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Comparative Study
. 2023 Jan 13;1(1):CD011019.
doi: 10.1002/14651858.CD011019.pub4.

Telerehabilitation for people with low vision

Ava K Bittner  1 , Patrick D Yoshinaga  2 , Thanitsara Rittiphairoj  3   4 , Tianjing Li  5
Affiliations
Comparative Study

Telerehabilitation for people with low vision

Ava K Bittner et al. Cochrane Database Syst Rev. .

Abstract

Background: Low vision affects over 300 million people worldwide and can compromise both activities of daily living and quality of life. Rehabilitative training and vision assistive equipment (VAE) may help, but some visually impaired people have limited resources to attend in-person visits to rehabilitation clinics to be trained to learn to use VAE. These people may be able to overcome barriers to care through access to remote, internet-based consultation (telerehabilitation).

Objectives: To compare the effects of telerehabilitation with face-to-face (e.g. in-office or inpatient) vision rehabilitation services for improving vision-related quality of life and near reading ability in people with visual function loss due to any ocular condition. Secondary objectives were to evaluate compliance with scheduled rehabilitation sessions, abandonment rates for VAE devices, and patient satisfaction ratings.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register) (2021, Issue 9); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any language restriction or study design filter in the electronic searches; however, we restricted the searches from 1980 onwards because the internet was not introduced to the public until 1982. We last searched CENTRAL, MEDLINE Ovid, Embase, and PubMed on 14 September 2021, and the trial registries on 16 March 2022.

Selection criteria: We included randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in which participants diagnosed with low vision had received vision rehabilitation services remotely from a human provider using internet, web-based technology compared with an approach involving in-person consultations.

Data collection and analysis: Two review authors independently screened titles and abstracts retrieved by the searches of the electronic databases and then full-text articles for eligible studies. Two review authors independently abstracted data from the included studies. Any discrepancies were resolved by discussion.

Main results: We identified one RCT/CCT that indirectly met our inclusion criteria, and two ongoing trials that met our inclusion criteria. The included trial had an overall high risk of bias. We did not conduct a quantitative analysis since multiple controlled trials were not identified. The single included trial of 57 participants utilized a parallel-group design. It compared 30 hours of either personalized low vision training through telerehabilitation with a low vision therapist (the experimental group) with the self-training standard provided by eSight using the eSkills User Guide that was self-administered by the participants at home for one hour per day for 30 days (the comparison group). The trial investigators found a similar direction of effects for both groups for vision-related quality of life and satisfaction at two weeks, three months, and six months. A greater proportion of participants in the comparison group had abandoned or discontinued use of the eSight Eyewear at two weeks than those in the telerehabilitation group, but discontinuance rates were similar between groups at one month and three months. We rated the certainty of the evidence for all outcomes as very low due to high risk of bias in randomization processes and missing outcome data and imprecision. AUTHORS' CONCLUSIONS: The included trial found similar efficacy between telerehabilitation with a therapist and an active control intervention of self-guided training in mostly younger to middle-aged adults with low vision who received a new wearable electronic aid. Given the disease burden and the growing interest in telemedicine, the two ongoing studies, when completed, may provide further evidence of the potential for telerehabilitation as a platform for providing services to people with low vision.

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Conflict of interest statement

One reason for conducting this systematic review was to establish a knowledge base to guide the design of future randomized controlled trials to evaluate the efficacy of telerehabilitation for a primarily elderly, visually impaired population. Along with this systematic review, Dr Tianjing Li has received funding to collect pilot data to demonstrate the feasibility of using telerehabilitation as a platform for delivering low vision rehabilitation services. The systematic review and the pilot data collected will lay the foundation for preparing randomized controlled trial applications.

Dr Bittner has received funding from the National Eye Institute, National Institutes of Health; the American Academy of Optometry Foundation; and Envision Research Institute to conduct pilot studies and randomized controlled trials of telerehabiliation for low vision, for which Dr Yoshinaga is a co‐investigator.

TR has no conflicts of interest to declare.

Figures

1
1
Study flow diagram.
2
2
Forest plot of comparison: 1 Telerehabilitation versus self‐training, outcome: 1.2 Proportion of participants lost to follow‐up.
3
3
Forest plot of comparison: 1 Telerehabilitation versus self‐training, outcome: 1.3 Proportion of participants with incomplete treatment.
4
4
Forest plot of comparison: 1 Telerehabilitation versus self‐training, outcome: 1.4 Proportion of participants reporting technical difficulties with the intervention.
5
5
Forest plot of comparison: 1 Telerehabilitation versus self‐training, outcome: 1.5 Proportion of participants abandoning devices.
1.1
1.1. Analysis
Comparison 1: Telerehabilitation versus self‐training , Outcome 1: Postintervention vision‐related quality of life
1.2
1.2. Analysis
Comparison 1: Telerehabilitation versus self‐training , Outcome 2: Proportion of participants lost to follow‐up
1.3
1.3. Analysis
Comparison 1: Telerehabilitation versus self‐training , Outcome 3: Proportion of participants with incomplete treatment
1.4
1.4. Analysis
Comparison 1: Telerehabilitation versus self‐training , Outcome 4: Proportion of participants reporting technical difficulties with the intervention
1.5
1.5. Analysis
Comparison 1: Telerehabilitation versus self‐training , Outcome 5: Proportion of participants abandoning devices
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References

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References to other published versions of this review

Bittner 2014
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