Title: Low vision service outcomes: a systematic review
Author: Alison Binns, Catey Bunce, et al; Publisher: RNIB; Year of publication: 2009.
RNIB commissioned some research to investigate the benefits for people with visual impairment, of an integrated low vision and rehabilitation pathway, and to determine whether this integrated approach has additional benefits for users, to standard low vision and rehabilitation care. The outputs of this project include a review of the literature on different models of low vision and rehabilitation in sight loss and the impact on patient outcomes, and a report of identified good practice as measured against the NHS Recommended Standards for Low Vision services, of both integrated and standard services.
There is a lack of high quality evidence to support the effectiveness of low vision service provision.
The majority of studies use a relatively weak ‘before and after’ comparison design, many do not provide a full description of the intervention studied and results are not always reported in full.
There has been little agreement about how best to measure outcomes and this frustrates study comparisons.
Low vision aids improve reading ability and are valued by service users.
Well resourced rehabilitation programmes (e.g. Veterans Affairs programmes in USA) can produce large improvements in ‘functional ability’ but there is no evidence that they improve ‘generic health related quality-of-life’.
There is contradictory evidence about the ability of services to improve ‘vision related quality-of-life’.
Despite several reports of small improvements in mood following low vision rehabilitation there is no evidence that even the well resourced Veterans Affairs programme can reduce depressive symptoms in its client group. However, other types of programme such as “Independent Living Programmes” and “Adaptive Skills Training” may help people ‘adjust’ to vision loss.
There is no evidence that ‘enhanced’ services are better at improving ‘vision related quality of life’ than ‘standard’ hospital based services in the UK.
There is no evidence that ‘multidisciplinary services’ are better at improving vision related quality of life than ‘optometric services’ in Holland.
There is evidence that a ‘group based health education programme’ is more effective than an ‘individual intervention’.
There is some evidence that rehabilitation outcomes peak at around 2-3 months and decline thereafter but this is not a universal finding.
There is some evidence that rehabilitation outcomes are better following more intense rehabilitation programmes but, the optimum ‘dose’ has not yet been established.
There is very little information about rehabilitation outcomes in children and none about outcomes in those of ‘working age’ and in minority groups.
Only 2 studies are directly relevant to the cost of low vision rehabilitation but it is not possible to conclude that the programmes studied were cost effective.
Robust research methods and high quality reporting are necessary to advance our understanding of how rehabilitation services can best help people with a visual impairment.