An evaluation of health-related quality of life and its relation with functional vision in children with cerebral visual impairment

BACKGROUND

Health-related Quality of Life (HRQOL) and its relation with functional vision is understudied in cerebral visual impairment (CVI).

AIMS

Characterising HRQOL, comparing child self- and parent proxy-reports, and exploring relations with functional vision.

METHODS AND PROCEDURES

Seventy-three children with CVI (n females = 33; n males = 40; Mean performance age = 7y2m) were included. HRQOL was measured with Pediatric Quality of Life Inventory (PedsQL) child self- and parent proxy-reports and compared using Wilcoxon signed-rank tests. Risk for impaired HRQOL was evaluated using cut-off scores. Parents scored functional vision using the Insight Questions Inventory and the Flemish CVI Questionnaire.

OUTCOMES AND RESULTS

61 % (self-reported) or 66 % of children (proxy-reported) were at-risk for impaired total HRQOL. Ratings were correlated (rs = 0.305; p = 0.013); however, children rated higher total HRQOL compared to parent-proxy (r = 0.382; p = 0.002). The Insight Questions Inventory and the PedsQL proxy-report were correlated (rp = -0.454; p < 0.001), the Flemish CVI Questionnaire was negligibly correlated (rp = -0.244; p = 0.041).

CONCLUSIONS AND IMPLICATIONS

HRQOL is reduced in CVI, and both child and parent perspectives are crucial. HRQOL and functional vision are intricately related, and impairment in one negatively affects the other.

Quality of life, functioning and participation of children and adolescents with visual impairment: A scoping review

BACKGROUND

Vision has a key role in children's neuromotor, cognitive and social development. Children with visual impairment attain developmental milestones at later stages and are at higher risk of developing psychological disorders and social withdrawn.

AIMS

We performed a scoping review to summarize the mostly used instruments assessing the impact of visual impairment on quality of life, functioning and participation of children and adolescents. In addition, the main findings of the included studies are discussed.

METHODS AND PROCEDURES

We searched for papers assessing quality of life, functioning and participation of children and adolescents with visual impairment from 0 to 18 years old conducted between 2000 and 2023.

OUTCOMES AND RESULTS

In total, 69 studies met the inclusion criteria and were included in the review. Child self-report, caregivers-proxy and self-report questionnaires as well as interviews were used. The results showed that quality of life, functioning and participation are significantly reduced in children and adolescents with visual impairment, and that the impact depends on different factors (e.g., severity of the impairment, age).

CONCLUSIONS AND IMPLICATIONS

Considering the significant impact of visual impairment on quality of life, functioning and participation on this population, it is fundamental to develop integrated and multi-dimensional assessment programs that evaluate the impact of visual impairment on those dimensions considering different contexts of life (e.g., family, school, leisure time). WHAT THIS PAPER ADDS?: The present review aims to give an overview of what is known about the impact of visual impairment on quality of life, functioning and participation of children and adolescents. We assumed a biopsychosocial perspective which, in line with the definition of health by the International Classification of Functioning, Disability and Health (WHO, 2001), considered how body functions and structures, functioning, participation and environmental factors dynamically interact to define the health, or the disease, status of a person at a certain moment of life. We reported the most used instruments for the assessment of quality of life, participation, and functioning, with a specific interest on Patient-Reported Outcome Measures and self-report measures. By reporting the different instruments used, we gave a broad overview about the available tools that can be used in clinical as well as in research field to assess quality of life, functioning and participation in this population. Additionally, the review of the existing literature allowed us to demonstrate that those dimensions are negatively impacted by visual impairment and thus they should be considered in the assessment programs. Specifically, there is the need to provide more integrated assessment programs that investigate the impact of visual impairment on children and adolescents' social and emotional wellbeing, everyday functioning and social relationship, considering their subjective experience together with the one of caregivers, teachers, health care professionals, and other relevant adults involved in their life. Additionally, it is essential to plan and implement multidimensional assessment programs that consider how all areas of life are differently impacted by visual impairment.

Individual, family, and environmental determinants of vision-related quality of life of children and young people with visual impairment

Childhood visual impairment can have a significant impact on an individual's development. To improve clinical care and develop appropriate psychosocial interventions of these patients, it is necessary to understand the contributing and modifiable factors that both identify individuals in greater need and could be targeted in interventions. Here we investigate the broader individual, family, and environmental factors associated with vision-related quality of life (VQoL) of children and young people with visual impairment (CYP-VI). Data for this cross-sectional study were collected from September 2014 to May 2017 to develop and validate two vision-specific patient-reported outcome measures (PROMs) for CYP-VI. Patients were recruited from 22 hospitals in the United Kingdom and were aged 7-18 years with visual impairment as per WHO criteria. Participants self-completed the two PROMs, VQoL and Functional Vision Questionnaires. Clinical characteristics were extracted from medical records. Their carers provided information on family sociodemographic backgrounds. Associations between the VQoL scores and other factors were examined using Spearman's correlation, Kruskal-Wallis, Wilcoxon rank-sum tests, and quantile regression models. The sample consisted of 152 CYP-VI (67 females). Better VQoL was significantly associated with better functional vision overall (rSpearman = -0.52), parent-reported absence of additional chronic conditions (dCohen = 0.46), attending mainstream (versus other) school (dCohen = 0.44), higher socio-economic status (rSpearman = 0.17) and higher parental education level (rSpearman = 0.20). No other investigated factors were significantly associated with VQoL. The final quantile regression model included functional vision scores and the presence of additional health condition. Variation in self-reported VQoL in CYP-VI can be partly accounted for by factors relating to the clinical status of the affected child and, more importantly, by non-health-related factors. This needs to be considered in clinical practice when assessing vision-specific outcomes and providing support to CYP-VI, as well as in the development of future interventions.

Inclusive classroom interaction in lower secondary education

Following the German parliament’s ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD) in 2008, inclusive pedagogy has become increasingly relevant for educational science and educational policy. Empirical studies of classes which combine students with and without visual impairment mainly focus on questions of performance and well-being, while not directly examining classroom interactions. Our research seeks to address this notable lack of in-situ studies, using a selected case as an example and illustrating the potential of such an approach through reconstructing the contradictory expectations of inclusive teaching as a specific conflict of norms. This approach ought to demonstrate the potential insights to be gained by reconstructing and interpreting relevant communicative processes of meaning-construction. Based on transcribed interactions in an inclusive fifth-grade class, we interpret the scene of classroom instruction with regard to the normative conflict between the egalitarian promise of participation and a non-egalitarian focus on performance. Adopting a methodology of second-order observation, as outlined in Systems Theory, allows us to conduct an analysis of normativity in order to understand which norms prevail in interactions with students with and without visual impairment. At the center of the analysis is not only the common discrepancy between an inclusive school’s policy and its interactive implementation. Rather, our interpretations also show how the ableist norm of performance is navigated and negotiated among all participants in classroom communication and how the multitude of norms and expectations surrounding inclusive teaching come into conflict, that is, in the paradoxical structural tension between the operational necessity of establishing a separation between students and the policy imperative of decategorization.