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Schow T, Wehling EI, Falkenberg HK, Norup A, Kristensen KS. Assessment of visual problems after acquired brain injury: a survey of current practice in Danish hospitals. J Rehabil Med 2024; 56:jrm28793. [PMID: 38742932 PMCID: PMC11107834 DOI: 10.2340/jrm.v56.28793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury. DESIGN A survey study. SUBJECTS A total of 143 respondents from hospital settings, with background in occupational therapy and physical therapy, participated in the survey. METHODS The survey questionnaire, developed collaboratively by Danish and Norwegian research groups, encompassed 22 items categorically covering "Background information", "Clinical experience and current practice", "Vision assessment tools and protocols", and "Assessment barriers". It was sent out online, to 29 different hospital departments and 18 separate units for occupational therapists and physiotherapists treating patients with acquired brain injury. RESULTS Most respondents worked in acute or subacute hospital settings. Few departments had an interdisciplinary vision team, and very few therapists had formal education in visual problems after acquired brain injury. Visual assessment practices varied, and there was limited use of standardized tests. Barriers to identifying visual problems included patient-related challenges, knowledge gaps, and resource limitations. CONCLUSION The study emphasized the need for enhanced interdisciplinary collaboration, formal education, and standardized assessments to address visual problems after acquired brain injury. Overcoming these challenges may improve identification and management, ultimately contributing to better patient care and outcomes in the future.
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Affiliation(s)
- Trine Schow
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark; Neurorehabilitation-Cph, Copenhagen, Denmark.
| | - Eike Ines Wehling
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Helle K Falkenberg
- Department of optometry, radiography and lighting design, University of South-Eastern Norway, Notodden, Norway
| | - Anne Norup
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark; Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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Sorbello S, Rose K, French A, Rowe F, Lau S. Meeting the need for post-stroke vision care in Australia: a scoping narrative review of current practice. Disabil Rehabil 2024; 46:1928-1935. [PMID: 37227234 DOI: 10.1080/09638288.2023.2214743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Determine current vision care pathways and practices for stroke survivors in Australia and internationally, focusing on identifying reoccurring gaps in these pathways and unmet care needs. METHOD A scoping narrative review was conducted to identify literature related to post-stroke vision care practices and perspectives of patients and health professionals. RESULTS A total of 16193 articles were retrieved and 28 deemed eligible for inclusion. Six were Australian, 14 from the UK, four from the USA, and four from within Europe. Post-stroke vision care is largely unstandardized, with substantial inconsistency in the use of vision care protocols, who executes them and at what point in post-stroke care they are utilised. Health professionals and stroke survivors expressed that unmet care needs were primarily a result of lack of education and awareness regarding post-stroke eye problems. Other gaps in care pathways related to the timing of vision assessment, provision of ongoing support, and the integration of eye-care specialists into the stroke team. CONCLUSION Further research is needed into current Australian post-stroke vision care to accurately assess whether the needs of stroke survivors are being met. Available evidence indicates that in Australia, there is a requirement for well-defined protocols for vision screening, education, management, and referral of stroke survivors.
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Affiliation(s)
- Shanelle Sorbello
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Kathryn Rose
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Amanda French
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Fiona Rowe
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Sonia Lau
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Wentz JR, Wentz EE, Pierce SR. Preliminary assessment of a standardized vision screening guideline in a pediatric inpatient rehabilitation unit. J Pediatr Rehabil Med 2024; 17:199-209. [PMID: 38143397 PMCID: PMC11307041 DOI: 10.3233/prm-220137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/11/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the impact of a standardized vision screen guideline on occupational therapy vision screens in a pediatric inpatient rehabilitation unit. METHODS Charts of patients admitted to a pediatric inpatient rehabilitation before guideline implementation (n = 47) versus charts after implementation (n = 47) were randomly, retrospectively reviewed to explore differences in visual skills screened and use of standardized assessments. RESULTS Significant improvements (p < = 0.05) were found in the number of visual skills screened (p = 0.034), use of standardized assessments (p = 0.005), and screening of the specific visual skills of accommodative amplitude (p = 0.05), suppression (p = 0.015), and double vision (p < 0.001). CONCLUSION Implementation of a standardized vision screen guideline improved the frequency of vision screens during occupational therapy evaluations in a pediatric inpatient rehabilitation unit. The use of standardized assessments may also improve the quality of vision screens by encouraging staff to complete more comprehensive vision screens, including screening more visual skills, and by prompting use of standardized assessments, which can improve accuracy of screening procedures.
