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LOVESME_lit_review.doc - Low vision service outcomes a...

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Low vision service outcomes: a systematic review September 2009 This review has been prepared for the RNIB as part of the Low Vision Service Model Evaluation (LOVSME) project.
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Authors: Alison Binns, Cardiff University Catey Bunce, Moorfields Eye Hospital Chris Dickinson, University of Manchester Robert Harper, Manchester Royal Eye Hospital Rhiannon Tudor-Edwards, Bangor University Maggie Woodhouse, Cardiff University Pat Linck, Bangor University Alan Suttie, Fife Society for the Blind. Jonathan Jackson, Royal Victorial Hospital Jennifer Lindsay, Royal Victoria Hospital James Wolffsohn, Aston University Lindsey Hughes, British and Irish Orthoptic Society Tom Margrain, Cardiff University Advisory Panel: Mary Bairstow, Vision 2020 UK Andy Fisher, Focal Point UK Lisa Hughes, Service User Marek Karas, Optometric Advisor Robert W Massof, Hopkins University School of Medicine. Anita Morrison-Fokken, FOCUS Birmingham Joan A Stelmack, Edward E. Hines Jr VA Hospital, Illinois. Gaynor Tromans. FOCUS Birmingham 2
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Contents 1 Executive Summary ................................................................. 6 1.1 Quality of Evidence ............................................................................ 7 1.2 Does rehabilitation improve outcomes for service users? .................. 7 1.3 Is there evidence that some services are better than others? ........... 8 1.4 Do rehabilitation outcomes deteriorate with time? ............................. 9 1.5 Is more rehabilitation better? ............................................................. 9 1.6 Studies on children, those of working age and minority groups ......... 9 1.7 How cost-effective is low vision service provision? ............................ 9 2 Introduction ............................................................................ 12 2.1 Visual Impairment: the scale of the problem .................................... 12 2.2 Causes of visual impairment in older adults ..................................... 15 2.3 Visual loss in children ....................................................................... 16 2.4 The Consequences of Visual Impairment ........................................ 16 2.5 The psychosocial impact of visual loss ............................................ 17 2.6 The economic impact of visual impairment and associated disabilities ........................................................................................ 19 2.7 Vision Rehabilitation Services .......................................................... 20 2.8 Outcome Measures for Assessing the Effectiveness of a Service ...26 2.8.1 Traditional Outcome Measures ................................................. 26 2.8.2 Quality-of-life and Functional Self-Assessment Tools ............... 27 2.8.3 Economic outcomes .................................................................. 29 2.9 Implementation of Outcome Measures ............................................ 30 2.9.1 Mode of Implementation ............................................................ 30 2.9.2 Timing of Outcome Assessment ................................................ 31 3 Objectives ............................................................................... 34 3.1 Primary objective: ............................................................................ 34 3.2 Secondary objectives: ...................................................................... 34 4 Methods ................................................................................... 34 4.1 Outcomes Assessed ........................................................................ 34 4.2 Inclusion/Exclusion Criteria .............................................................. 35 4.3 Literature Searching Methods .......................................................... 37 3
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4.4 Evaluating Quality of Evidence ........................................................ 38 4.5 Data extraction ................................................................................. 39 4.6 Statistical methods ........................................................................... 39 5 Results .................................................................................... 41 5.1 Search Results ................................................................................. 41 5.2 Quality of included studies ............................................................... 41 5.3 Evidence Synthesis .......................................................................... 45 5.4 Effect of Low Vision Service Intervention on Clinical Measures of Visual Function ................................................................................. 45 5.5 Frequency of Use of LVAs Following Low Vision Service Intervention and Satisfaction with LVAs and Service ........................................... 48 5.6 Effect of Low Vision Service Intervention on Performance of Activities of Daily Living (ADLs) ....................................................... 49 5.7 Effect of Low Vision Service Intervention on Vision-Related Quality- of-Life ............................................................................................... 54 5.8 Effect of Low Vision Service Intervention on Mood .......................... 58 5.9 Effect of Low Vision Service Intervention on Generic Health-Related Quality-of-Life ................................................................................... 62 5.10 The Differential Effect of Low Vision Service Models on Rehabilitation Outcomes .................................................................. 63 5.11 The Effect of Follow-up Timing on Rehabilitation Outcomes ........... 68 5.12
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