Counselling, prescription and instruction-effects of closed circuit television systems in rehabilitation of visually impaired adults

One of the major problems of visually impaired people is the inability to read. Without special low vision aids, they have less or no access to newspapers, magazines, journals or mail, are less capable to communicate in printed or written texts and have less or no access to the modern ways of communication such as internet and email. These reading problems are a major threat to the social functioning and independency. In the Netherlands, several forms of rehabilitation for blind and visually impaired persons are available. Important goals of the rehabilitation process are counselling, to prescribe reading aids and to give instructions how to use these aids. A closed-circuit television system (CCTV) offers the highest level of magnification of all low vision aids. Therefore, CCTVs are prescribed to those patients who have profound or severe low vision, most of them being elderly. CCTVs do have disadvantages, they are expensive and most types are not portable. Furthermore the high magnification causes the actual field of the exposed text to be rather small. For many patients it takes effort to actually use the device and sometimes the prescribed CCTV will not be used at all. Studies on the process of counselling, prescribing CCTVs and on the effects of instructions on the use are scarce and standardized protocols are lacking. Also, those studies regarding the use of CCTVs performed in the past mainly focus on reading speed and are hard to compare. Other aspects of outcome such as the benefits and problems of CCTVs are virtually unknown. This study will examine the whole process of counselling and prescribing CCTVs and the outcomes of the use of CCTVs. It will focus on several specific objectives: 1) the actual process of counselling, prescribing and delivering a CCTV to visually impaired adults (18+); 2) the development of a standardized method to instruct and train patients how to use a CCTV; 3)the effectiveness of this instruction and training program in the use of a CCTV and 4) the feasibility of this instruction and training program. In the first part of the study we will focus on the actual process of counselling, instruction and delivering of CCTVs. Stakeholders will be interviewed and weaknesses of this process will be discussed. As an outcome of this information, a standardized protocol to train new CCTV users will be developed. In the second part, the design of the study is a two group pragmatic randomised controlled trial. One group will receive the CCTV as soon as possible after the prescription and will receive only the usual delivery instructions by the distributor of the aid; this group will serve as control group. The other group will follow the new standardized training program on how to use the CCTV. Before entering the randomisation process, the first measurements will be performed (baseline); immediately after receiving the CCTV (before entering the training program) and three months later when the program is finished data will be collected during a home visit. We will videotape the use of the CCTV in the participants own house. These tapes will be rated by independent investigators, who are not aware which patients received training, using a rating protocol. We will investigate several outcomes. First, we will use reading speed of both a standardised text and the participant’s own texts but will also focus on the participants usual reading activities and needs. To assess if the participant understands the texts, Aarnoutse tests combined with quiz questions will be used. Second, we will use several measures such as visual acuity, age, gender, years of education, former reading activities and co-morbidity as co-variables. Third, we will ask participants to register the use of the CCTV and ask them in a semi-structured way to the use as well. Finally, to study the feasibility, we will discus the effects of the process of counselling, prescribing the CCTV and delivery instructions and training with both patients and rehabilitation workers. After finishing the study we will inform rehabilitation workers in the field of low vision on the outcomes of our study. Since there are only a few studies in the field of the use of CCTVs, none on the rehabilitation protocols, and no randomised trials to the outcome of training effects on the use of CCTVs, we expect to be able to publish our findings in international journals.