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Affiliation(s)
- Jordan R. Wentz
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Hazelton C, Thomson K, Todhunter-Brown A, Campbell P, Chung CS, Dorris L, Gillespie DC, Hunter SM, McGill K, Nicolson DJ, Williams LJ, Brady MC. Interventions for perceptual disorders following stroke. Cochrane Database Syst Rev 2022; 11:CD007039. [PMID: 36326118 PMCID: PMC9631864 DOI: 10.1002/14651858.cd007039.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non-invasive brain stimulation, pharmacological and surgical approaches. OBJECTIVES To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain. DATA COLLECTION AND ANALYSIS One review author assessed titles, with two review authors independently screening abstracts and full-text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB-1 tool, and quality of evidence using GRADE. A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update. MAIN RESULTS We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch-somatosensory disorders. None addressed stroke-related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non-invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL): Somatosensory disorders: one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure. Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention. Visual perception disorders: no trials measuring ADL compared an intervention with no treatment or control. In addition, six trials reported ADL outcomes in a comparison of active intervention versus active intervention, relating to somatosensation (three trials), touch (one trial) and vision (two trials). AUTHORS' CONCLUSIONS: Following a detailed, systematic search, we identified limited RCT evidence of the effectiveness of interventions for perceptual disorders following stroke. There is insufficient evidence to support or refute the suggestion that perceptual interventions are effective. More high-quality trials of interventions for perceptual disorders in stroke are needed. They should recruit sufficient participant numbers, include a 'usual care' comparison, and measure longer-term functional outcomes, at time points beyond the initial intervention period. People with impaired perception following a stroke should continue to receive neurorehabilitation according to clinical guidelines.
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Affiliation(s)
- Christine Hazelton
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Charlie Sy Chung
- Rehabilitation Services, Fife Health and Social Care Partnership, Dunfermline, UK
| | - Liam Dorris
- Paediatric Neurosciences, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Susan M Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Kris McGill
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Linda J Williams
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Marian C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Colwell MJ, Demeyere N, Vancleef K. Visual perceptual deficit screening in stroke survivors: evaluation of current practice in the United Kingdom and Republic of Ireland. Disabil Rehabil 2022; 44:6620-6632. [PMID: 34455876 DOI: 10.1080/09638288.2021.1970246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Visual perceptual deficits are frequently underdiagnosed in stroke survivors compared to sensory vision deficits or visual neglect. To better understand this imparity, we evaluated current practice for screening post-stroke visual perceptual deficits. METHODS We conducted a survey targeted at professionals working with stroke survivors involved in screening visual perceptual deficits across the United Kingdom and the Republic of Ireland. RESULTS Forty orthoptists and 174 occupational therapists responded to the survey. Visual perceptual deficit screening was primarily conducted by occupational therapists (94%), with 75∼100% of stroke survivors screened per month. Respondents lacked consensus on whether several common post-stroke visual deficits were perceptual or not. During the screening, respondents primarily relied on self-reports and observation (94%), while assessment batteries (58%) and screening tools were underutilised (56%) and selected inappropriately (66%). Respondents reported lack of training in visual perception screening (20%) and physical/cognitive condition of stroke survivors (19%) as extremely challenging during screening. CONCLUSIONS Visual perceptual deficits are screened post-stroke at a similar rate to sensory vision or visual neglect. Underdiagnosis of visual perceptual deficits may stem from both reliance on subjective and non-standardised screening approaches, and conflicting definitions of visual perception held among clinicians. We recommend increased training provision and use of brief performance-based screening tools.IMPLICATIONS FOR REHABILITATIONLack of agreement among clinicians on what constitutes as visual perceptual or sensory vision deficits may prove problematic, as precise and exact language is often required for clinical decision-making (e.g., referrals).Biases for more familiar visual (perceptual) deficits held among clinicians during the screening process may lead to other visual deficits being missed.To avoid problems being missed, clinicians should aim to use standardised assessments rather than stroke survivor self-report and observations of function when screening for visual perceptual difficulties.
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Affiliation(s)
- Michael J Colwell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Kathleen Vancleef
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Courtney-Harris M, Jolly N, Rowe F, Rose K. Validation of a vision-screening tool for use by nurses and other non-eye care health practitioners on stroke survivors. Contemp Nurse 2022; 58:276-284. [PMID: 35861106 DOI: 10.1080/10376178.2022.2104334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Neryla Jolly
- Graduate School of Health, Orthoptics, University of Technology Sydney, Australia
| | - Fiona Rowe
- Department of Primary care & Mental Health, University of Liverpool, United Kingdom
| | - Kathryn Rose
- Graduate School of Health, Orthoptics, University of Technology Sydney, Australia
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Garcia C, Collins R, McCabe D, Galvin R, Boland P. Impact of visual field loss post-stroke on activities of daily living: a prospective cohort study. Neuropsychol Rehabil 2022:1-16. [PMID: 35679176 DOI: 10.1080/09602011.2022.2081219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study investigated the ADL performances of people with VFL after an acute stroke using an observation-based evaluation of ADL skills, the Assessment of Motor and Process Skills. The AMPS was administered on initial assessment and at ≥11 weeks follow-up on 58 adults with a mild stroke, with (n = 16) and without VFL (n = 42), over a 13-month period. The AMPS guidelines on clinically relevant difference of 0.30 logits were used to determine the differences of the groups' ADL performance on initial assessment and follow-up. The study found that the ADL motor and process scores did not differ significantly on initial assessment. The study observed no clinically relevant difference between the ADL motor and process scores of between the VFL and non-VFL on initial assessment and follow-up but demonstrated clinically relevant improvements in ADL motor and process scores of both groups from initial assessment to follow-up. VFL does not have an additional negative impact on ADL performance of those with a mild stroke and does not impede improvement of ADL performance over time.
