Graham V1
1California State University Northridge, Physical Therapy, Northridge, United States
Background: Falls in older adults from multiple factors including visual impairment (VI) are common, and VI is a strong independent risk factor for falls. Visual impairment is not a clinical practice area for physical therapists, nor required in accredited Physical Therapy curricula, despite the fact that physical therapists are key practitioners for balance, mobility and fall prevention. A knowledge gap exists regarding the role of vision in mobility and the specific type of visual impairment that leads to increased fall risk.
Purpose: Reduce falls in visually impaired older adults. We are conducting a case control study to compare balance and walking function between 1) adults with juvenile onset VI (beginning before age 18), 2) those with adult onset VI (beginning after age 18), and 3) control group without visual impairment. In prior studies, we convened a group of researchers with expertise in vision and mobility and determined that multifactorial data collection in this population is both safe and feasible.
Methods: We recruited people over age 50 with and without visual impairment; after informed consent was given, enrolled independently ambulatory English speaking subjects without postural hypotension, vertigo or dementia. Subjects completed vision tests: visual acuity, Tangent Screen visual field, Mars contrast sensitivity, and Random Dot 2 stereoacuity; mobility tests: gait analysis, Balance Error Scoring System to assess static balance, and 4 item Dynamic Gait Index (DGI) to evaluate dynamic balance and gait mobility; questionnaires: the Activity Balance Confidence scale, and the Independent Mobility Questionnaire; and interviewed about health and vision history. Visual impairment was defined as having habitual vision worse than 20/70 in each eye or visual field loss of worse than 20 degrees. Descriptive statistics and generalized linear regression analyses were conducted to compare mobility scores among three different groups. Study approved by institutional IRB.
Results: A total of 49 adults participated with a mean (SD) age of 70.9 (10.0) years, 71.4% female. Seventeen subjects (34.6%) were visually impaired, 6 were juvenile onset. The participants with normal vision were older than the other groups (p=0.0003). Mean (SD) ETDRS visual acuity were 44.5 (20.5) for juvenile onset VI, 35.6 (18.6) for adult onset VI, and 78.5 (12.4) for the control group without VI (p=0.0002). DGI scores were lower in juvenile onset VI 10.6 compared to the control group (9.2) (p=0.05).
Conclusion(s): A larger sample size is needed to confirm findings, with ongoing data collection to obtain a sample size of 108 to achieve statistical significance (p=.05). Further interprofessional study of problem is advised.
Implications: This area of clinical practice is promising and recommend screening for visual impairment and specific interventions to address visual impairment be included in physical therapy education and clinical practice for holistic patient management.
Keywords: Fall, Risk, Vision
Funding acknowledgements: Project supported by Summer Seed grants from CSUN and from Western University.
Purpose: Reduce falls in visually impaired older adults. We are conducting a case control study to compare balance and walking function between 1) adults with juvenile onset VI (beginning before age 18), 2) those with adult onset VI (beginning after age 18), and 3) control group without visual impairment. In prior studies, we convened a group of researchers with expertise in vision and mobility and determined that multifactorial data collection in this population is both safe and feasible.
Methods: We recruited people over age 50 with and without visual impairment; after informed consent was given, enrolled independently ambulatory English speaking subjects without postural hypotension, vertigo or dementia. Subjects completed vision tests: visual acuity, Tangent Screen visual field, Mars contrast sensitivity, and Random Dot 2 stereoacuity; mobility tests: gait analysis, Balance Error Scoring System to assess static balance, and 4 item Dynamic Gait Index (DGI) to evaluate dynamic balance and gait mobility; questionnaires: the Activity Balance Confidence scale, and the Independent Mobility Questionnaire; and interviewed about health and vision history. Visual impairment was defined as having habitual vision worse than 20/70 in each eye or visual field loss of worse than 20 degrees. Descriptive statistics and generalized linear regression analyses were conducted to compare mobility scores among three different groups. Study approved by institutional IRB.
Results: A total of 49 adults participated with a mean (SD) age of 70.9 (10.0) years, 71.4% female. Seventeen subjects (34.6%) were visually impaired, 6 were juvenile onset. The participants with normal vision were older than the other groups (p=0.0003). Mean (SD) ETDRS visual acuity were 44.5 (20.5) for juvenile onset VI, 35.6 (18.6) for adult onset VI, and 78.5 (12.4) for the control group without VI (p=0.0002). DGI scores were lower in juvenile onset VI 10.6 compared to the control group (9.2) (p=0.05).
Conclusion(s): A larger sample size is needed to confirm findings, with ongoing data collection to obtain a sample size of 108 to achieve statistical significance (p=.05). Further interprofessional study of problem is advised.
Implications: This area of clinical practice is promising and recommend screening for visual impairment and specific interventions to address visual impairment be included in physical therapy education and clinical practice for holistic patient management.
Keywords: Fall, Risk, Vision
Funding acknowledgements: Project supported by Summer Seed grants from CSUN and from Western University.
Topic: Older people; Health promotion & wellbeing/healthy ageing; Primary health care
Ethics approval required: Yes
Institution: California State University Northridge
Ethics committee: Institutional Review Board, Research and Sponsored Programs
Ethics number: IRB# 1617-111
All authors, affiliations and abstracts have been published as submitted.
