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      Effects and feasibility of a standardised orientation and mobility training in using an identification cane for older adults with low vision: design of a randomised controlled trial

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          Orientation and mobility training (O&M-training) in using an identification cane, also called symbol cane, is provided to people with low vision to facilitate independent participation in the community. In The Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised O&M-training in using the identification cane was developed. This training consists of two face-to-face sessions and one telephone session during which, in addition to usual care, the client's needs regarding mobility are prioritised, and cognitive restructuring techniques, action planning and contracting are applied to facilitate the use of the cane. This paper presents the design of a randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision.


          A parallel group randomised controlled trial was designed to compare the standardised O&M-training with usual care, i.e. the O&M-training commonly provided by the mobility trainer. Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial (N = 190). The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility. Secondary outcomes include quality of life, feelings of anxiety, symptoms of depression, fear of falling, and falls history. Data for the effect evaluation are collected by means of telephone interviews at baseline, and at 5 and 17 weeks after the start of the O&M-training. In addition to an effect evaluation, a process evaluation to study the feasibility of the O&M-training is carried out.


          The screening procedure for eligible participants started in November 2007 and will continue until October 2009. Preliminary findings regarding the evaluation are expected in the course of 2010. If the standardised O&M-training is more effective than the current O&M-training or, in case of equal effectiveness, is considered more feasible, the training will be embedded in the Dutch national instruction for mobility trainers.

          Trial registration

          ClinicalTrials.gov NCT00946062

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          Most cited references 53

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          Development and initial validation of the Falls Efficacy Scale-International (FES-I).

          There is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a range of languages and cultural contexts, permitting direct comparison between studies and populations in different countries and settings. To develop a modified version of the Falls Efficacy Scale to satisfy this need, and to establish its psychometric properties, reliability, and concurrent validity (i.e. that it demonstrates the expected relationship with age, falls history and falls risk factors). Cross-sectional survey. Community sample. 704 people aged between 60 and 95 years completed The Falls Efficacy Scale-International (FES-I) either in postal self-completion format or by structured interview. The FES-I had excellent internal and test-retest reliability (Cronbach's alpha=0.96, ICC=0.96). Factor analysis suggested a unitary underlying factor, with two dimensions assessing concern about less demanding physical activities mainly in the home, and concern about more demanding physical activities mainly outside the home. The FES-I had slightly better power than the original FES items to discriminate differences in concern about falling between groups differentiated by sex, age, occupation, falls in the past year, and falls risk factors (chronic illness, taking multiple or psychoactive medications, dizziness). The FES-I has close continuity with the best existing measure of fear of falling, excellent psychometric properties, and assesses concerns relating to basic and more demanding activities, both physical and social. Further research is required to confirm cross-cultural and predictive validity.
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            The disablement process.

            Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicians tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.
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              An activities index for use with stroke patients.

              Scales of 'Activities of Daily Living' measure only a patient's ability for self-care. There is no brief scale to measure lifestyle, although this would be useful in determining rehabilitation goals. This paper describes such a scale, developed for use with stroke patients. The data obtained relate to pre-morbid and post-stroke levels of activities. Factor analysis indicates three major factors (domestic chores, leisure/work, outdoor activities). Two of these factors are sex-linked, as predicted. Some evidence is noted of the sensitivity of the index to severity of stroke.

                Author and article information

                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                27 August 2009
                : 9
                : 153
                [1 ]Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, Maastricht, the Netherlands
                [2 ]CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD Maastricht, the Netherlands
                [3 ]VU University Medical Center, Department of Ophthalmology, and the Institute for Research in Extramural Medicine (EMGO), P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
                [4 ]University of Groningen, Institute of Human Movement Sciences, P.O. Box 72, 9700 AB Groningen, and VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
                [5 ]Bartiméus, Institute for the Blind and Visually Impaired, Oudenoord 325, 3513 EP Utrecht, the Netherlands
                [6 ]Rotterdam University of Applied Sciences, School of Healthcare Studies, Museumpark 40, 3015 CX Rotterdam, the Netherlands
                [7 ]Royal Visio, National Foundation for the Visually Impaired and Blind, P.O. Box 1180, 1270 BD Huizen, the Netherlands
                [8 ]Sensis – Organisation for Blind and Partially Sighted People, Department of Innovation and Expertise, P.O. Box 54, 5360 AB Grave, the Netherlands
                Copyright © 2009 Zijlstra et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Study Protocol

                Health & Social care


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