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Affiliation(s)
| | | | - Djh McCabe
- Tallaght University Hospital, Dublin, Ireland.,Vascular Neurology Research Foundation, Dept of Neurology, and Stroke Services, Tallaght University Hospital, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK.,Academic Unit of Neurology School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Pauline Boland
- School of Allied Health, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Vancleef K, Colwell MJ, Hewitt O, Demeyere N. Current practice and challenges in screening for visual perception deficits after stroke: a qualitative study. Disabil Rehabil 2020; 44:2063-2072. [PMID: 33016779 DOI: 10.1080/09638288.2020.1824245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We document current clinical practice and needs in screening for visual perception problems after stroke to inform development of new screening tools. MATERIALS AND METHODS We interviewed 12 occupational therapists and 13 orthoptists. Interviews were thematically analysed using the Value Proposition Canvas, a model which establishes challenges and facilitators in what people want to achieve. RESULTS Participants' understanding of visual perception varied and often included sensory and cognitive deficits. Occupational therapists commonly screened for visual field deficits and hemispatial neglect, while other aspects of visual cognition were rarely assessed. A positive screening result triggered an orthoptic referral. Screening generally occurred during functional assessments and/or with in-house developed tools. Challenges to practice were: lack of time, lack of training, environmental and stroke survivor factors (e.g., aphasia), insufficient continuation of care, and test characteristics (e.g., not evidence-based). Facilitators were: quick and practical tools, experienced staff or tools with minimal training requirements, a streamlined care pathway. CONCLUSIONS Screening employs non-standardised assessments and rarely covers higher visual perceptual deficits. We demonstrates the need for an evidence-based visual perception screen, which should ideally be 15 min or less, be portable, and require minimal equipment. The screen should be suitable for bedside testing and aphasia-friendly.Implications for rehabilitationThere is a high demand for training on what visual perception deficits are and how to screen for them.Building local relationships between orthoptists and occupational therapists is perceived as highly beneficial for providing good vision and visual perception care for stroke survivors.Occupational therapists should be alert for visual perceptual deficits in their patients preferably through systematic screening with standardised assessments such as the shortened version of the Rivermead Perceptual Assessment Battery or Occupational Therapy Adult Perceptual Screening Test.
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Affiliation(s)
- Kathleen Vancleef
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Michael J Colwell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Olivia Hewitt
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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9
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Rowe FJ, Hepworth LR, Howard C, Hanna KL, Helliwell B. Developing a stroke-vision care pathway: a consensus study. Disabil Rehabil 2020; 44:487-495. [DOI: 10.1080/09638288.2020.1768302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R. Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Claire Howard
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Kerry L. Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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10
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Yoo PY, Scott K, Myszak F, Mamann S, Labelle A, Holmes M, Guindon A, Bussieres AE. Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey. The Canadian Journal of Occupational Therapy 2020; 87:117-126. [PMID: 31896281 DOI: 10.1177/0008417419892393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. The existing literature on the effectiveness of interventions targeting vision, visual-perceptual impairments following acquired brain injury (ABI) is scarce and unlinked to occupational performance. PURPOSE. To explore current occupational therapy practice in vision-rehabilitation among adults with ABI in Canada, and to determine the evidence-practice gaps. METHODS. An online survey was made available through the Canadian Association of Occupational Therapists (CAOT) website, and disseminated to seven public healthcare institutions in Quebec. The survey collected respondent demographic information, and the types and frequency of treatments delivered. Descriptive statistics were conducted to determine interventions' frequency. Participant comments were collected and grouped into recurring themes. FINDINGS. Over half (55%) of respondents regularly use evidence-based interventions when addressing visual acuity (VA) and visual field (VF) deficits, but only very few (3%) use it when dealing with oculomotor function and visual stress impairments. IMPLICATIONS. Results gave a glimpse of interventions used and suggested the need for further research in vision rehabilitation.
