The Impact of Visual Impairments on Mobility Performance in
Transcript Of The Impact of Visual Impairments on Mobility Performance in
UNLV Theses, Dissertations, Professional Papers, and Capstones
5-1-2017
The Impact of Visual Impairments on Mobility Performance in Community-Dwelling Older Adults
Lauren Andrew University of Nevada, Las Vegas Talia Davis University of Nevada, Las Vegas Christian Johnson University of Nevada, Las Vegas
Follow this and additional works at: https://digitalscholarship.unlv.edu/thesesdissertations Part of the Physical Therapy Commons
Repository Citation Andrew, Lauren; Davis, Talia; and Johnson, Christian, "The Impact of Visual Impairments on Mobility Performance in Community-Dwelling Older Adults" (2017). UNLV Theses, Dissertations, Professional Papers, and Capstones. 2920. http://dx.doi.org/10.34917/10983003
This Dissertation is protected by copyright and/or related rights. It has been brought to you by Digital [email protected] with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself. This Dissertation has been accepted for inclusion in UNLV Theses, Dissertations, Professional Papers, and Capstones by an authorized administrator of Digital [email protected] For more information, please contact [email protected]
THE IMPACT OF VISUAL IMPAIRMENTS ON MOBILITY PERFORMANCE IN COMMUNITY-DWELLING OLDER ADULTS
By
Lauren Andrew Talia Davis
Christian Johnson
A doctoral project submitted in partial fulfillment of the requirements for the
Doctor of Physical Therapy
Department of Physical Therapy School of Allied Health Sciences
Division of Health Sciences The Graduate College
University of Nevada, Las Vegas May 2017
Copyright 2017 by Lauren Andrew, Talia Davis, and Christian Johnson All Rights Reserved.
THE GRADUATE COLLEGE We recommend the doctoral project prepared under our supervision by Lauren Andrew, Talia Davis, and Christian Johnson Entitled The Impact of Visual Impairments on Mobility Performance in Community Dwelling Older Adults Is approved in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy Department of Physical Therapy Kai-Yu Ho, P.h.D, Research Project Coordinator Szu-Ping Lee, P.h.D, Research Project Advisor Merrill Landers, P.h.D, Chair, Department Chair Physical Therapy Kathryn Hausbeck Korgan, P.h.D., Interim Dean of the Graduate College May 2017
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ABSTRACT Background and Purpose: Falls are a major concern for elderly adults and can have a significant impact on overall health and well-being. Declines in vision with aging may be related to the development of fear of falling (FOF) and impaired mobility. It is possible that impaired vision due to common eye diseases can increase the FOF avoidance behavior and affect mobility function in this population. The purpose of this study was to investigate the relation among visual impairment, mobility performance, and FOF avoidance behavior in older adults. Methods: Inclusion criteria for eligible participants were: 50 years of age and older, able to walk 50 m without assistance, and able to understand simple instructions related to the assessments. A total of 455 participants from local community adult activity centers (males=152, females=303; age=73.1±7.7 years, range=51-97 years) participated. Physical mobility was assessed using an instrumented Timed Up-and-Go test. Visual acuity (VA) was tested using a standard Snellen chart. Avoidance behavior was assessed using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). Participants’ general health and presence of eye diseases (age-related macular degeneration, cataracts, and glaucoma) was assessed using a survey of medical history. A two-way ANOVA was used to investigate effect of VA and avoidance behavior on TUG performance. An additional two-way ANOVA test was used to investigate the effect of self-reported eye disease and avoidance behavior on TUG performance. Results and Discussion: There was a statistically significant difference between avoiders and nonavoiders’ TUG score (avoiders=12.45±5.85 sec, non-avoiders 8.29±3.48, p<0.001). The VA has no significant effect on TUG time (no impairment= 8.69 ± 3.49 sec, mild impairment= 9.42 ± 5.05 sec, moderate impairment= 8.11 ± 2.08 sec, severe impairment= 9.45 ± 2.68 sec, p=0.791). There is no significant VA group by avoider group interaction (p=0.66). There was also a statistically significant difference in TUG scores between participants with and without eye disease (eye disease=9.37±5.08, no eye disease=8.29±2.80, p=0.004). There is no significant eye disease by avoider group interaction (p=0.144).
