The impact of orientation and mobility training on mobility, participation and quality of life in older adults with visual impairments: a randomized controlled trial

During the next decades the number of older people with visual impairment will
increase substantially. Visual impairments are associated with mobility
problems and limitations in physical and social functioning and may threaten
independent functioning. To improve functioning and promote independent living
orientation and mobility instruction is offered to older persons with visual
impairments.

Yet, up until now no thorough and systematic study has been performed to
evaluate the effects of orientation and mobility instruction with respect to
using an identification cane in this population. In addition, in the
Netherlands a standardized format of this instruction is lacking, despite a
nationally organized orientation and mobility training for facilitators of this
instruction. A standardized orientation and mobility instruction might improve
functioning in older people with visual impairments as well as the
implementation of this instruction by the facilitators.

In light of the aforementioned the current study has three objectives:
1) to standardize orientation and mobility instruction for older people with
visual impairments who use the identification cane;
2) to evaluate the effects of this standardized orientation and mobility
instruction on mobility, participation and quality of life;
3) to evaluate the feasibility and acceptability of the standardized
orientation and mobility instruction.

A randomized controlled trial with random allocation to the intervention or
control group will be conducted. The intervention group will receive the
standardized orientation and mobility training while the control group receives
the regular orientation and mobility training (that is care as usual). To avoid
contamination, facilitators who provide the standardized instruction and
consequently receive training to perform this instruction will solely provide
instruction to people in the intervention group; facilitators of people
allocated to the control group will receive no additional training.

The intervention consists of a standardized orientation and mobility
instruction that is based on the regular instruction and information obtained
from the manual of the national orientation mobility training for facilitators
and in-depth interviews with facilitators. The standardized instruction
comprises two individual sessions of approximately 2 hours each on using the
identification cane, applying the cane in daily life and goal setting with
regard to applying the cane. The number and duration of the sessions is
comparable to the regular instruction that is also individually conducted.

The burden and risks associated with participating in the study are considered
small as a standardized version of a regular instruction will be evaluated. In
addition to four extra questions during the intake procedure, the additional
burden for the study population consists solely of the assessments, which
comprise three to four telephone interviews of about 30 minutes. To this end,
the fact that the study population consists of visually impaired people aged 55
years or older is taken into account.