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Rowe FJ, Hepworth LR, Kirkham JJ. Development of core outcome sets for vision screening and assessment in stroke: a Delphi and consensus study. BMJ Open 2019; 9:e029578. [PMID: 31501115 PMCID: PMC6738691 DOI: 10.1136/bmjopen-2019-029578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Visual impairment following stroke is common with a reported incidence of visual impairment in 60% of stroke survivors. Screening for visual impairment is neither routine nor standardised. This results in a health inequality where some stroke survivors receive comprehensive vision assessment to identify any existent visual problems while others receive no vision assessment leaving them with unmet needs from undiagnosed visual problems. The aim of this study was to define two core outcome sets (COS), one for vision screening and one for full visual assessment of stroke survivors. DESIGN A list of potentially relevant visual assessments was created from a review of the literature. The consensus process consisted of an online 3-round Delphi survey followed by a consensus meeting of the key stakeholders. PARTICIPANTS Stakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers. SETTING University. OUTCOME MEASURES COS. RESULTS Following the consensus process we recommend the following nine assessments for vision screening: case history, clinical observations of visual signs, visual acuity, eye alignment position, eye movement assessment, visual field assessment, visual neglect assessment, functional vision assessment and reading assessment. We recommend the following 11 assessments for full vision assessment: case history, observations, visual acuity, eye alignment position, eye movement assessment, binocular vision assessment, eye position measurement, visual field assessment, visual neglect assessment, functional vision assessment, reading assessment and quality of life questionnaires. CONCLUSIONS COS are defined for vision screening and full vision assessment for stroke survivors. There is potential for their use in reducing heterogeneity in routine clinical practice and for improving standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and for further exploration of core outcome measures.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
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12
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Hepworth L, Rowe F. Ten Years On - A Survey of Orthoptic Stroke Services in the UK and Ireland. Br Ir Orthopt J 2019; 15:89-95. [PMID: 32999979 PMCID: PMC7510389 DOI: 10.22599/bioj.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: In 2007 a national orthoptic survey identified poor provision of vision assessment for stroke survivors. The purpose of this study is to report a 10-year update of this survey to identify changes in clinical practice over recent years. Methods: An online practice survey of registered orthoptists (British and Irish Orthoptic Society, BIOS) was undertaken to scope vision services for stroke survivors. Results: At the time of this survey, there were 223 orthoptic departments and 227 stroke units in the UK and Ireland. 317 responses were received representing 178 orthoptic departments – an 80% response rate for orthoptic departments. Of the respondents, 92% reported having a stroke unit in their hospital. A stroke/vision service was provided by 98% of responding orthoptic departments for 77% of stroke units but with only half providing a vision service on the stroke unit. Only 33% of vision services were funded and funding remains the primary barrier to providing a stroke/vision service. About 85% of respondents were aware of the national clinical guidelines for stroke and the BIOS extended practice guidelines for stroke. Conclusions: There has been a positive increase in awareness of stroke-related visual impairment and a steady improvement in provision of eye care for stroke survivors. However, there remains a lack of provision of specialist vision services specifically on stroke units which infers a health inequality for stroke survivors who have visual impairment. Their visual impairments can remain undetected and thus undiagnosed and unmanaged due to unsatisfactory patient care.
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Affiliation(s)
- Lauren Hepworth
- Department of Health Services Research, University of Liverpool, UK
| | - Fiona Rowe
- Department of Health Services Research, University of Liverpool, UK
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Hazelton C, Pollock A, Walsh G, Brady MC. Scanning training for rehabilitation of visual field loss due to stroke: Identifying and exploring training tools in use. Br J Occup Ther 2018. [DOI: 10.1177/0308022618809900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
IntroductionVisual field loss affects one fifth of stroke survivors, limiting daily activities and reducing quality of life. Scanning training is a commonly used intervention, but there is variation in how this is delivered. This study aimed to identify the scanning training tools used in Scotland and describe their training parameters, delivery and suitability for use with stroke survivors.MethodAn email survey identified scanning training tools used in Scotland. Two expert panel meetings gained consensus on the motor, language and cognitive skills required to use each scanning training tool. Video capture techniques gathered objective measures of training parameters.ResultsTen scanning training tools were identified. These tools used four delivery methods: paper-based, computer software, web-based and specialised equipment. They aimed to improve reading, perception or general visual skills. Fast, saccadic eye movements were most frequently targeted: two interventions also encouraged head movements. Session duration, frequency and therapist support varied considerably. The level of motor, language and cognitive skills required for each tool was determined.ConclusionScanning training tools used in Scotland vary in delivery modality, functional abilities required for use and visual skills trained. This information will support clinical decision-making and inform future research on training effectiveness and feasibility.
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Affiliation(s)
- Christine Hazelton
- Research Fellow, Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, UK
| | - Alex Pollock
- Senior Research Fellow, NMAHP Research Unit, Glasgow Caledonian University, UK
| | - Glyn Walsh
- Senior Lecturer (retired), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Marian C Brady
- Professor, NMAHP Research Unit, Glasgow Caledonian University, UK
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14
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Turton AJ, Angilley J, Longley V, Clatworthy P, Gilchrist ID. Search training for people with visual field loss after stroke: A cohort study. Br J Occup Ther 2017. [DOI: 10.1177/0308022617743481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction People with visual field loss after stroke often experience difficulties in everyday activities. The purpose of this study was to assess the acceptability of search training as used within occupational therapy and the feasibility of possible measures for use in a future trial. Method Nine participants took part in a goal oriented intervention that was delivered three times a week for 3 weeks. Patient reports of acceptability and outcomes using the Visual Function Questionnaire-25 were collected. Participants’ room-search behaviour before and after the intervention was recorded using a head-worn camera. Results Eight participants completed nine treatment visits. All participants reported improved awareness and attention to the blind side during activities following the intervention. Seven participants’ change scores on the Visual Function Questionnaire-25 exceeded six points. Patterns of head-direction behaviour and overall room-search times were variable across patients; markedly, improved performance was only evident in the most severely affected participant. Conclusion The intervention was acceptable. The Visual Function Questionnaire-25 is a feasible measure for assessing patient-reported outcomes. While the room search was informative about individuals’ behaviour, more sophisticated methods of gaze tracking would allow search processes to be determined in real-world activities that are relevant to patients’ goals.
