Methodological quality of the review: Medium confidence

Author: Rees G, Ponczek E, Hassell J, Keeffe JE, Lamoureux EL

Region: India, Australia, United Kingdom (UK), United States of America (USA), Germany, Netherlands, Sweden, Canada.

Sector: Low vision

Sub-sector: Depression, rehabilitation, vision impairment

Equity focus: Adults aged 18 and above

Review type: Effectiveness review

Quantitative synthesis method: Narrative analysis

Qualitative synthesis methods: Not applicable

Background

Psychological distress and depression is common in people with vision loss and is associated with heightened disability. Given its prevalence, it is critical to understand the impact of vision rehabilitation on psychological well-being. There is a need to determine if low vision rehabilitation services improve psychological well-being or prevent psychological problems, or there is a need to integrate specific psychological interventions into rehabilitation programmes.

Research objectives

To outline current evidence for the impact of low vision rehabilitation programmes on psychological well-being; and to describe and summarize the effects of novel interventions designed to specifically to address psychological needs in people with vision impairment.

Main findings

The authors included 35 reports, which reported on 30 studies. A third of the studies reviewed (10) were randomized controlled trials (RCTs); six studies consisted of non-RCTs and almost half of the studies (14) employed pre-/post-test research designs without a control group. Five RCTs were considered of good methodological quality; of the remaining five RCTs, one had the potential for detection bias, three had the potential for selection bias and one had the potential of both attrition and detection bias. Of the non-RCTs, three had the potential of attrition bias and all but one had the potential for detection bias.

Findings suggested that multidisciplinary low-vision rehabilitation services might improve aspects of psychological well-being such as vision-specific quality of life, but had limited impact on depressive symptoms. Specifically designed psychological group and individual programmes based on cognitive-behavioural techniques showed an improvement in a range of psychological outcomes and might be able to prevent depressive symptoms in people with vision impairment. The authors noted that further studies with sophisticated designs and well-validated outcome measures were required to understand the effectiveness, mechanisms, moderators and cost-effectiveness of existing and new low-vision rehabilitation programmes on psychological well-being in people with low vision.

Methodology

Inclusion criteria consisted of studies evaluating rehabilitation services for people with low vision impairment using randomized, non-randomized, or pre-/post-test designs. Participants consisted of adults aged 18 years and above with visual acuity of less than 6/12 or significant visual field loss; and only studies that included scales or subscales assessing mental health, psychological symptoms, or measures of vision-specific distress or adjustment were included. Studies that assessed broader aspects of psychological well-being, including constructs such as self-efficacy and coping, were also considered for inclusion.

The authors conducted a search on Medline, CINAHL, PsycINFO, CSA Illumina Social Services Abstracts databases and Central, from inception to 2010. Bibliographies of all relevant reviews and primary studies were examined for relevant papers and experts in the field were contacted to identify further published and in press papers. The authors noted that the search did not include dissertation abstracts or unpublished literature.

Data extraction and assessment of risk of bias of included studies was conducted by two reviewers independently, and although the study selection was conducted by two reviewers it is not reported if this was conducted independently.

The authors conducted a narrative synthesis of included studies, which seemed appropriate due to the variety of study designs included in the review.

Applicability/external validity

Authors noted that there was a scarcity of high-quality studies; therefore it was not possible to generalize the results.

Geographic focus

The authors included studies mostly from high-income settings, such as Australia, UK, USA, Germany, Netherlands, Sweden and Canada. Although one of the studies included in the review was conducted in India, a lower- and middle-income country, authors did not discuss the applicability of the results in this setting.

Quality assessment

There is medium confidence in the conclusions about the effects of this study as important limitations were identified. As the authors noted, the literature search was limited to peer-reviewed reports published in English and did not include dissertations or other grey literature, which suggests that publication bias may be present and some cultural differences may not have been considered. Although the authors used appropriate methods to extract data of included studies and assess the risk of bias, they did not avoid selection bias as screening of articles for inclusion was not conducted independently by the two reviewers. Nevertheless, the authors note that due to the scarcity of high-quality studies, firm conclusions regarding the impact of multidisciplinary low-vision rehabilitation services on psychological outcomes are not possible. Source