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Conclusion: The results of this study indicated that the presence of one or more self-reported eye diseases and higher FOF avoidance behavior were both associated with decreased mobility. Contrary to the initial hypothesis of the present study, there was no relation between VA and mobility, nor VA and FOF avoidance behavior. It is important for clinicians to inquire about the presence of eye diseases and administer the FFABQ to older adults in order to identify risk factors related to decline in physical mobility. Presently, the continued use of the Snellen chart to assess for VA as a part of fall risk assessment may be inadequate. Future studies should focus on developing a more comprehensive clinical assessment of vision that expands beyond visual acuity for the geriatric population.
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ACKNOWLEDGEMENTS This research study was made possible by the UNLVPT Student Opportunity Research Grant. The authors would like to thank Szu-Ping Lee, PT, PhD for his guidance as principle investigator of this study. The authors would also like to thank Sue Schuerman, PT, PhD, GCS for her help with this project. Additionally, the authors would like to thank the staff at Sun City Anthem, Sun City Summerlin, Centennial Hills Active Adult Center, Nevada Hand Housing and Neighborhood Development, Boulder City Hospital, and Heritage Park Senior Facility for their assistance in participant recruitment and data collection.
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TABLE OF CONTENTS ABSTRACT ........................................................................................................................................... iii ACKNOWLEDGEMENTS ..................................................................................................................... v LIST OF TABLES ................................................................................................................................ vii LIST OF FIGURES..............................................................................................................................viii INTRODUCTION................................................................................................................................... 1 METHODS ............................................................................................................................................. 4 RESULTS ............................................................................................................................................... 7 DISCUSSION ......................................................................................................................................... 8 CONCLUSION ..................................................................................................................................... 12 REFERENCES...................................................................................................................................... 13 CURRICULUM VITAE........................................................................................................................ 19
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LIST OF TABLES Table 1. Demographic Data ................................................................................................................... 15 Table 2. Outcome Measures .................................................................................................................. 15 Table 3. Pearson Correlation.................................................................................................................. 15
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LIST OF FIGURES Figure 1. Force Plate Instrumented Stool ............................................................................................... 16 Figure 2. TUG Test at 3m...................................................................................................................... 16 Figure 3. Snellen Chart.......................................................................................................................... 17 Figure 4. TUG Performance by Visual Acuity ....................................................................................... 17 Figure 5. TUG Performance by FFABQ ................................................................................................ 18 Figure 6. TUG Performance by Eye Disease .......................................................................................... 18
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5-1-2017
The Impact of Visual Impairments on Mobility Performance in Community-Dwelling Older Adults
Lauren Andrew University of Nevada, Las Vegas Talia Davis University of Nevada, Las Vegas Christian Johnson University of Nevada, Las Vegas
Follow this and additional works at: https://digitalscholarship.unlv.edu/thesesdissertations Part of the Physical Therapy Commons
Repository Citation Andrew, Lauren; Davis, Talia; and Johnson, Christian, "The Impact of Visual Impairments on Mobility Performance in Community-Dwelling Older Adults" (2017). UNLV Theses, Dissertations, Professional Papers, and Capstones. 2920. http://dx.doi.org/10.34917/10983003
This Dissertation is protected by copyright and/or related rights. It has been brought to you by Digital [email protected] with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself. This Dissertation has been accepted for inclusion in UNLV Theses, Dissertations, Professional Papers, and Capstones by an authorized administrator of Digital [email protected] For more information, please contact [email protected]
THE IMPACT OF VISUAL IMPAIRMENTS ON MOBILITY PERFORMANCE IN COMMUNITY-DWELLING OLDER ADULTS
By
Lauren Andrew Talia Davis
Christian Johnson
A doctoral project submitted in partial fulfillment of the requirements for the
Doctor of Physical Therapy
Department of Physical Therapy School of Allied Health Sciences
Division of Health Sciences The Graduate College
University of Nevada, Las Vegas May 2017
Copyright 2017 by Lauren Andrew, Talia Davis, and Christian Johnson All Rights Reserved.