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Affiliation(s)
- Ailie J Turton
- Senior Lecturer, Department of Allied Health Professions, University of the West of England, Bristol, UK
| | - Jayne Angilley
- Clinical Specialist Occupational Therapist Stroke, Stroke Therapy Team, Camborne and Redruth Community Hospital, Cornwall Partnership NHS Foundation Trust, UK
| | - Verity Longley
- PhD Student, School of Psychological Sciences, University of Manchester, UK
| | - Philip Clatworthy
- Consultant Stroke Neurologist, North Bristol NHS Trust, UK
- Stroke Association Thompson Family Senior Clinical Lecturer, University of Bristol, UK
| | - Iain D Gilchrist
- Professor of Neuropsychology, School of Experimental Psychology, University of Bristol, UK
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Bunce C, Zekite A, Wormald R, Rowe F. Sight Impairment registration due to stroke-A small yet significant rise? Brain Behav 2017; 7:e00866. [PMID: 29299385 PMCID: PMC5745245 DOI: 10.1002/brb3.866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives In the United Kingdom, when an individual's sight falls to and remains at a certain threshold, they may be offered registration as sight impaired. Recent analysis of causes of registrable sight impairment in England/Wales indicated that visual impairment due to stroke had increased as a proportionate cause of sight loss. We aim to assess whether there is evidence of an increase in incidence of certification for sight impairment due to stroke in England/Wales between 2008 and 2014. Materials and Methods The number of certifications with a main cause of sight impairment being stroke was obtained from the Certifications Office London. Directly standardized rates per 100,000 were computed with 95% confidence intervals and examined. Poisson regression was used to assess evidence of trend over time. Results In the year ending 31st March 2008, 992 people were newly certified with stroke with an estimated DSR of 2.1 (2.0 to 2.2) per 100,000 persons at risk. In the year ending March 31st 2014, there were 1310 certifications with a DSR of 2.5 (2.4 to 2.7). Figures were higher for men than women. Poisson regression indicated an estimated incidence rate ratio of 1.03 per year with 95% confidence intervals of 1.028 to 1.051, P < .001. Conclusions These data suggest a small but statistically significant increase in the incidence of certifiable visual impairment due to stroke between 2008 and 2014. Figures are, however, considerably lower than estimated, perhaps suggesting that more should be done to address the visual needs of those who have suffered stroke.
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Affiliation(s)
- Catey Bunce
- Department of Primary Care & Public Health SciencesKings College LondonLondonUK
- Institute of Ophthalmology, UCLLondonUK
- Department of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
| | - Antra Zekite
- Research and DevelopmentMoorfields Eye Hospital NHS Foundation TrustLondonUK
| | - Richard Wormald
- Department of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineLondonUK
- Research and DevelopmentMoorfields Eye Hospital NHS Foundation TrustLondonUK
| | - Fiona Rowe
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
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16
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Hanna KL, Rowe FJ. Clinical versus Evidence-based Rehabilitation Options for Post-stroke Visual Impairment. Neuroophthalmology 2017; 41:297-305. [PMID: 29344068 PMCID: PMC5764068 DOI: 10.1080/01658107.2017.1337159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022] Open
Abstract
The aim of this study was to identify which treatments for post-stroke visual impairment have a supportive evidence base, and which are being used in practice without supportive evidence. A systematic review of the literature reporting on the available treatment options was compared against the visual treatments used in the Vision In Stroke (VIS) study. Treatments were identified for visual field, visual neglect, visual perception and ocular motility disorders. Visual scanning therapies for hemianopia and neglect have an established evidence base. However, a number, such as typoscopes and advice options, have limited detail of their effectiveness and require further research.
