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Visual, musculoskeletal, and balance symptoms in people with visual impairments
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-6364-2145
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Worldwide, about 300 million people have some kind of visual impairment (VI). Most people with VI are in the older age range, as visual deficits increase with age. It is not unusual that people with VI suffer both from neck pain or scapular area symptoms and reduced balance, which they consider to be symptoms of old age. However, their symptoms may not be attributable to age, but rather to poor vision.

Aims: First, to identify associations between visual, musculoskeletal and balance symptoms in people engaging in near work every day and in people with VI. Second, to design and validate a suitable instrument for gathering information about visual, musculoskeletal and balance symptoms in people with VI. Third, to explore differences in perceived symptoms between VI patients and people with normal vision in cross-sectional studies and by following a group of age-related macular degeneration (AMD) patients in a longitudinal study. Fourth, to identify the most specific predictors of higher levels of visual, musculoskeletal and balance symptoms.

Methods: A specific instrument was developed: the Visual, Musculoskeletal and Balance symptoms (VMB) questionnaire. Patients with VI were compared to an age-matched reference group with normal vision in three different studies in order to detect differences in self-reported symptoms between the groups. In addition, a follow-up was conducted in a group of AMD patients.

Results: Patients with VI reported higher levels of VMB symptoms than controls, and this increased over time. Visual deficits and the need for visual enhancement increased the risk of VMB symptoms.

Conclusion: People with VI run a potentially higher risk of VMB symptoms than age-matched controls.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , p. 76
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 162
Keywords [en]
Visual impairment, musculoskeletal symptoms, balance symptoms, visual enhancing aids, age-matched controls
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-57087ISBN: 978-91-7529-192-5 (print)OAI: oai:DiVA.org:oru-57087DiVA, id: diva2:1089059
Public defence
2017-06-02, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2017-10-18Bibliographically approved
List of papers
1. Eye-neck interactions triggered by visually deficient computer work
Open this publication in new window or tab >>Eye-neck interactions triggered by visually deficient computer work
2011 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 39, no 1, p. 67-78Article in journal (Refereed) Published
Abstract [en]

Objectives: To study the joint occurrence of eye-and-neck/scapular area symptoms and their association with occupational risk factors in a cross-sectional sample of professional information technology users.

Study population: The participants consisted of 3,971 employees who worked with computers for a minimum of one hour a day. 2,551 (73%) were men and 945 (27%) women, with an age range of 18 up to 64 years. The mean age was 38.1 (SD = 10.7) for men and 37.6 (SD = 12.0) for the women. The measures were obtained via a self-administered survey in combination with a visual examination conducted by an optometrist.

Methods: Two complementary logistic regression analyses with forced entry was conducted on n = 3,496 (88% adjusted response rate) cases. The effect of ocular symptoms on the risk of reporting musculoskeletal symptoms, or vice versa, was examined first in two separate binominal logistic regression analyses. Age, Gender, Near work variable and Visual functioning variables were included in these analyzes. Variables associated with the risk of developing an increase in either symptom category were also examined in two additional binomial logistic regression analyses.

Results: Exposure to spectacles (single vision, multifocal, or progressive correction) in combination with a visual acuity < 1 surfaced as a key mediator of symptoms from the neck/scapular area (p < 0.01). A vergence disparity (uncompensated vergence error) similarly was associated with an augmented risk of developing an increase in neck/scapular area symptoms (p < 0.05). The most influential risk factor for neck/scapular area symptoms were ocular symptoms and vice versa (p < 0.0001).

Conclusions: The results support the hypothesis which postulates that eye-neck/scapular area symptoms interaction may be due to a functional coupling from and between the eye-neck/scapular area muscles [28].

Place, publisher, year, edition, pages
IOS Press, 2011
Keywords
Asthenopia, eyestrain, gaze-control, musculoskeletal, neck pain
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-57576 (URN)10.3233/WOR-2011-1152 (DOI)000292543000009 ()21673430 (PubMedID)2-s2.0-79960774196 (Scopus ID)
Available from: 2017-05-08 Created: 2017-05-08 Last updated: 2018-05-07Bibliographically approved
2. Reliability and Validity of the Visual, Musculoskeletal, and Balance Complaints Questionnaire
Open this publication in new window or tab >>Reliability and Validity of the Visual, Musculoskeletal, and Balance Complaints Questionnaire
2016 (English)In: Optometry and Vision Science, ISSN 1040-5488, E-ISSN 1538-9235, Vol. 93, no 9, p. 1147-1157Article in journal (Refereed) Published
Abstract [en]

Purpose: To evaluate the reliability and validity of the 15-item Visual, Musculoskeletal, and Balance Complaints Questionnaire (VMB) for people with visual impairments, using confirmatory factor analysis (CFA) and with Rasch analysis for use as an outcome measure.

