title: Orientation and mobility training for adults with low vision.
abstract: BACKGROUND
  Orientation and mobility (O&M) training is provided to people who are visually impaired to help them maintain travel independence. It teaches them new orientation and mobility skills to compensate for reduced visual information.
  
  
  OBJECTIVE
  The objective of this review was to assess the effects of O&M training, with or without associated devices, for adults with low vision.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library, 2010, Issue 3), MEDLINE (January 1950 to March 2010), EMBASE (January 1980 to March 2010), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to March 2010), System for Information on Grey Literature in Europe (OpenSIGLE) (March 2010), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) (March 2010), ClinicalTrials.gov (http://clinicaltrials.gov) (March 2010), ZETOC (March 2010) and the reference lists of retrieved articles. There were no language or date restrictions in the search for trials. The electronic databases were last searched on 31 March 2010.
  
  
  METHODS
  We planned to include randomised or quasi-randomised trials comparing O&M training with no training in adults with low vision.
  
  
  METHODS
  Two authors independently assessed the search results for eligibility, evaluated study quality and extracted the data.
  
  
  RESULTS
  Two small studies satisfied the inclusion criteria. They were consecutive phases of development of the same training curriculum and assessment tool. The intervention was administered by a volunteer on the basis of written and oral instruction. In both studies the randomisation technique was inadequate, being based on alternation, and masking was not achieved. Training had no effect in the first study but tended to be beneficial in the second but not to a statistically significant extent. Reasons for differences between studies may have been: the high scores obtained in the first study, suggestive of little need for training and small room for further improvement (a ceiling effect), and the refinement of the curriculum allowing better tailoring to patients' specific needs and characteristics, in the second study.
  
  
  CONCLUSIONS
  The review found two small quasi-randomised trials with similar methods, comparing training to physical exercise and assessing O&M physical performance by means of a volunteer or a professional, which were unable to demonstrate a difference. Therefore, there is little evidence on which type of O&M training is better for people with low vision who have specific characteristics and needs. Orientation and mobility instructors and scientists should plan randomised controlled trials (RCTs) to compare the effectiveness of different types of O&M training. A consensus is needed on the adoption of standard measurement instruments of mobility performance which are proven to be reliable and sensitive to the diverse mobility needs of people with low vision. For this purpose, questionnaires and performance-based tests may represent different tools that explore people with low vision's subjective experience or their objective functioning, respectively. In fact, it has to be observed that low vision rehabilitation research is increasingly shifting towards the use of quality of life questionnaires as an outcome measure, sometimes with the aim to study complex and multidisciplinary interventions including different types of education and support, of which O&M can be a component. An example of this is an ongoing cluster RCT conducted by Zijlstra et al. in The Netherlands. This trial is designed to compare standardised O&M training with usual O&M care not only for its effectiveness, but also its applicability and acceptability. This study adopts validated questionnaires for patients' subjective assessment of performance during activities of daily living. As performance assessment does not need to be made by an O&M trainer, this allows for masking of assessors and a patient-centred outcome measure.
authors.affiliation: Department of Specialised Surgical Sciences, University of Florence, Via le Morgagni 85, Florence, Italy, 50134.
authors.forename: Gianni
authors.initials: G
authors.lastname: Virgili
authors.forename: Gary
authors.initials: G
authors.lastname: Rubin
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D008124:Locomotion; D009949:Orientation; D016032:Randomized Controlled Trials as Topic; D014195:Travel; D015354:Vision, Low / Q000534:rehabilitation*
references.citation: Am J Optom Physiol Opt. 1977 Jan;54(1):35-42
references.pmid: 860749
references.citation: BMC Health Serv Res. 2009 Aug 27;9:153
references.pmid: 19712448
references.citation: J Rehabil Res Dev. 2000 Jan-Feb;37(1):101-8
references.pmid: 10847577
references.citation: JAMA. 2003 Oct 15;290(15):2057-60
references.pmid: 14559961
references.citation: J Am Geriatr Soc. 2002 Jan;50(1):136-45
references.pmid: 12028258
references.citation: Optom Vis Sci. 1998 Jul;75(7):525-37
references.pmid: 9703042
references.citation: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007146
references.pmid: 19370674
references.citation: J R Stat Soc Ser A Stat Soc. 2009 Jan;172(1):137-159
references.pmid: 19381330
references.citation: Stat Med. 2008 Feb 28;27(5):711-27
references.pmid: 17703496
references.citation: Optom Vis Sci. 2001 Sep;78(9):657-66
references.pmid: 11587200
references.citation: Invest Ophthalmol Vis Sci. 1999 Apr;40(5):865-77
references.pmid: 10102283
references.citation: J Med Libr Assoc. 2006 Apr;94(2):130-6
references.pmid: 16636704
references.citation: Arch Ophthalmol. 2004 Apr;122(4):477-85
references.pmid: 15078664
references.citation: Am J Optom Arch Am Acad Optom. 1970 Aug;47(8):619-28
references.pmid: 5273102
references.citation: J Am Optom Assoc. 1996 Jul;67(7):403-9
references.pmid: 8888866
references.citation: Optom Vis Sci. 1998 Jul;75(7):518-24
references.pmid: 9703041
references.citation: BMJ. 1999 Sep 11;319(7211):670-4
references.pmid: 10480822
references.citation: BMJ. 2005 Oct 8;331(7520):817
references.pmid: 16183652
references.citation: Clin Exp Optom. 2000 Sep-Oct;83(5):279-282
references.pmid: 12472432
references.citation: Surv Ophthalmol. 2001 May-Jun;45(6):531-48
references.pmid: 11425359
references.citation: BMJ. 2007 Nov 3;335(7626):914-6
references.pmid: 17974687
references.citation: Arch Ophthalmol. 2002 Jun;120(6):774-80
references.pmid: 12049583