A holistic model of low vision care for improving vision-related quality of life

Vision impairment can have a significant impact on the wellbeing and quality of life of an individual. Vision rehabilitation has the potential to improve these areas; however, four in five patients with vision impairment are not being referred to the appropriate services. Barriers to on-referral include, but are not limited to: (1) misunderstandings by both practitioners and patients alike regarding which individuals with vision impairment might benefit or qualify for low vision services; (2) lack of awareness of available services; (3) unfamiliarity with practice guidelines; (4) miscommunication between practitioners and patients; (5) required patient travel or limitations in access; and (6) the perceived costs of goods and services. Further, current referral patterns do not represent a holistic patient-centric approach. Vision-related quality of life questionnaires are tools which can assist health professionals in providing optimal individualised care. This review explores current evidence regarding low vision service delivery within Australia and globally, the impact of vision impairment on activities of daily living, the instruments used for the assessment of vision-related quality of life (VRQOL), competing priorities of individual needs in low vision services and rehabilitation, and provides recommendations for a more patient-centred model of care.     

Impact of adjusting for inter‐rater variability in conference abstract ranking and selection processes

Background/aim

Scientific conferences provide a forum for clinicians, educators, students and researchers to share research findings. To be selected to present at a scientific conference, authors must submit a short abstract which is then rated on its scientific quality and professional merit and is accepted or rejected based on these ratings. Previous research has indicated that inter‐rater variability can have a substantial impact on abstract selection decisions. For their 2015 conference, the Occupational Therapy Australia National Conference introduced a system to identify and adjust for inter‐rater variability in the abstract ranking and selection process.

Method

Ratings for 1340 abstracts submitted for the 2015 and 2017 conferences were analysed using many‐faceted Rasch analysis to identify and adjust for inter‐rater variability. Analyses of the construct validity of the abstract rating instrument and rater consistency were completed. To quantify the influence of inter‐rater variability of abstract selection decisions, comparisons were made between decisions made using Rasch‐calibrated measure scores and decisions that would have been made based purely on raw average scores derived from the abstract ratings.

Results

Construct validity and measurement properties of the abstract rating tool were good to excellent (item fit MnSq scores ranged from 0.8 to 1.2; item reliability index = 1.0). Most raters (24 of 27, 89%) were consistent in their use of the rating instrument. When comparing abstract allocations under the two conditions, 25% of abstracts (n = 341) would have been allocated differently if inter‐rater variability was not accounted for.

Conclusion

This study demonstrates that, even with a strong abstract rating instrument and a small rater pool, inter‐rater variability still exerts a substantial influence on abstract selection decisions. It is recommended that all occupational therapy conferences internationally, and scientific conferences more generally, adopt systems to identify and adjust for the impact of inter‐rater variability in abstract selection processes.