Multidisciplinary visual rehabilitation in low- and middle-income countries: a systematic review

Abstract

Objective: To systematically identify the evidence for effectiveness of rehabilitation interventions in people who are visually impaired, living in low-and middle-income countries.Methods: Fifteen databases and the grey literature were searched up until February 2020; papers were identified according to eligibility criteria, and assessed for risk of bias. Eligible studies were controlled trials (randomised or non-randomised) of rehabilitation interventions for blind or visually impaired adults or children from low-and middle-income countries. Possible outcomes included visual acuity, activities of daily living, safety, quality of life and psychological status.Results: Fifteen eligible studies were identified from India (7), Turkey (4), Nigeria (2), Croatia (1) and Iran (1). Six studies were randomised, seven were non-randomised trials, and in two the method of allocation was not clear. Participants were adults (6), children ( 7) and both adults and children (2). Seven studies were small (n≤65) and examining the effect of training programmes. Remaining studies compared the effect of low vision aids (3), economic rehabilitation, goalball, rehabilitation compliance and service delivery methods (2), including one large four-arm randomised trial (n=436). Studies measured a variety of outcomes, and mostly showed a positive effect of interventions for pre-and post-intervention assessment, although between intervention group comparisons were often inconclusive. Overall, only four studies had a low risk of bias. Conclusions:A lack of high-quality evidence for rehabilitation interventions is a barrier to provision of low vision services in low-and middle-income countries. Future research should focus on establishing effectiveness and cost-effectiveness of devices and models of vision rehabilitation appropriate for lowresource settings.

Disability in children and adolescents: the extent of the impact on psychiatric disorders and educational deficits

“…A recent systematic review about rehabilitation programs for visually impaired students indicated promising results related to depression and highlighted the need for training for teachers to be able to better identify and refer comorbid cases. 14 Among the same sample, motor disability was marginally associated with ADHD. Although there is insufficient information to explain this association, there seems to be an overlap in symptoms, with some individuals with ADHD presenting deficits in fine and gross motor coordination, global kinetic movements, global motricity, balance, body schema, and spatial and temporal organization.…”