Head-mounted Visual Assistive Technology-related Quality of Life Changes after Telerehabilitation

Abstract

Significance: Head-mounted low vision devices have become a viable alternative to enhance residual vision. This study supports the use of a head-mounted display to improve aspects of functional vision and quality of life. Much is still unknown regarding the required frequency, duration, or potential effectiveness of this telerehabilitation training protocol or what characteristics best identify optimal users.

Purpose: A randomized study explored the effect of telerehabilitation on quality of life and functional vision in individuals with low vision using a head-mounted display.

Methods: We recruited 57 participants (age, 21 to 82 years; mean, 54.5 years) among new prospective eSight Eyewear users, randomized 1:1 into two parallel groups; the experimental group received the telerehabilitation training provided by a low vision therapist, whereas the control group received the self-training standard offered by the device manufacturer and without involvement of a low vision therapist. The primary outcome measures were the impact of telerehabilitation on validated measures of assistive technology-related quality of life: the Psychosocial Impact of Assistive Devices Scale and the Quebec User Evaluation of Satisfaction with Assistive Technology scale. Exploratory outcomes were the assessment of self-reported functional vision using the Veterans Affairs Low Vision Visual Functioning Questionnaire-48 and cybersickness associated with head-mounted display use with the Simulator Sickness Questionnaire.

Results: Assistive technology-related quality of life was improved when measured by the satisfaction scale but not the psychosocial scale within the first 3 months, independently of training type. Overall, functional vision improvement was observed within the first 2 weeks of device use and maintained during the 6-month study, independently of group type. Cybersickness outcomes were similar between training groups and did not change significantly for 6 months.

Conclusions: eSight Eyewear, either with telerehabilitation or with the manufacturer self-training comparison, improved functional vision and increased users' quality of life within the initial 3 months of device training and practice.

FIGURE 1

Chart showing participant flow that summarizes the design of the study with each following aspects: recruitment, enrollment, allocation with intervention types, evaluation timeline, and primary and secondary outcomes.

FIGURE 2

Results of the Psychosocial Impact of Assistive Devices Scale (PIADS) at baseline, 2 weeks, and 3 and 6 months after randomization. The result patterns were similar in the three subscales of this questionnaire. Therefore, the results for the self-esteem, or the competency, or the adaptability domains are not presented here. The score statistically significantly improved over time across participants in both study groups. However, subsequent pairwise comparisons did not reveal any specific effects. None of the subscales improved statistically significantly over time (all, P > .05).

FIGURE 3

Results of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) at baseline, 2 weeks, and 3 and 6 months after randomization. The scores statistically significantly improved over time in both study groups. The mean (standard deviation) baseline score was 29.46 (10.80), which improved to 34.85 (8.19) after 3 months of device use and training. Scores did not demonstrate a significant change after 3 months (all, P > .05). *P < .05.

FIGURE 4

Results of the Veterans Affairs Low Vision Visual Functioning Questionnaire-48 (VA LV VFQ-48) at baseline, 2 weeks, and 3 and 6 months after randomization. Results for the reading, or the visual information, or the visual motor, or the mobility domains are not presented here because the patterns were similar in four subscales of the questionnaire. Visual ability statistically significantly improved over time in both study groups. The mean (standard deviation [SD]) baseline visual ability score was 0.99 (0.93) logit units, which improved to 2.19 (1.07) logits, 2.35 (1.05) logits, and 2.38 (1.07) logits after 2 weeks and 3 and 6 months of device use and training, respectively. *P < .05.