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Affiliation(s)
- K. L. Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom
| | - F. J. Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom
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17
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Salbach NM, Wood-Dauphinee S, Desrosiers J, Eng JJ, Graham ID, Jaglal SB, Korner-Bitensky N, MacKay-Lyons M, Mayo NE, Richards CL, Teasell RW, Zwarenstein M, Bayley MT. Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: process evaluation of a cluster randomized trial. Implement Sci 2017; 12:100. [PMID: 28764752 PMCID: PMC5539742 DOI: 10.1186/s13012-017-0631-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Stroke Canada Optimization of Rehabilitation by Evidence-Implementation Trial (SCORE-IT) showed that a facilitated knowledge translation (KT) approach to implementing a stroke rehabilitation guideline was more likely than passive strategies to improve functional walking capacity, but not gross manual dexterity, among patients in rehabilitation hospitals. This paper presents the results of a planned process evaluation designed to assess whether the type and number of recommended treatments implemented by stroke teams in each group would help to explain the results related to patient outcomes. Methods As part of a cluster randomized trial, 20 rehabilitation units were stratified by language and allocated to a facilitated or passive KT intervention group. Sites in the facilitated group received the guideline with treatment protocols and funding for a part-time nurse and therapist facilitator who attended a 2-day training workshop and promoted guideline implementation for 16 months. Sites in the passive group received the guideline excluding treatment protocols. As part of a process evaluation, nurses, and occupational and physical therapists, blinded to study hypotheses, were asked to record their implementation of 18 recommended treatments targeting motor function, postural control and mobility using individualized patient checklists after treatment sessions for 2 weeks pre- and post-intervention. The percentage of patients receiving each treatment pre- and post-intervention and between groups was compared after adjusting for clustering and covariates in a random-effects logistic regression analysis. Results Data on treatment implementation from nine and eight sites in the facilitated and passive KT group, respectively, were available for analysis. The facilitated KT intervention was associated with improved implementation of sit-to-stand (p = 0.028) and walking (p = 0.043) training while the passive KT intervention was associated with improved implementation of standing balance training (p = 0.037), after adjusting for clustering at patient and provider levels and covariates. Conclusions Despite multiple strategies and resources, the facilitated KT intervention was unsuccessful in improving integration of 18 treatments concurrently. The facilitated approach may not have adequately addressed barriers to integrating numerous treatments simultaneously and complex treatments that were unfamiliar to providers. Trial registration Unique identifier-NCT00359593 Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0631-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada. .,Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada.
| | - Sharon Wood-Dauphinee
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
| | - Johanne Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue nord, Bureau FM-2208, Sherbrooke, QC, J1H 5N4, Canada
| | - Janice J Eng
- University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Ottawa, K1G 5Z3, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Nicol Korner-Bitensky
- School of Physical and Occupational Therapy, McGill University, 3630 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Dalhousie University, Office 405 Forrest Building, 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Nancy E Mayo
- Division of Clinical Epidemiology, Division of Geriatrics, McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion R4.29, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada
| | - Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience physique de Québec (IRDPQ) Site Hamel, 525 Boul. Wilfrid-Hamel Est, Québec, QC, G1M 2S8, Canada
| | - Robert W Teasell
- Parkwood Institute, 550 Wellington Road, London, ON, N6C 0A7, Canada
| | - Merrick Zwarenstein
- Schulich School of Medicine and Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada
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18
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Affiliation(s)
- Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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19
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Hanna KL, Hepworth LR, Rowe FJ. The treatment methods for post-stroke visual impairment: A systematic review. Brain Behav 2017; 7:e00682. [PMID: 28523224 PMCID: PMC5434187 DOI: 10.1002/brb3.682] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 12/23/2022] Open
Abstract
AIM To provide a systematic overview of interventions for stroke related visual impairments. METHOD A systematic review of the literature was conducted including randomized controlled trials, controlled trials, cohort studies, observational studies, systematic reviews, and retrospective medical note reviews. All languages were included and translation obtained. This review covers adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke and were discussed separately. We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Article selection was performed by two authors independently. Data were extracted by one author and verified by a second. The quality of the evidence and risk of bias was assessed using appropriate tools dependant on the type of article. RESULTS Forty-nine articles (4142 subjects) were included in the review, including an overview of four Cochrane systematic reviews. Interventions appraised included those for visual field loss, ocular motility deficits, reduced central vision, and visual perceptual deficits. CONCLUSION Further high quality randomized controlled trials are required to determine the effectiveness of interventions for treating post-stroke visual impairments. For interventions which are used in practice but do not yet have an evidence base in the literature, it is imperative that these treatments be addressed and evaluated in future studies.
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Affiliation(s)
- Kerry Louise Hanna
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
| | | | - Fiona J. Rowe
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
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20
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Turton AJ, Angilley J, Chapman M, Daniel A, Longley V, Clatworthy P, Gilchrist ID. Visual search training in occupational therapy – an example of expert practice in community-based stroke rehabilitation. Br J Occup Ther 2015. [DOI: 10.1177/0308022615600180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Visual searching is an essential component of many everyday activities. Search training is practised as part of occupational therapy to improve performance skills both in people with hemianopia and those with spatial inattention post stroke. Evaluation of the effectiveness of such training first requires a systematic and detailed description of the intervention. To this end, this study describes the practice of a specialist occupational therapist. Method Single sessions of intervention delivered by the occupational therapist to five participants with visual search disorders post stroke were video recorded. The recordings were analysed for content using a framework approach. Results The occupational therapist educated participants about the impact of their visual impairment on everyday activities. She used instructions, spatial cueing, placement of objects and verbal feedback to train increased amplitudes of eye and head movements, to direct attention into the blind field or neglected space and to encourage systematic searching during occupations and activities. Activities were graded by manipulating the area for attention and complexity in the environment. Conclusion This investigation provides a detailed description of a specialist occupational therapist’s community-based intervention for improving visual search post stroke.
