Blind rehabilitation quality of life outcomes in visually impaired veterans and their caregivers

TK Kuyk, Ph.D., JL Elliott, M.A., S Mitchell, M.A., E McIntosh, B.S., and C Owsley, Ph.D., M.P.H.

Birmingham VA Medical Center, The University of Alabama at Birmingham

Objectives: To determine the effect of completion of a blind rehabilitation program on the quality of life (QOL) of moderate to severely visually impaired veterans. To also determine if veterans' participation in blind rehabilitation has a significant impact on the quality of life of the persons they identify as their primary caregivers (e.g. spouse).

Methods: QOL was assessed in a heterogeneous sample of 150 visually impaired (legally blind) veterans just prior to and at two and six months after they completed a VA blind rehabilitation program. The National Eye Institute Visual Function Questionnaire (NEI-VFQ) 25 item version plus appendix questions (39 items total) was the primary QOL instrument used for veterans. Standard scoring was used and yielded 12 sub-scale scores.  A similar assessment of QOL was conducted for 90 persons the veterans identified as their primary caregivers (e.g. spouse, family member). QOL for caregivers was assessed with the National Center for Health Statistics General Well-Being Scale (GWBS) and a set of modified NEI-VFQ questions. The modifications were made in order to assess the impact of the veterans' vision loss on different functions performed by the caregivers. The questionnaires were administered during telephone interviews.

Results: For the visually impaired veterans, scores at 2 and 6 months post rehabilitation were significantly higher than pre-rehabilitation scores for 8 of the 12 NEI-VFQ subscales. At two months, the largest changes (on a 100 point scale) were for subscales measuring performance of tasks using near vision (27), distance vision (14), and color vision (12). Social function increased by 9 points and smaller positive changes were found for mental health, dependency (on others), role limitations, and peripheral vision. There were no changes in the sub-scales for driving, general health, general vision and ocular pain. At six months, small, but mostly insignificant decreases were found for 10 or 12 subscales. However, the collective probability of this event is less than 0.066 (Binomial Test). For caregivers a significant positive change was found in only one of the six subscales (Happiness) of the GWBS. Modified VFQ items also formed 6 subscales, of which one, social functioning showed a significant positive change, and another, mental health, approached significance.

Conclusions: Following blind rehabilitation, vision specific QOL in visually impaired veterans improved significantly. The ability to perform near and distance tasks improved the most and may be related to training and use of low vision aids. The QOL improvement was present at two and six months post rehabilitation. However, small declines in subscale scores occurred between 2 and 6 months that suggest some erosion of QOL over time.  Although caregivers reported small gains along some dimensions of QOL, these were smaller and less extensive than those reported by the veterans.

Funding Acknowledgment: This study was funded by the VA Rehabilitation Research and Development Service, project # C2240-RA.