Mobility and access to transport issues as experienced by people with vision impairment living in urban and rural Ireland

Global certification of visual impairment registries: A scoping review

BACKGROUND

Visual impairment is a global problem which is predicted to rise in the coming years. Some of the biggest causes of visual impairment globally include uncorrected refractive error, cataract and age-related macular degeneration. People with a visual impairment often require support and so many countries hold registers of visual impairment. These registers can sit at a national, regional or local level. This scoping review aims to identify which countries hold visual impairment registries and have published data from them.

METHODS

Medline All, Embase and EBSCOHost were searched using several search terms after consulting an information specialist. All papers after the year 2000 were included in the scoping review. All results are shown using a PRISMA diagram and presented narratively.

RESULTS

The total number of articles and papers identified was 1266; after screening and review, 57 articles were included in the review from 2000 to 2024. These articles came from 19 different countries and encompassed national, regional and local visual impairment databases. Many countries cited age-related macular degeneration as the major cause of blindness with diabetic retinopathy and glaucoma following. In less economically developed countries, refractive error was the main cause of sight loss. There were papers which focused on specific eye conditions such as glaucoma and diabetic retinopathy or on specific cohorts including working-age population and children. The leading causes of blindness in children appeared to be inherited retinal diseases, albinism and cerebral visual impairment.

CONCLUSION

Certification of visual impairment is held differently across the world. There is commonality among different countries regarding the major causes of visual impairment in both adults and children. The importance of holding visual impairment registers to support people with a visual impairment and to plan services is essential.

Barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa within a global context

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

Risk mitigation at train stations: underlying causes of slips, trips, and falls for passengers with reduced mobility

Slips, trips, and falls (STFs) occur frequently at train stations and on trains, and result in passengers injuries. STFs underlying causes focussing on passengers with reduced mobility (PRM) were investigated. Mixed methods combining observation and retrospective interviews were used. Thirty-seven participants between 24 and 87 years of age completed the protocol. They navigated between three selected stations while wearing the Tobii eye tracker. In retrospective interviews, they were asked to explain their actions in selected video segments. The research identified the dominant risky locations and risk-taking behaviour in risky locations. For example: (i) risky locations were the vicinity of obstacles, (ii) risky behaviour was not looking at the gap between the platform and train. The dominant risky locations and behaviours could be considered as underlying causes of slips, trips, and falls for PRMs. They can be applied during planning and design of rail infrastructure to predict and mitigate STFs.Practitioner summary: A significant number of slips, trips, and falls (STFs) occurs at railway stations, and often result in personal injury. This research identified the dominant risky locations and behaviour as underlying causes of STFs for people with reduced mobility (PRMs). The recommendations presented could be implemented to mitigate such risk.

Active Lifestyle and Mobility of Adults with Vision Impairment: A Multiphase Mixed-Methods Study

Individuals with vision impairment (VI) are less physically active than their sighted peers, heightening their risk of chronic illness. This study aimed to explore real and perceived barriers and promoters of an active lifestyle among adults with VI. We used mixed-methods, including a quantitative analysis of spatial data and a qualitative analysis of input from focus groups. The data were analyzed using descriptive statistics, graphical and thematic analysis. The spatial analysis highlighted frequent impediments, including high proportions of inaccessible crosswalks and stairs, a high density of obstacles (12/km) and almost inexistent guidance markings (0.1/km). Factors influencing active lifestyle of individuals with VI reported in the focus groups included: VI severity and self-confidence; accessibility of the physical environment as well as support and consideration of the society; use of behavioral strategies, striving for good health and willpower. Combined psychosocial, behavioral and infrastructural modifications could enhance active lifestyles among adults with VI. Consideration of the needs of individuals with VI is critical among environmental planners. Sustainable solutions for improving accessibility and mobility in the city for individuals with VI will influence not only their social integration but will enable them to adopt an active lifestyle and reduce their risk of chronic illness.

An Exploratory Assessment of Self-Reported Satisfaction with Infrastructure and Out-of-Home Activities for People with Vision Impairments

PURPOSE

The purpose of this study is to assess the satisfaction levels of people with VI with regard to infrastructure and outdoor activities. Furthermore, this study aims to develop an assessment model for the levels of difficulty in using public transport.

