandomised controlled trial

ParticipantsOlder adults (55 yrs and older) with low vision living in the community

InterventionsStandardised Orientation and Mobility (O&M) Training versus Regular O&M Training (comparator).

OutcomesPrimary Outcomes: Activities of daily life (subscale of the Groningen Activity Restriction Scale (GARS)), Distance activities and mobility (subscales of the Visual Functioning Questionnaire (VFQ)).

Secondary Outcomes: activities index (Frenchay Activities Index (FAI)), social support interactions (Social Support List (SSL 12-I)), health-related quality of life (EuroQol 5D (EQ5D)), feelings of anxiety (anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A)), concerns about falling (falls efficacy scale international (FES-I))

Starting dateNov 2007

Contact informationG.I.J.M. Kempen

NotesInformation on the training delivered - http://www.ncbi.nlm.nih.gov/pubmed/22734105