Background
Objectives of the study and the current paper
Methods/Design
Study design and setting
Study population
Inclusion criteria: | Exclusion criteria: |
---|---|
- Aged 55 years or over | |
- Low vision | - Language or hearing problems that impede completing an interview by telephone |
- Living independently in the community or in a home for older people | - Confinement to bed or possible nursing home admission that impede completion of the O&M-training |
- Able to see large obstacles and to go outside for a short walk or doing groceries | |
- One of the following: | |
▪ experiencing difficulties with safely crossing a street | - Permanent use of a walking aid incompatible with the use of an identification cane |
▪ experiencing difficulties with recognising acquaintances outdoors | - Having recently received an O&M-training in the use of an identification cane and permanent use of this cane |
▪ willing to become recognisable as being partially sighted by using the identification cane | |
- Written informed consent | |
- Orientation and Mobility training (O&M-training) in the use of an identification cane |
Randomisation and masking
Orientation and mobility training
Characteristics | Regular O&M-training* | Standardised O&M-training |
---|---|---|
Elements: | 1. Exploration of client's needst
| 1. Exploration of client's needst
|
2. Providing information, e.g. on walking aids, canes and techniques related to orientation and safe behaviourt
| 2. Prioritising the client's needsc
| |
3. Training techniques - related to orientation and safe behaviour -outdoors while using the identification canet, c
| 3. Providing information, e.g. on walking aids, canes and techniques related to orientation and safe behaviourt
| |
4. Formulating, performing and evaluating action plansc
| ||
5. Training techniques - related to orientation and safe behaviour -outdoors while using the identification canet, c
| ||
6. formulating action plans/contractingc
| ||
Applied techniques: | - (Unknown) | - Prioritising client's needs |
- Cognitive restructuring | ||
- Action planning | ||
- Contracting | ||
- Providing direct feedback | ||
- Stimulating individual problem solving/finding realistic solutions | ||
Number of sessions: | Variable, mostly 1-2 sessions (range 1-5) | 3 sessions |
Frequency: | Variable, mostly weekly (if multiple sessions were conducted) | Every other week |
Duration: | - Complete training time: | - Complete training time: |
▪ variable (range 60-120 min) | ▪ session 1: 90 min | |
▪ session 2: 80 min | ||
▪ session 3: 25 min | ||
- Training time indoors: | - Training time indoors: | |
▪ variable (range 15-60 min) | ▪ session 1: 60 min | |
▪ session 2: 40 min | ||
▪ session 3: 25 min | ||
Format of sessions: | Face-to-face | Session 1 and 2: face-to-face |
Session 3: telephone contact | ||
Location of session: | Variable, mostly client's home environment | Client's home environment |
Measures
Effect evaluation
Variable | No. of items | Range* |
---|---|---|
Primary outcome measures | ||
ADL self care (ADL subscale of the GARS) [40] | 11 |
11 to 44 |
8 |
8 to 40 | |
Secondary outcome measures
| ||
15 | 15 to 60
| |
Social support interactions SSL12-I [45] | 12 | 12 to 48
|
Feelings of loneliness [46] | 1 | 1 to 6
|
Health-related quality of life (EQ5D) [47] | 5 |
5 to 15 |
6 |
6 to 30 | |
7 |
0 to 21 | |
7 |
0 to 21 | |
16 |
16 to 64 | |
Fear of falling [46] | 1 |
1 to 5 |
Activity avoidance due to fear of falling [46] | 1 |
1 to 5 |
Number of indoor falls in the previous 6 months† [46] | 1 |
1 to 6 |
Number of outdoor falls in the previous 6 months† [46] | 1 |
1 to 6 |
Process evaluation
Variable | Measurement |
---|---|
Population reached | |
Target population and proportion of the intended target population | TI-Rp, SQt |
General characteristics of the participants and trainers | Qt |
Number of participants that refused, dropped out or completed the training | Qt |
Reasons for withdrawal | Qt |
Performance according to protocol
| |
Format, preparation time and duration of the session | Qt |
Per session component: extent to which carried out, duration and active participation by the participant* | Qt |
Extent to which the trainer achieved to: | |
- related to identification cane: provide information, raise the participant's awareness of its advantages, demonstrate the use and have the participant experience the use of the cane* | Qt |
- have the participant phrase his/her important activities related to mobility and how to perform activities safely and independently* | Qt |
- have the participant setting goals regarding an action plan* | Qt |
- teach orientation skills* and teach mobility skills* | Qt |
Exposure and engagement
| |
Total number of sessions | Qt |
Use of materials* | TIp, Qt |
Overall opinion of the trainer/participant regarding the participant's engagement in: | |
- the training | TIp, Qt |
- formulating of an action plan and carrying out an action plan* | Qt |
Exposure and adherence to homework | TIp |
Extent to which the participant complied with contracts* | Qt |
Quality of actions plans formulated by the participants* | Qt |
Opinion on the training
| |
Overall opinion on the training | TIp, Qt |
Opinion regarding: | |
- number, duration and course of the sessions | TIp, Qt |
- homework and comprehensibility of the complete training | TIp |
- number of extra training sessions needed | TIp, Qt |
- whether the O&M-training met the participant's need for mobility support | TIp, Qt |
Usefulness regarding: | |
- discussing mobility problems, receiving information on different kinds of canes and practicing with the identification cane | TIp |
- formulating an action plan and carrying out an action plan* | TIp |
- contracting with respect to formulating and carrying out action plans* | Tip |
Burden experienced by the participant | TIp |
Recommendation of the training to others | TIp |
Overall opinion on the trainer | TIp, Qt |
Perceived benefit or achievement
| |
Benefit regarding: | |
- the O&M-training | TIp |
- advantages of an identification cane and self-confidence | Qt |
- realistic action planning* | Qt |
Use of identification cane in daily life | Qt |
Achievement regarding: | |
- identification cane: knowledge, aware of advantages and having experienced the cane | TIp |
- able to think how to perform an activity safely and independently | TIp |
- self-confidence and performance of an activity safely and independently | TIp |
- formulating a realistic action plan* and carrying out an action plan* | TIp |
- skills for orientation and skills for mobility | TIp |
- safe and independent participation outdoors | TIp, Qt |
- optimal use of personal capabilities | TIp, Qt |
- starting new activities and/or taking up former activities that were avoided due to the mobility problems | TIp, Qt |
Experienced barriers and potential solutions
| |
Deviations of each session component* | Qt |
Main goal of contact - time spent on issues not related to O&M-training | Qt |
Strong and weak aspects of the O&M-training | TIp, Qt |
Hampering and stimulating factors for use of the standardised O&M-training* | Qt |
Matters for improvement - materials and standardised O&M-training* | Qt |