METHODS

Participants in a standardized survey questionnaire included 74 participants with VI. Three assessment-ordered probit models were estimated based on self-reported responses.

RESULTS

Estimation results revealed that the use of public transport is extremely difficult for 83.47% of older participants. In addition, 84.2% of people with albinism have extreme difficulty using public transport. Furthermore, 53.98% of people with restricted horizontal and vertical fields face extreme difficulty using public transport. There was dissatisfaction with outdoor activities among 97.40% of people with macular disease. The results show that 51.70% of people with normal or near-normal horizontal visual fields and restricted vertical planes are satisfied with their level of outdoor activity while 72.65% of people with retinal diseases expressed dissatisfaction with the existing infrastructure.

CONCLUSION

This study revealed that the experiences of people with VI are heterogeneous and depend on their eye condition, access to assistive technology, and socioeconomic characteristics. Results clearly show evidence of heterogeneity among individuals with VI. The combination of horizontal and vertical restrictions yields random parameters, underscoring the heterogeneous experiences of people with VI, influenced by their eye condition and access to assistive devices. Our results have important implications for developing targeted interventions to enhance the mobility of people with VI.

Navigating the Unseen City: Town Planners, Architects, Ophthalmic Professionals, and Charity Opinions on Navigating of the Built Environment with a Visual Impairment

People with a visual impairment often find navigating around towns and cities difficult. Streetscape features such as bollards, street cafés, and parked cars on pavements are some of the most common issues. in this paper semi-structured interviews were conducted with stakeholders including built environment professionals, visually impaired individuals, ophthalmic professionals, and sight loss charities. All stakeholders felt there were barriers and enablers to navigating streets with a visual impairment. Stakeholders agreed these can have an impact on the daily lives of those with a visual impairment. While built environment professionals knew of policies and guidance around accessibility for people with a visual impairment, there was a lack of professional knowledge about the spectrum of visual impairment. Despite this, stakeholders felt these small changes could have a positive impact, making accessible cities for all. A collaborative approach to streetscape design and further education could help create better environments for all.

The Fujian eye cross sectional study: objectives, design, and general characteristics

Purpose

To describe the objective and design of the Fujian Eye Study and to introduce the general characteristics and vision condition of this study.

Methods

The Fujian Eye Study (FJES) is a population-based cross-sectional survey on the public eye health status of residents over 50 years old in the entire Fujian Province of Southern China, which contains both urban and rural areas and coastal and inland regions. 10,044 participants were enrolled using a two-stage cluster sampling design and underwent a questionnaire and a series of standard examinations both physical and ocular. The main subgroups of data collection included age, sex, region, refractive error, education background, income, eating habits, smartphone usage in the dark, complaints of eye discomfort, history of chronic diseases, consumption of tobacco, alcohol, or tea.

Results

8211 (81.8%) participants were finally included and were divided into urban populations (4678 subjects) and rural populations (3533 subjects) and coastal residents (6434 subjects) and inland residents (1777 subjects); 4836 participants were female. The mean age was 64.39 (SD 8.87) years (median 64 years; range 50–98 years). 227 (3.33%) had vision impairment (VI), 195 (2.87%) had low vision and 14 (0.21%) were blind. The mean presenting near visual acuity (PNVA) was 0.28 (0.17), the mean presenting distance visual acuity (PDVA) was 0.61 (0.30), and the mean best corrected visual acuity (BCVA) was 0.82 (0.28).

Conclusions

The FJES collected detailed questionnaire information and overall ocular and physical examinations, which provide the opportunity to identify risk factors and images of VI and eye diseases and to evaluate their associations with chronic diseases and basic personal information.

Inclusive planning: African policy inventory and South African mobility case study on the exclusion of persons with disabilities

Background

The Sustainable Development Goals (SDGs) and universal design (UD) principles call for inclusive planning. Within the transportation field, this includes the development or improvement of facilities that accommodate people with disabilities. Between 10% and 20% of the African population is affected by disabilities. A lack of understanding of the needs of people with disabilities leads to isolation. Within the transportation field, isolation manifests itself as a reduction in trip-making.

