Can we associate the hours of clinical services at the rehabilitation outcomes? The case of the visual impairment rehabilitation program

Occupational Therapy Interventions for Older Adults With Low Vision

Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. Findings from the systematic review of occupational therapy for older adults with low vision were published in the January/February 2020 issue of the American Journal of Occupational Therapy (AJOT) and in AOTA's Occupational Therapy Practice Guidelines for Older Adults With Low Vision, published in the March/April 2020 issue of AJOT. In this article, we describe a case report of an older adult with low vision who was referred to outpatient occupational therapy services because of a recent progression of her age-related macular degeneration that led to a decline in functional independence. Each article in the Evidence Connection series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

Interventions Within the Scope of Occupational Therapy Practice to Improve Performance of Daily Activities for Older Adults With Low Vision: A Systematic Review

IMPORTANCE

The prevalence of low vision increases with age. Low vision has detrimental effects on older adults' independence.

OBJECTIVE

To identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities for older adults with low vision.

DATA SOURCES

Literature published between 2010 and 2017 was searched in CINAHL, Cochrane Databases, MEDLINE, OTseeker, and PsycINFO.

STUDY SELECTION AND DATA COLLECTION

The authors screened and appraised studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Studies were eligible if the participants' mean age was 55 yr or older, the level of evidence was Level III or higher, the intervention was within the scope of occupational therapy practice, and the outcome measures assessed the performance of daily activities.

FINDINGS

Fourteen studies met the review criteria. Three intervention themes were identified: low vision rehabilitation services (n = 6), self-management approach (n = 6), and tango (n = 2). Moderate evidence was found for low vision rehabilitation services. Low evidence was found for using the self-management approach or adding the self-management approach to existing low vision rehabilitation services. Low evidence was found for tango.

CONCLUSION AND RELEVANCE

This systematic review supports the use of low vision rehabilitation services as an effective approach. Occupational therapy practitioners are encouraged to be part of multidisciplinary teams that offer comprehensive low vision evaluations and multicomponent services.

WHAT THIS ARTICLE ADDS

Low vision rehabilitation that offers multidisciplinary services, including occupational therapy, is effective in promoting independence among older adults with low vision.

Occupational Therapy Interventions Supporting Leisure and Social Participation for Older Adults With Low Vision: A Systematic Review

IMPORTANCE

Evidence supports interventions for social participation for older adults with low vision.

OBJECTIVE

This systematic review examined the evidence for interventions within the scope of occupational therapy practice to maintain, restore, and improve performance and quality of life in leisure and social participation for older adults with low vision.

DATA SOURCES

MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were searched for articles published from January 2010 to March 2017 that described interventions within the scope of occupational therapy practice for older adults with low vision (mean age 55+).

STUDY SELECTION AND DATA COLLECTION

Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines were followed and applied for this review. Exclusion criteria included publications outside of the period of the study, participants with mean age <55 yr, and interventions outside the occupational therapy scope of practice.

FINDINGS

The search yielded 455 articles, of which 3 Level III studies met the inclusion criteria. Low evidence with high risk of bias was found for interventions supporting social participation. Group therapy, more hours of direct service over a shorter duration, and fitting with low vision devices resulted in improvements in social participation and other outcomes.

CONCLUSION AND RELEVANCE

Little evidence exists to support occupational therapy interventions in the areas of leisure and social participation. More research is needed in these areas.

WHAT THIS ARTICLE ADDS

There continues to be a need for research studies in the areas of leisure and social participation.

Occupational Therapy Practice Guidelines for Older Adults With Low Vision

Importance: The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision.

Objective: This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation.

Method: We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research.

Results: Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice.

Conclusions and Recommendations: Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation.

What This Article Adds: This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.