Abstract
Purpose :
Vision problems after stroke are common. Even if national guidelines state that all stroke patients should have their vision assessed, vision problems are commonly overlooked due to lack of knowledge and structured assessment in stroke health care.The aim of this project was to describe current clinical practice of visual assessment in Norwegian stroke units, and compare stroke units with and without access to an eye department.
Methods :
A cross-sectional web-based survey was sent out to all 50 Norwegian stroke units. The survey had 28 items including pre-defined options, agreement statements and free-text response alternatives. Levels of agreement was reported as a 5-point likert scale. Topics included assessment routines, organization, competence and documentation of visual assessment and follow-up. Free-text answers were analyzed with a simple content analysis.
Results :
36 stroke units from all 4 health regions responded (29 local, 7 regional hospitals). 18 had access to an eye department. 18 respondents were occupational therapists, 13 nurses, 2 doctors, 2 physiotherapists and 1 neurologist. 32 worked full time, 26 had >2 yr of experience. 24 had no formal vision competence. 20 reported >2 professions were involved in assessing vision. 20 stroke units routinely assessed vision on all in-patients, 18 only if vision problems were suspected and 2 did not assess vision specifically. Only 17 used a systematic vision assessment. most used neurological examination, NIHSS or ADL observations. 13 offered vision rehabilitation, most referred to ophthalmologist (20), optometrist (8) or other rehabilitation (18). Preliminary analysis showed that respondents from units with an eye department had significantly poorer vision and stroke knowledge (p = .049). Lack of vision terminology was a barrier for documenting and describe visual assessments (mean 3.9, SD= 1.1), and free text confirmed ophthalmologist's reports difficult to understand and to lack implication for other rehabilitation or everyday life.
Conclusions :
Results showed that stroke units lack vision assessment routines, awareness and competence related to assessing vision after stroke. Results support a need for structured routines and increased knowledge in vision related terminology. Future studies should include consensus studies on best vision practice, how to improve competence and how vision should be integrated in stroke care and rehabilitation.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.