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Dominic L Brown, Chris Bradley, Robert W Massof, Gislin Dagnelie, Judith E Goldstein; Agreement Between Functional History and Plan of Care in Low Vision Rehabilitation. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1718 – F0036.
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© ARVO (1962-2015); The Authors (2016-present)
For successful low vision rehabilitation (LVR), the clinician’s plan of care (POC) should agree with the patient’s functional visual goals. A retrospective review of patient records tests this premise by determining the level of agreement between patients’ functional histories (FH) and their POCs. Further, this study aims to explore the application of functional domain classifications as a method of classifying elements in the FH of the patient, and estimating how well the provider’s POC addresses those elements.
As a feasibility study, we analyzed the FH and POC of 20 consecutive new patients at the Wilmer Eye Institute Lions Vision Rehabilitation Service. The FH was reviewed and each element assigned to one of 11 functional domains, 10 from the Dutch Activity Inventory (PMID: 21090911) and an 11th (glare) that we created. The proportion of the domains identified in the FH that were addressed in the POC was calculated and served as the dependent variable. Pearson correlations between the dependent variable and age, best-corrected visual acuity of the better seeing eye (BCVA), and contrast sensitivity (CS) were estimated for the sample of patients.
Of the 20 records included in this feasibility study, 50% of patients had 100% agreement between functional domains identified in the FH and POC. The other half had levels of functional domain agreement uniformly distributed from 18%-91%. The overall mean (SD) level of functional domain agreement was 78% (28%). The correlation between the level of agreement and age in our sample was -0.38. The most common domains documented in the FH were learning and applying knowledge (90%), mobility (50%) and glare (50%). The least common were self-care (0%), general tasks and demands (10%), and community/social/civic life (30%).
The distribution of the levels of functional domain agreement found in this study demonstrates the feasibility of the described approach in determining how thoroughly clinicians address the needs of patients. Our method provides a means of retrospectively determining the level of functional agreement between FH and POC that otherwise cannot be done in the absence of structured questionnaires. This is an ongoing study, which will expand towards evaluating various methods of retrospectively categorizing elements in the FH and POC.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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