THE GRADUATE COLLEGE We recommend the doctoral project prepared under our supervision by Lauren Andrew, Talia Davis, and Christian Johnson Entitled The Impact of Visual Impairments on Mobility Performance in Community Dwelling Older Adults Is approved in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy Department of Physical Therapy Kai-Yu Ho, P.h.D, Research Project Coordinator Szu-Ping Lee, P.h.D, Research Project Advisor Merrill Landers, P.h.D, Chair, Department Chair Physical Therapy Kathryn Hausbeck Korgan, P.h.D., Interim Dean of the Graduate College May 2017
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ABSTRACT Background and Purpose: Falls are a major concern for elderly adults and can have a significant impact on overall health and well-being. Declines in vision with aging may be related to the development of fear of falling (FOF) and impaired mobility. It is possible that impaired vision due to common eye diseases can increase the FOF avoidance behavior and affect mobility function in this population. The purpose of this study was to investigate the relation among visual impairment, mobility performance, and FOF avoidance behavior in older adults. Methods: Inclusion criteria for eligible participants were: 50 years of age and older, able to walk 50 m without assistance, and able to understand simple instructions related to the assessments. A total of 455 participants from local community adult activity centers (males=152, females=303; age=73.1±7.7 years, range=51-97 years) participated. Physical mobility was assessed using an instrumented Timed Up-and-Go test. Visual acuity (VA) was tested using a standard Snellen chart. Avoidance behavior was assessed using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). Participants’ general health and presence of eye diseases (age-related macular degeneration, cataracts, and glaucoma) was assessed using a survey of medical history. A two-way ANOVA was used to investigate effect of VA and avoidance behavior on TUG performance. An additional two-way ANOVA test was used to investigate the effect of self-reported eye disease and avoidance behavior on TUG performance. Results and Discussion: There was a statistically significant difference between avoiders and nonavoiders’ TUG score (avoiders=12.45±5.85 sec, non-avoiders 8.29±3.48, p<0.001). The VA has no significant effect on TUG time (no impairment= 8.69 ± 3.49 sec, mild impairment= 9.42 ± 5.05 sec, moderate impairment= 8.11 ± 2.08 sec, severe impairment= 9.45 ± 2.68 sec, p=0.791). There is no significant VA group by avoider group interaction (p=0.66). There was also a statistically significant difference in TUG scores between participants with and without eye disease (eye disease=9.37±5.08, no eye disease=8.29±2.80, p=0.004). There is no significant eye disease by avoider group interaction (p=0.144).
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Conclusion: The results of this study indicated that the presence of one or more self-reported eye diseases and higher FOF avoidance behavior were both associated with decreased mobility. Contrary to the initial hypothesis of the present study, there was no relation between VA and mobility, nor VA and FOF avoidance behavior. It is important for clinicians to inquire about the presence of eye diseases and administer the FFABQ to older adults in order to identify risk factors related to decline in physical mobility. Presently, the continued use of the Snellen chart to assess for VA as a part of fall risk assessment may be inadequate. Future studies should focus on developing a more comprehensive clinical assessment of vision that expands beyond visual acuity for the geriatric population.
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ACKNOWLEDGEMENTS This research study was made possible by the UNLVPT Student Opportunity Research Grant. The authors would like to thank Szu-Ping Lee, PT, PhD for his guidance as principle investigator of this study. The authors would also like to thank Sue Schuerman, PT, PhD, GCS for her help with this project. Additionally, the authors would like to thank the staff at Sun City Anthem, Sun City Summerlin, Centennial Hills Active Adult Center, Nevada Hand Housing and Neighborhood Development, Boulder City Hospital, and Heritage Park Senior Facility for their assistance in participant recruitment and data collection.
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TABLE OF CONTENTS ABSTRACT ........................................................................................................................................... iii ACKNOWLEDGEMENTS ..................................................................................................................... v LIST OF TABLES ................................................................................................................................ vii LIST OF FIGURES..............................................................................................................................viii INTRODUCTION................................................................................................................................... 1 METHODS ............................................................................................................................................. 4 RESULTS ............................................................................................................................................... 7 DISCUSSION ......................................................................................................................................... 8 CONCLUSION ..................................................................................................................................... 12 REFERENCES...................................................................................................................................... 13 CURRICULUM VITAE........................................................................................................................ 19
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LIST OF TABLES Table 1. Demographic Data ................................................................................................................... 15 Table 2. Outcome Measures .................................................................................................................. 15 Table 3. Pearson Correlation.................................................................................................................. 15
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LIST OF FIGURES Figure 1. Force Plate Instrumented Stool ............................................................................................... 16 Figure 2. TUG Test at 3m...................................................................................................................... 16 Figure 3. Snellen Chart.......................................................................................................................... 17 Figure 4. TUG Performance by Visual Acuity ....................................................................................... 17 Figure 5. TUG Performance by FFABQ ................................................................................................ 18 Figure 6. TUG Performance by Eye Disease .......................................................................................... 18
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