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

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods/design</p> <p>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.</p> <p>Discussion</p> <p>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.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00946062</p

Eenzaamheid en zelfmanagementvaardigheden bij visueel beperkte ouderen

 0,001). De multivariate hiërarchische regressieanalyse toont aan dat de zelfmanagementvaardigheid self-efficacy, partner status en zelfwaardering samenhangen met eenzaamheid. Visus-gerelateerde variabelen, zoals de ernst en de duur van de visuele beperking, zijn niet geassocieerd met eenzaamheid. Discussie. Visueel beperkte ouderen zijn een risicogroep als het gaat om eenzaamheid. De samenhang met zelfmanagementvaardigheden biedt mogelijkheden aangezien deze vaardigheden aangeleerd kunnen worden en daarmee eenzaamheidsgevoelens bij visueel beperkte ouderen kunnen verminderen. Een aangepaste versie van dit paper is verschenen in Journal of Aging and Health, doi:10.1177/0898264311399758

Gecombineerde ondersteuning in Ontmoetingscentra voor mensen met dementie en hun mantelzorgers vergeleken met reguliere dagbehandeling

BACKGROUND: A previous study in Amsterdam showed that combined family support in the Meeting Centres Support Programme, in which persons with dementia patients and their carers are both supported by one professional staff, is more effective in influencing behaviour problems and mood of dementia patients living in the community than non-integrated support, such as day care only. A multi-centre implementation study tests if similar effects are achieved in other regions of The Netherlands. METHODS: A pretest-posttest control group design was applied. 112 dementia patients who visited psychogeriatric day care in eight community centres across the country and in three nursing homes, and their carers participated in the study. The patients in the experimental group (n=89) received support from the Meeting Centres Support Programme together with their carers, while the control group (n=23) received day care only. Behaviour problems (aggressive behaviour, inactivity, non-social behaviour) and mood (dissatisfaction, depressive behaviour) were assessed using standardized observation scales. Quality of life was assessed by interviewing the patients. RESULTS: After 7 months the Meeting Centres Support Programme, compared to regular day care, showed a moderately positive effect on the degree of total behaviour problems (effect size=0.52), especially on inactivity (effect size=0.37) and non-social behaviour (effect size=0.60), a large effect on depressive behaviour (effect size=0.92) and a moderate effect on self-esteem (effect size=0.43). CONCLUSIONS: The Meeting Centres Support Programme proves to be more effective than regular day care in influencing behaviour problems, especially inactivity and non-social behaviour, and depressed mood. Participation in the programme also seems to have a positive effect on self-esteem, an important aspect of quality of life. These findings surpass the results of the Amsterdam study and confirm the surplus value of the Meeting Centres Support Programme as compared to regular day care for people with mild to severe dementi