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Affiliation(s)
- Ailie J Turton
- Senior Lecturer, University of the West of England, Bristol, UK
| | - Jayne Angilley
- Clinical Specialist Occupational Therapist (Stroke), West Stroke Team Camborne & Redruth Community Hospital, Peninsula Community Health, Cornwall, UK
| | - Marie Chapman
- Occupational Therapist, National Star College, Gloucestershire, UK
| | - Anna Daniel
- Occupational Therapist, North Bristol NHS Trust, Bristol, UK
| | - Verity Longley
- PhD Student, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Philip Clatworthy
- Consultant Stroke Neurologist, North Bristol NHS Trust and University of Bristol, Bristol, UK
| | - Iain D Gilchrist
- Professor of Neuropsychology, University of Bristol, Bristol, UK
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Rowe F, Walker M, Rockliffe J, Pollock A, Noonan C, Howard C, Currie J. Delivery of high quality stroke and vision care: experiences of UK services. Disabil Rehabil 2015; 38:813-817. [PMID: 26114629 DOI: 10.3109/09638288.2015.1061604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We sought to identify exemplars of high quality care provision from established stroke vision services. METHODS We identified areas of high quality services across the UK, judged as having integrated stroke/vision care provision for stroke survivors. Healthcare professionals were selected to participate in 1:1 interviews or focus groups. A strengths-weaknesses-opportunities-threats (SWOT) framework was used to lead the discussion in a semi-structured format. Thematic analysis was undertaken. RESULTS Interviewees (n = 24) from 14 NHS Trusts included eye clinic managers, nurses, orthoptists, occupational therapists and physiotherapists. Identified strengths of their services included established communication, training provision for stroke team staff, "open access" for referrals, use of standardised screening/referral forms, provision of lay summaries and information sheets, patients assessed on the stroke unit with continued follow-up and initial visual assessments made within 1 week of stroke onset. Weaknesses included lack of funding, insufficient orthoptic cover, and time consuming retraining of stroke staff because of staff rotation and changes. Opportunities included increasing the number (or length) of orthoptic sessions and training of stroke staff. Perceived threats related to funding and increased appointment waiting times. CONCLUSIONS Practical elements for improved stroke and vision care provision are highlighted which can be implemented with relatively little financial inputs. Implications for Rehabilitation Integrated vision services within stroke units can improve the detection of visual problems in stroke survivors leading to earlier visual rehabilitation. Orthoptists within core stroke teams are beneficial to the delivery of a high quality service. This study illustrates clear practical elements to support the provision of high quality integrated stroke and vision services. Relatively little financial inputs are required to fund such services but with larger potential to improve patient care.
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Affiliation(s)
- Fiona Rowe
- a Department of Health Services Research , University of Liverpool , Liverpool , UK
| | - Marion Walker
- b Department of Stroke Rehabilitation , University of Nottingham , Nottingham , UK
| | | | - Alex Pollock
- d Nursing, Midwifery and AHP Research Unit, Glasgow Caledonian University , Glasgow , UK
| | - Carmel Noonan
- e Department of Ophthalmology , Aintree University Hospital NHS Foundation Trust , Liverpool , UK
| | - Claire Howard
- f Department of Orthoptics , Salford Royal NHS Foundation Trust , Manchester , UK , and
| | - Jim Currie
- g Different Strokes (London South East) , Milton Keynes , UK
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22
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Herron S. Review of experience with a collaborative eye care clinic in inpatient stroke rehabilitation. Top Stroke Rehabil 2015; 23:67-75. [PMID: 26043286 DOI: 10.1179/1074935715z.00000000065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Visual deficits following stroke are frequently subtle and are often overlooked. Even though these visual deficits may be less overt in nature, they are still debilitating to survivors. Visual deficits have been shown to negatively impact cognition, mobility, and activities of daily living (ADL). There is little consistency across healthcare facilities regarding protocol for assessing vision following stroke. OBJECTIVE This research was designed to describe a profile for patients exhibiting visual deficits following stroke, examine the role of occupational therapists in vision assessment, and discuss a potential model to provide a protocol for collaboration with an eye care professional as part of the rehabilitation team. METHODS The sample consisted of 131 patients in an inpatient rehabilitation (IPR) unit who were identified as having potential visual deficits. Occupational therapists on an IPR unit administered initial vision screenings and these patients were subsequently evaluated by the consulting optometrist. Frequencies were calculated for the appearance of functional symptoms, diagnoses, and recommendations. Correlations were also computed relating diagnoses and recommendations made. RESULTS All patients referred by the occupational therapist for optometrist evaluation had at least one visual diagnosis. The most frequent visual diagnoses included: saccades (77.7%), pursuits (61.8%), and convergence (63.4%). There was also a positive correlation between number of functional symptoms seen by occupational therapists and visual diagnoses made by the optometrist (r = 0.209, P = 0.016). CONCLUSION Results of this study support the need for vision assessment following stroke in IPR, confirm the role of occupational therapists in vision assessment, and support the need for an optometrist as a member of the rehabilitation team.