Methods

This paper investigates the availability of transport policies and guidelines in 29 different African countries, focusing on the inclusion of persons with disabilities. A desktop study was conducted creating heat maps for 29 African countries, followed by the analysis of secondary data in the case study area, South Africa, demonstrating that the lack of adequate policies, guidelines, and appropriate implementation leads to a lack of accessibility, opportunities, and social isolation, measured through trip frequencies.

Results

The data analysed revealed that many African countries omit, or only superficially include, people with disabilities in their transport policy framework. Ghana has the most inclusive People with Disabilities Act, while South Africa is most inclusive regarding their planning and design of transport facilities and services. In South Africa, 4.5% of the population did not travel at all in the 7 days before the interview, as disability or age prevented them from doing so, or due to a lack of appropriate travel services. When comparing the trip rates per week, people with disabilities travel significantly less, between 27.2% and 65.8%, than their abled counterparts.

Conclusions

The study reveals that people with disability live less integrated, more isolated lives due to the lack of acknowledgement in the transport policy framework and accommodation in infrastructure and services. The results underpin the need for disability-inclusive planning in the African context and provide recommendations for actions that mitigate the isolation challenges faced by people with disabilities. Municipalities play a crucial role in improving the quality of life for people with disabilities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00775-1.

"When I need to travel, I feel feverish": Everyday experiences of transport inequalities among older adults in Dhaka, Bangladesh

Background and Objectives

Buses are the most common form of public transport for older adults in developing countries. With over 37% of total trips, buses are the principal mode of transport in Dhaka. The majority of older adults are dependent on buses because of their affordability relative to other modes such as auto-rickshaws, rideshares, and taxis. This study aims to investigate key barriers in accessing buses in Dhaka and the consequences of these barriers to the everyday mobility of older adults.

Research Design and Methods

Thirty participants aged 60 and older were recruited from 2 socioeconomically different neighborhoods in Dhaka. We employed a thematic analysis of visual surveys and in-depth interviews to understand older adults’ spatial and cultural context and their experiences using buses in their everyday lives.

Results

Boarding and deboarding buses were common barriers for older adults due to overcrowding and traffic congestion. In addition, older adults faced challenges such as ageism, gender discrimination, and undesirable behavior by transport personnel and co-passengers. These barriers affected their independent mobility and influenced their access to work and social life, contributing to their social exclusion.

Discussion and Implications

This study illustrates the challenges faced by older adults when accessing public transport and the need to improve access to work, health care, and social life. Inclusive transport policies are essential in low- and middle-income countries to improve the well-being of older adults.

A qualitative exploration of the sociology of poststroke visual impairments and the associated health inequalities

INTRODUCTION

Inequalities have been found to exist within the visually impaired stroke population on an individual level, in relation to demographic differences, unequal access to vision services, transport, employment, and financial repercussions. The long-term impact of living with poststroke visual impairments must be explored, in order to identify complications accessing NHS services and to inform possible changes to service planning and delivery in order to tackle such complications.

AIM

To explore the extent of health inequalities within visually impaired stroke survivors in the northwest of England and discuss potential solutions to these.

METHODS

Focus groups and individual interviews (n = 13 stroke survivors and n = 1 spouse) were conducted between October 2016 and January 2017. Transcription and thematic analysis of the transcripts was undertaken, using line-by-line coding, underpinned with social constructionism.

RESULTS

The findings draw on lived experiences of stroke survivors across their journey from prestroke to life after stroke. The three overarching experiences of stroke and visual impairment that emerged in respondent accounts were constructed in terms of "loss," concerning (a) the physical being, (b) the psychosocial being and, (c) the systematic organization of health care.

CONCLUSION

The stroke survivors frequently reported a complete lack of visual care, with many recounting apathetic experiences, often resonating power imbalance in the healthcare system. Where suitable care is being offered after stroke, a desire for a personalized approach to rehabilitation, with adapted communication methods specific to individual needs, featured strongly in many of the respondent accounts. The findings emphasize a need to ensure vision rehabilitation is offered to all stroke survivors suffering from poststroke visual impairment, and to educate stroke clinicians and patients of the bigger picture of life after stroke, highlighting all forms of available support.

Reduced social participation among seniors with self-reported visual impairment and glaucoma

Objective

Social participation benefits health. We assessed the relationship between self-reported visual impairment (VI) and glaucoma versus seniors’ social participation.

