Longitudinal observation, evaluation and interpretation of coping with mental (emotional) health in low vision rehabilitation using the Dutch ICF Activity Inventory.

BACKGROUND: Since there is evidence that mental health aspects (such as depression) may inhibit an optimal rehabilitation outcome, there is growing interest in the psychosocial aspects of vision loss as part of rehabilitation. The purpose of this study is to provide more insight into the construct validity and (longitudinal) interpretation of goals related to 'Coping with mental (emotional) health aspects' which are part of the recently developed 'Dutch ICF Activity Inventory (D-AI). Moreover, the data allowed to provide some insight in the outcome in this domain in relation to rehabilitation programs followed in Dutch Multidisciplinary Rehabilitation Centers at baseline and follow-up. METHODS: In a cohort of 241 visually impaired persons, the D-AI was assessed at baseline (enrollment), 4 and 12 months, The importance and difficulty of the D-AI goals 'Handle feelings', 'Acceptance', and 'Feeling fit' and difficulty scores of underlying tasks were further analyzed, together with similar or related standardized questionnaires. At baseline, Spearman correlations were determined between D-AI goals and task and additional questionnaires to investigate the construct validity. Corrected and uncorrected linear mixed models were used to determine longitudinal rehabilitation outcomes in relation to rehabilitation programs followed. RESULTS: Baseline correlations indicated that the difficulty of tasks and the umbrella goal 'Acceptance' were not similar. Longitudinal analyses provided insight in some subtle differences in concepts measured at the goal and task level of the D-AI, as well as similar validated questionnaires. After correcting for confounding variables, none of the underlying task difficulty scales changed over time. For goal difficulty scores only 'Acceptance' was reported to be significantly less difficult at 4 and 12 months follow-up. Importance scores of goals were stable from baseline to follow-up. CONCLUSION: With respect to the constructs measured, results support the formulation of the new goal question 'Emotional life' which replaces the goals 'Handle feelings' and 'Acceptance'. Results indicate that MRCs should pay more attention to problems related to mental health. They have started to use the D-AI as it seems a promising tool to investigate and evaluate rehabilitation needs (including those related to mental health) over time and to clearly define rehabilitation goals from the very start.

Evaluation of reading, writing, and watching TV using the Dutch ICF Activity Inventory.

PURPOSE: To investigate the longitudinal outcomes of rehabilitation (from baseline to 4 and 12 months) at a multidisciplinary rehabilitation center. The three goals ("Reading," "Writing," and "Watching TV") were measured with the Dutch ICF Activity Inventory (D-AI). In addition, outcomes were compared with the Low Vision Quality-of-Life questionnaire (LVQOL) for better insight into the (longitudinal) interpretation. METHODS: In a cohort of 241 visually impaired persons, corrected and uncorrected linear mixed models were used to determine longitudinal rehabilitation outcomes for the D-AI goals "Reading," "Writing," and "Watching TV," and difficulty and underlying tasks, as well as for the LVQOL scales "Basic aspects" and "Reading and fine work." At baseline, Spearman correlations were determined for similar scales of the D-AI and LVQOL. RESULTS: Importance scores of goals were stable over time. Difficulty scores decreased over time, but the differences were not significant at each measurement moment. For reading, difficulty of underlying tasks seemed to reflect the (change in) difficulty at the goal level; however, change in writing tasks did not reflect the change in the umbrella goal. Each of the three subscales of underlying tasks of the goal "Watching TV" changed in a different way. Changes in similar LVQOL scales were comparable, although less pronounced and more influenced by depression. Prescription or advice of low-vision aids and training in visual devices was not related (p > 0.01) with any of the outcome measures. CONCLUSIONS: It seems reasonable to conclude that the decrease in perceived difficulty was an effect of rehabilitation. The D-AI goal scores for difficulty were less influenced by depression and may be more sensitive to measure change over time compared with the LVQOL. Importance scores may not be useful for evaluation purposes.

Psychometric analyses to improve the Dutch ICF Activity Inventory.

PURPOSE: In the past, rehabilitation centers for the visually impaired used unstructured or semistructured methods to assess rehabilitation needs of their patients. Recently, an extensive instrument, the Dutch ICF Activity Inventory (D-AI), was developed to systematically investigate rehabilitation needs of visually impaired adults and to evaluate rehabilitation outcomes. The purpose of this study was to investigate the underlying factor structure and other psychometric properties to shorten and improve the D-AI. METHODS: The D-AI was administered to 241 visually impaired persons who recently enrolled in a multidisciplinary rehabilitation center. The D-AI uses graded scores to assess the importance and difficulty of 65 rehabilitation goals. For high-priority goals (e.g., daily meal preparation), the difficulty of underlying tasks (e.g., read recipes, cut vegetables) was assessed. To reduce underlying task items (>950), descriptive statistics were investigated and factor analyses were performed for several goals. The internal consistency reliability and test-retest reliability of the D-AI were investigated by calculating Cronbach α and Cohen (weighted) κ. Finally, consensus-based discussions were used to shorten and improve the D-AI. RESULTS: Except for one goal, factor analysis model parameters were at least reasonable. Internal consistency reliability was satisfactory (range, 0.74 to 0.93). In total, 60% of the 65 goal importance items and 84.4% of the goal difficulty items showed moderate to almost perfect κ values (≥0.40). After consensus-based discussions, a new D-AI was produced, containing 48 goals and less than 500 tasks. CONCLUSIONS: The analyses were an important step in the validation process of the D-AI and to develop a more feasible assessment tool to investigate rehabilitation needs of visually impaired persons in a systematic way. The D-AI is currently implemented in all Dutch rehabilitation centers serving all visually impaired adults with various rehabilitation needs.

Feasibility of the Dutch ICF Activity Inventory: a pilot study.

BACKGROUND: Demographic ageing will lead to increasing pressure on visual rehabilitation services, which need to be efficiently organised in the near future. The Dutch ICF Activity Inventory (D-AI) was developed to assess the rehabilitation needs of visually impaired persons. This pilot study tests the feasibility of the D-AI using a computer-assisted telephone interview. METHODS: In addition to the regular intake, the first version of the D-AI was assessed in 20 patients. Subsequently, patients and intake assessors were asked to fill in an evaluation form. Based on these evaluations, a new version of the D-AI was developed. RESULTS: Mean administration time of the D-AI was 88.8 (± 41.0) minutes. Overall, patients and assessors were positive about the D-AI assessment. However, professionals and 60% of the patients found the administration time to be too long. All included items were considered relevant and only minor adjustments were recommended. CONCLUSION: The systematic character of the revised D-AI will prevent topics from being overlooked and indicate which needs have the highest priority from a patient-centred perspective. Moreover, ongoing assessment of the D-AI will enhance evaluation of the rehabilitation process. To decrease administration time, in the revised D-AI only the top priority goals will be fully assessed. Using the D-AI, a rehabilitation plan based on individual needs can be developed for each patient. Moreover, it enables better evaluation of the effects of rehabilitation. A larger validation study is planned.