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

Study protocol of an effect and process evaluation of the Stamina model; a Structured and Time-effective Approach through Methods for an Inclusive and Active working life

Background: The working environment should be a naturally integrated part of business development. Provisions are in place that address the employer's obligations to investigate, carry out and follow up activities in such a way that ill health and accidents at work are prevented and a satisfactory working environment is achieved. Still, there are organizations that not properly perform systematic work environment management. In order to improve adherence, interventions and models focused on these issues need to be easy to understand and provide rapid feedback of results in order to be implemented. The Stamina model has recently been implemented in Sweden. The model is a participatory organizational systematic model facilitating the work environment, productivity and quality. It is a support model that provides structured and recurrent feedback in the systematic work environment management. The aim of the present paper is to thoroughly describe the Stamina model and the studies that are designed to investigate the effect, to increase the understanding of how and why the model was or was not effective, and to identify factors that facilitate implementation. Methods: The paper presents a project consisting of two related evaluation parts. Part one is an effect evaluation with an active group applying the Stamina model and a control group. This part investigate effects on proxy outcomes that are relevant for health and productivity. Part two is a process evaluation with a qualitative design. This part will be based on semi-structured interviews with various stakeholders, such as employees, first line managers, project managers, facilitators and representatives from the management group, in the organizations. Discussion: Many interventions found to be effective in research projects fail to translate into meaningful outcomes across multiple contexts. In this project a participatory approach will be adopted, including the possibility to modify the model according to organizational needs and preconditions. Valuable knowledge regarding the design and implementation of the model will be generated in order to develop a model that is suitable and sustainable in organizations