Methods

Data from individuals aged ≥65 years responding to the Canadian Community Health Survey Healthy Aging 2008/2009 (n = 16,369) was analyzed. Participation in eight social activities by seniors with and without self-reported VI or glaucoma was compared.

Results

Seniors with VI had significantly reduced participation (p<0.05) in sports/physical activities (18.0% vs. 33.6%), family/friendship activities outside the household (39.7% vs. 53.0%), service club/fraternal organization activities (11.4% vs. 18.4%), volunteer/charity work (13.4% vs. 24.9%), educational/cultural activities (16.2% vs. 24.5%), and other social recreational activities (21.6% vs. 31.0%) compared to those without VI. Differences in participation in church/religious activities (40.6% vs. 44.5%) and community/professional association activities (15.3% vs. 18.0%) were non-significant between seniors with and without VI. Seniors with glaucoma versus those without had significantly reduced participation (p<0.05) in family/friendship activities (46.6% vs. 52.9%), sports/physical activities (26.0% vs. 33.6%) and volunteer/charity work (20.4% vs. 24.9%). No participation in any social activity was significantly higher among seniors with VI versus those without (10.1% vs. 2.9%, p<0.05), but was similar among seniors with and without glaucoma (3.9% vs. 3.1%, p>0.05). After adjusting for the effects of age, sex, education, household income, ethnicity, job status and chronic diseases (adjusted odds ratio, aOR = 3.4 (95% confidence interval (CI) 2.0–5.8), seniors with VI but no glaucoma were more likely not to engage in any social activities compared to seniors without VI and no glaucoma. Seniors with glaucoma but without VI had a similar level of non-participation (aOR = 0.9, 95%% CI 0.5–1.7).

Conclusions

Significantly reduced social participation was found across six community activities among seniors with self-reported VI and in three activities among those with self-reported glaucoma. Policies and programs that help seniors with VI or glaucoma engage in social activities are needed.

Transporting People with Visual Impairments: Knowledge of University Campus Public Transportation Workers

Introduction:

To support independent travel skills and accessibility for people with visual impairments (i.e., those who are blind or have low vision), this research acknowledges bus driver perceptions of visual impairment and investigates how bus drivers interact with visually impaired travelers who ride public transportation.

Methods:

This study utilized the Social Responsibility about Blindness Scale and a researcher-created instrument to explore how bus drivers interact with visually impaired travelers.

Results:

Fifty-five drivers participated in this study, with 94.55% of these drivers reporting that they have had experiences interacting with visually impaired passengers. The top concern drivers reported was ensuring these passengers located the correct stop (26.56%). Using Likert-type scale ratings to assess driver knowledge and role in assisting passengers with vision loss, overall mean average of driver knowledge was 3.33 ( SD = 1.09, V = 1.23), indicating, as a whole, driver knowledge was in the range of “unsure/don’t know.”

Discussion:

Although many campus area bus drivers have experience interacting with passengers who are visually impaired, the attitude of drivers toward visual impairment is varied, and their knowledge of visual impairments is limited.

Implications for practitioners:

Based on results, drivers recognize that accommodations may be needed for passengers with vision loss, and they have an interest in learning how to assist passengers who are visually impaired who ride campus transportation. Based on this outcome, in-service training for drivers to address interactions and accommodations for passengers with vision loss may be warranted within public transportation operations.

WRINKLED VASCULARIZED RETINAL PIGMENT EPITHELIUM DETACHMENT PROGNOSIS AFTER INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY

BACKGROUND/PURPOSE

Neovascular age-related macular degeneration (nAMD) is frequently associated with vascularized pigment epithelial detachment (v-PED). We observed a peculiar characteristic of v-PED characterized by small lacy folds of the retinal pigment epithelium, appearing as a wrinkled PED (w-PED) on spectral domain optical coherence tomography (SD-OCT). Our purpose was to describe the visual prognosis and number of intravitreal injections in w-PED compared with non-w-PED.