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Affiliation(s)
- Sarah Herron
- Marianjoy Rehabilitation Hospital , Wheaton, IL, USA
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23
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Care provision for poststroke visual impairment. J Stroke Cerebrovasc Dis 2015; 24:1131-44. [PMID: 25920755 DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/28/2014] [Accepted: 12/29/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We sought to explore the care provision for poststroke visual impairment and variations in this in the United Kingdom. METHODS Survey questions were developed and piloted with clinicians, academics, and users. Questions addressed types of visual problems; how these were identified, treated, and followed up; care pathways in use; links with other professions; and referral options. The survey was accessed via a Weblink, which was circulated through UK professional organizations to multiprofessional members of ophthalmic and stroke teams. RESULTS A total of 548 completed electronic surveys were obtained. In all, 49.5% of respondents represented stroke teams, 42.5% eye teams, and 8% from other teams, for example, emergency care. Many respondents (41%) saw patients within 1 week of stroke. Nineteen percent did not personally test vision: 11% had a visiting clinician to test vision, and 22% used screening tools. Validated tests were used for the assessment of visual acuity (39.5%), visual field (57.5%), eye movement (48.5%), and visual function (58.5%). Visual problems suspected by family or professionals were high (88.5%). Typical overall follow-up period of vision care was less than 3 months. In all, 46% of respondents used designated care pathways for stroke survivors with visual problems; 33.5% of respondents did not provide visual information leaflets. CONCLUSIONS Significant inequality exists in care for stroke survivors who experience visual problems. There is great variability in how vision screening is undertaken, which vision tests are used, methods of referral to eye care services, how visual problems are managed, and what vision information is provided to stroke survivors/carers. Further work is required to ensure equality and effective care.
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Rowe FJ, Barton PG, Bedson E, Breen R, Conroy EJ, Cwiklinski E, Dodridge C, Drummond A, Garcia-Finana M, Howard C, Johnson S, MacIntosh C, Noonan CP, Pollock A, Rockliffe J, Sackley C, Shipman T. A randomised controlled trial to compare the clinical and cost-effectiveness of prism glasses, visual search training and standard care in patients with hemianopia following stroke: a protocol. BMJ Open 2014; 4:e005885. [PMID: 25034632 PMCID: PMC4120412 DOI: 10.1136/bmjopen-2014-005885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Homonymous hemianopia is a common and disabling visual problem after stroke. Currently, prism glasses and visual scanning training are proposed to improve it. The aim of this trial is to determine the effectiveness of these interventions compared to standard care. METHODS AND ANALYSIS The trial will be a multicentre three arm individually randomised controlled trial with independent assessment at 6 week, 12 week and 26 week post-randomisation. Recruitment will occur in hospital, outpatient and primary care settings in UK hospital trusts. A total of 105 patients with homonymous hemianopia and without ocular motility impairment, visual inattention or pre-existent visual field impairment will be randomised to one of three balanced groups. Randomisation lists will be stratified by site and hemianopia level (partial or complete) and created using simple block randomisation by an independent statistician. Allocations will be disclosed to patients by the treating clinician, maintaining blinding for outcome assessment. The primary outcome will be change in visual field assessment from baseline to 26 weeks. Secondary measures will include the Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual-5D and Short Form-12 questionnaires. Analysis will be by intention to treat. ETHICS AND DISSEMINATION This study has been developed and supported by the UK Stroke Research Network Clinical Studies Group working with service users. Multicentre ethical approval was obtained through the North West 6 Research ethics committee (Reference 10/H1003/119). The trial is funded by the UK Stroke Association. Trial Registration: Current Controlled Trials ISRCTN05956042. Dissemination will consider usual scholarly options of conference presentation and journal publication in addition to patient and public dissemination with lay summaries and articles. TRIAL REGISTRATION Current Controlled Trials ISRCTN05956042.
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Affiliation(s)
- F J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - P G Barton
- Department of Elderly Care, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - E Bedson
- Clinical Trials Research Unit, University of Liverpool, Liverpool, UK
| | - R Breen
- Clinical Trials Research Unit, University of Liverpool, Liverpool, UK
| | - E J Conroy
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - E Cwiklinski
- Clinical Trials Research Unit, University of Liverpool, Liverpool, UK
| | - C Dodridge
- Department of Orthoptics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - M Garcia-Finana
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - C Howard
- Department of Orthoptics, Salford Royal NHS Foundation Trust, Manchester, UK
| | - S Johnson
- Eye Clinic Impact Team, Royal National Institute for the Blind, Birmingham, UK
| | - C MacIntosh
- Department of Orthoptics, Oxford University Hospitals NHS Trust, Oxford, UK
| | - C P Noonan
- Department of Ophthalmology, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - A Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - C Sackley
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - T Shipman
- Department of Orthoptics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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