How to Measure Functional Vision and O&M...
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CRICOS 00111D TOID 3069 How to Measure Functional Vision and O&M Outcomes with VROOM & OMO Lil Deverell COMS PhD
Transcript of How to Measure Functional Vision and O&M...
CRICOS 00111D
TOID 3069
How to Measure Functional Vision
and O&M Outcomes with VROOM & OMO
Lil Deverell COMS PhD
Outline
1. Measuring O&M outcomes
• Constructivist (not objective) measures suit O&M
• “Functional” inquiry defined
• O&M environmental complexity scale
2. VROOM & OMO tools
• Practice
• Critique
We need measures in O&M
1. To benchmark functional status• Compare needs, triage referrals
2. To account for fluctuations• Lighting, fatigue, stress
3. To track disease progression• Deteriorating vision, arthritis, aging
4. To evaluate functional outcomes• O&M programs – aids, travel strategies
• Vision restoration treatments – bionic eye
• Lifestyle/wellbeing programs – social skills, diet, exercise
Problems measuring O&M
Hybrid research – incongruentHuman behaviour can be interpreted many ways
Objectivity vs constructivism
Mixed methods research Clinical trials = QUANT/qual priority
Functional research = QUAL/quant priority
Checklists and rating scalesMost don’t aggregate to a single score
What to measure?Speed and obstacle tallies are not important to clients
Need to capture functional, dynamic complexity
The solution needs to…
Fit with ordinary O&M assessment
– Practice-based evidence
Embrace person-centred practice
– Anyone, any age, any ability, anywhere, any time
Be holistic
– Reflect walking and wellbeing
Show precise changes
– Aggregate to a single numberhttps://twitter.com/bbcwritersroom/status/721407649162653696
Developing constructivist measures
Holistic fu
nction
al a
ssessm
en
t
A B C
Development of functional measures over time
A. Clinical O&M studies measuring
selected variables give only
partial/proxy findings
B. Holistic O&M assessment informs
Grounded Theories
C. Behaviourally anchored rating
scales are built from Grounded
Theories
- need to aggregate to a single score for easy comparisons
Defining functional inquiry (can’t be objective – this is constructivism)
Six essential characteristics:
Authenticity – what matters to the client
Embodiment – showing, not just telling
Community – the client’s cultural context
Integration – the client manages the variables
Diversity – investigate variety of times and places
Learning – knowledge builds through engagement
Community model of O&M Ax
Client’s O&M action is
the focus
Client is always located
in a particular context,
space and time
Multiple opinions
Fluid power
O&M Environmental Complexity Scale(Deverell, 2011, International Journal of O&M)
1 3 5
2 4 6
Simple
Complex
No action Pedestrian-paced action Traffic-paced action
Rate these places 1 – 6
- Speed?
- Simple or Complex?
Why two measures?
VROOM = vision-related outcomes in O&M
OMO = orientation and mobility outcomes
Vision ≠ O&M
Vision for reading ≠ vision for O&M
Both use behaviourally anchored rating scales
Both are co-rated = assessor + client + other stakeholders
Both are scored out of 50
Implementation
Informed consent
Ordinary O&M Ax• Interview + Observation + Rating conversation
• Scores + comments = results
• Line-ball decisions: always rate lower
Benchmark• Day travel with any aids the client normally uses
Comparisons/outcomes:• day/night (light, night-blindness)
• morning/afternoon (fatigue, ABI)
• with/without aids (e.g., guide, cane, dog)
• pre-post training (outcome measure)
Practice, questions, critique
Melbourne-Sarawak Research Collaboration Scheme Digital Health Project, September 2016 – September 2018
Optimising technology to measure functional vision, mobility and service outcomes for people with low vision or blindness