METHODS

In this retrospective, case-control series, we reviewed retrospectively medical records of 52 eyes of 51 patients who were consecutively included between November 1 and 30, 2015 with a previous minimum 3-year follow-up. Inclusion criteria were: neovascular age-related macular degeneration, affected with w-PED. Baseline characteristics, best-corrected visual acuity (BVCA), number of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVT) and maximal recurrence-free interval, that is, without intravitreal anti-vascular endothelial growth factor injection, were analyzed. A w-PED was defined as a v-PED ≥200 μm in height on SD-OCT imaging, presenting with at least 4 small lacy folds on the surface of the retinal pigment epithelium. Patients were compared with a control group, that is, patients harboring PED without wrinkle shape (non-w-PED). All patients had been treated by intravitreal anti-vascular endothelial growth factor injection of either ranibizumab (IVR) or aflibercept (IVA) using a pro re nata (PRN) protocol after three initial monthly treatments, with a minimum of follow-up of 3 years.

RESULTS

Two groups of patients were compared, w-PED (29 eyes, from 29 patients), and non-w-PED (23 eyes from 22 patients). In the w-PED group, mean BCVA evolved from 0.28 (±0.18) log MAR (20/40, range 20/25-20/63) at baseline, to 0.29 (±0.21) log MAR (20/40, range 20/25-20/63) at 1 year (P = 0.41), 0.34 (±0.26) log MAR (20/40, range 20/25-20/80) at 2 years (P = 0.49), 0.35 (±0.28) log MAR (20/40, range 20/25-20/80) at 3 years (P = 0.54). In the non-w-PED group, mean BCVA was 0.40 (±0.28) log MAR (20/50, range 20/25-20/100) at baseline and decreased to 0.48 (±0.46) log MAR (20/63, range 20/20-20/160) at 1 year (P = 0.19), 0.48 (±0.35) log MAR (20/63, range 20/25-20/125) at 2 years (P = 0.02), 0.60 (±0.38) log MAR (20/80, range 20/32-20/200) at 3 years (P = 0.002). In the w-PED group, the mean maximal documented recurrence-free interval was 7.87 (±2.94) months at Year 1, 13.5 (±7.52) at Year 2 and 14.78 (±10.70) at Year 3, versus 4.59 (±2.95) months at Year 1, 7.83 (±6.62) at Year 2, 8.57 (±11.18) at Year 3 in the non-w-PED group (P = 0.0004; 0.0101; 0.0168 respectively at Years 1, 2 and 3).

DISCUSSION

The evolution of v-PED after intravitreal anti-vascular endothelial growth factor injection is still difficult to predict despite intense clinical research in this topic. In our study, we noticed that w-PED might be a phenotypic prognosis factor for better visual acuity and longer maximal recurrence-free interval.

Low vision and mobility scooters: the experiences of individuals with low vision who use mobility scooters

Purpose: Older adults with low vision are a growing population with rehabilitation needs including support with community mobility to enable community participation. Some older adults with low vision choose to use mobility scooters to mobilize within their community, but there is limited research about the use by people with low vision. This paper describes a pilot study and asks the question: what are the experiences of persons with low vision who use mobility scooters? Methods: This study gathered the experiences of four participants with low vision, aged 51 and over, who regularly use mobility scooters. Diverse methods were used including a go-along, a semi-structured interview and a new measure of functional vision for mobility called the vision-related outcomes in orientation and mobility (VROOM). Findings: Four themes were found to describe experiences: autonomy and well-being, accessibility, community interactions and self-regulation. Discussion and implications: This study was a pilot for a larger study examining self-regulation in scooter users. However, as roles emerge for health professionals and scooters, the findings also provide evidence to inform practice, because it demonstrates the complex meaning and influences on performance involved in low vision mobility scooter use. Implications for rehabilitation Scooter use supports autonomy and well-being and community connections for individuals with both mobility and visual impairments. Low vision scooter users demonstrate self-regulation of their scooter use to manage both their visual and environmental limitations. Issues of accessibility experienced by this sample affect a wider community of footpath users, emphasizing the need for councils to address inadequate infrastructure. Rehabilitators can support their low vision clients' scooter use by acknowledging issues of accessibility and promoting self-regulation strategies to manage risks and barriers.

Mapping review of accessible pedestrian infrastructures for individuals with physical disabilities

BACKGROUND

Due to the ageing population and higher prevalence of individuals living with physical disabilities, there is a critical need for inclusive practices when designing accessible pedestrian infrastructures for ensuring social participation and equal opportunities.

