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Ruth M A Van Nispen, Hilde Petronella Adriana van der Aa, Ger van Rens; Inpatient low vision rehabilitation has a long term positive effect on participation, vision-related quality of life and adaptation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4765.
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© ARVO (1962-2015); The Authors (2016-present)
In the Netherlands, every year approximately 120 visually impaired adults with complex needs follow an inpatient multidisciplinary weekday rehabilitation program. The aim was to investigate its long term effectiveness on participation, vision-related quality of life (VRQOL) and mental health. Also, prognostic factors were studied as were the direct health care costs.
In a prospective longitudinal cohort, 74 adults (28% retinitis pigmentosa or Usher, 62% male, mean age 47 SD 15 years) were interviewed by telephone at baseline (Feb 2013-Jul 2014) and 10 and 18 months follow up (dropout 12%). The outcomes Participation and Activity Inventory, Low Vision Quality of Life subscales, Adaptation to Vision Loss, Center for Epidemiological Studies – Depression, Hospital Anxiety Depression Scale were fitted to item response theory models. Linear mixed models were used to analyze the effect of rehabilitation and prognostic factors. Costs of stay and of the interventions provided were calculated for each patient.
Improvement was found on participation, the LVQOL mobility and acceptance subscales and on adaptation (p<0.001). Visual functioning, depression and anxiety symptoms did not change significantly over time. Comorbidity and severity of vision loss were negative predictors of participation and VRQOL; duration of the visual impairment was a positive predictor. Mean duration of stay was 137 SD 50 days. The most often followed interventions were computer training (mean 130 hrs SD 60), leisure courses (63 SD 49), Braille training (60 SD 55), orientation and mobility training (54 SD 56), psychosocial counselling (53 SD 31). Mean costs per patient of stay were €10,624 (range 3,089-21,873) and interventions €25,546 (range 6,270-73,631).
Although some mental health outcomes and visual functioning did not improve, there was a strong long term positive effect of inpatient rehabilitation on participation, mobility, acceptance and adaptation. Pinpointing vulnerable groups within the inpatient setting may increase awareness of professionals and may help to fine-tune rehabilitation trajectories. The variability in the tailor-made trajectories warrants future studies into dose-response relations of (combinations of) interventions to reduce costs of the program and to further increase effectiveness.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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