PURPOSE

Summarize the physical characteristics of current pedestrian infrastructure design for individuals with physical disabilities (IPD - motor, visual and hearing) found in the scientific literature and assess its quality.

MATERIALS AND METHODS

A mapping review of the existing literature on pedestrian infrastructures specifically built for individuals with physical disabilities identifying measurable physical characteristics for their design was done using online databases (Urban Studies Abstracts, Geobase, PubMed, and Cairn and secondary research). Information about accessibility (physical characteristics) of existing pedestrian infrastructures was extracted. The quality of the evidence was assessed using the Guidelines for critical review form - Quantitative studies and Qualitative studies version 2.0 (SAGE Publications, Inc., Thousand Oaks, CA).

RESULTS

Of the 1131 articles identified, forty-one articles examined access to bus stops, curb ramps, lighting, pedestrian crossings, ramps, shared spaces, sidewalks and steps. Six articles reported on more than one physical disability. Quality scores were generally low (quantitative: 2-11/15 and qualitative: 1-22/23). Recommended design features differed for the same infrastructure.

CONCLUSIONS

While there were a fair number of articles (n = 41) documenting accessible design features of pedestrian infrastructures, the quality of the evidence was low. The review identified knowledge gaps. Although specific design solutions exist, they have not yet been tested among individuals with various or multiple types of physical disabilities to ensure access to pedestrian infrastructures by all. Implications for Rehabilitation Pedestrian infrastructures still pose problems to mobility, limiting social participation and quality of life outcomes for individuals with physical disabilities (motor, visual and hearing). The results of this mapping review show that few articles are concerned with the accessibility of pedestrian infrastructures for more than one type physical disability, which might lead to recommendations that are inadequate for individuals with differing disabilities, few recommendations have been compared, most studies have been performed in environments not representative of northern countries and their quality score was generally low. Health professionals and State Parties have a complementary expertise that should be put to use in the determination and implementation of best design solutions to ensure the respect of the needs of individuals with physical disabilities. This review can thus help them have an idea of what has already been done to identify what needs to be achieved to fill the gap of knowledge required to insure access for individuals with motor, visual as well as hearing disabilities. Rehabilitation profesionals should take part in the assessment of the proposed solutions as well as the development of new designs to fill knowledge gaps.

Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

The aim of this study was to report on the health inequalities facing stroke survivors with visual impairments as described in the current literature. A systemic review of the literature was conducted to investigate the potential health inequalities facing stroke survivors with subsequent visual impairments. A quality-of-evidence and risk-of-bias assessment was conducted for each of the included articles using the appropriate tool dependent on the type of article. Only four articles discussed health inequalities affecting stroke survivors with visual impairment specifically. A further 23 articles identified health inequalities after stroke, and 38 reported on health inequalities within the visually impaired UK or Irish population. Stroke survivors with visual impairment face inconsistency in eye care provision nationally, along with variability in the assessment and management of visual disorders. The subgroups identified as most at risk were females; black ethnicity; lower socioeconomic status; older age; and those with lower education attainment. The issue of inconsistent service provision for this population must be addressed in future research. Further research must be conducted in order to firmly establish whether or not stroke survivors are at risk of the aforementioned sociodemographic and economic inequalities.

The influence of cultural beliefs on the utilisation of rehabilitation services in a rural South African context: Therapists' perspective

No abstract available.

‘Is Seeing Perceiving?’ Exploring issues concerning access to public transport for people with sight loss

This research examined the needs and experiences of people with sight loss regarding access to bus and rail services in a large urban area in Ireland. A broad qualitative approach was used, so as to investigate people’s lived experiences both as passengers and as providers of public transport. Participants included 13 people with differing levels of sight loss and the Access Officers from two public transport organisations in the area. From this research, it is apparent that travel in the area by people with sight loss has improved since the introduction of key pieces of legislation. Awareness of sight loss and assistance given by staff members was the most prominent area of improvement reported by the participants. However, there appeared to be an inequality in access among people with sight loss, in that people with low vision appear to benefit more from access services than people who are totally blind. Research also showed that although technologies, including audible announcements, to assist passengers with more severe sight loss exist, they are not all available in Ireland yet or are not always effective. People’s own experience of sight loss and travelling as a person with reduced vision seems also to contribute to how accessible a transport service is and further research in this area is recommended.