Methods: Two studies evaluated the VMB. In Study 1, VMB data were collected from 1249 out of 3063 individuals between 18 and 104 years old who were registered at a low vision center. CFA evaluated VMB factor structure and Rasch analysis evaluated VMB scale properties. In Study 2, a subsample of 52 individuals between 27 and 67 years old with visual impairments underwent further measurements. Visual clinical assessments, neck/scapular pain, and balance assessments were collected to evaluate the convergent validity of the VMB (i.e. the domain relationship with other, theoretically predicted measures).

Results: CFA supported the a priori three-factor structure of the VMB. The factor loadings of the items on their respective domains were all statistically significant. Rasch analysis indicated disordered categories and the original 10-point scale was subsequently replaced with a 5-point scale. Each VMB domain fitted the Rasch model, showing good metric properties, including unidimensionality (explained variances ≥66% and eigenvalues <1.9), person separation (1.86 to 2.29), reliability (0.87 to 0.94), item fit (infit MnSq's >0.72 and outfit MnSq's <1.47), targeting (0.30 to 0.50 logits), and insignificant differential item functioning (all DIFs but one <0.50 logits) from gender, age, and visual status. The three VMB domains correlated significantly with relevant visual, musculoskeletal, and balance assessments, demonstrating adequate convergent validity of the VMB.

Conclusions: The VMB is a simple, inexpensive, and quick yet reliable and valid way to screen and evaluate concurrent visual, musculoskeletal, and balance complaints, with contribution to epidemiological and intervention research and potential clinical implications for the field of health services and low vision rehabilitation.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2016
Keywords
Visual complaints, musculoskeletal complaints, balance complaints, reliability, validity, confirmatory factor analysis, Rasch analysis, ergonomy
National Category
Ophthalmology
Identifiers
urn:nbn:se:oru:diva-50953 (URN)10.1097/OPX.0000000000000902 (DOI)000383908700021 ()27309524 (PubMedID)2-s2.0-84975166324 (Scopus ID)
Note

Funding Agencies:

REHSAM Research Program at the Swedish Social Insurance Agency 99368-2009/RS11

Swedish Council for Working Life & Social Research 2009-1761

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-04-20Bibliographically approved
3. Visual, musculoskeletal and balance symptoms in individuals with visual impairment and with age-normal vision
Open this publication in new window or tab >>Visual, musculoskeletal and balance symptoms in individuals with visual impairment and with age-normal vision
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-57584 (URN)
Available from: 2017-05-08 Created: 2017-05-08 Last updated: 2018-01-13Bibliographically approved
4. The relationship between low vision and musculoskeletal complaints: a case control study between age-related macular degeneration patients and age-matched controls with normal vision
Open this publication in new window or tab >>The relationship between low vision and musculoskeletal complaints: a case control study between age-related macular degeneration patients and age-matched controls with normal vision
2009 (English)In: Journal of optometry, ISSN 1989-1342, Vol. 2, no 3, p. 127-133Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Age-related Macular Degeneration (ARMD) patients often describe complaints from neck and scapula area muscles and a decreased postural control. In clinical assessment, these complaints are considered to be due to old age.PURPOSE: This study focuses on low-vision patients with ARMD, comparing them to age-matched controls without any eye disease, in order to evaluate if the linkage between self-rated visual complaints and musculoskeletal complaints is more prominent when low vision is present.METHODS: In a cross-sectional study, 24 ARMD patients, aged 65 to 85, were compared to a group of 24 controls without visual problems having a similar age distribution. Visual acuity, the need for magnification plus other optical and visual parameters were assessed. Visual, musculoskeletal and balance/proprioceptive complaints were collected by means of a self-rating questionnaire. The Visual Functioning Questionnaire - Near Activities Subscale (VFQ–NAS) was used to evaluate visual function and related complaints.RESULTS: The correlation between visual complaints and musculoskeletal complaints yielded significant values of the correlation coefficient when performed separately within each group, as well as when calculated on the entire data set [ARMD, Spearman’s rho (ρ)=0.60, P=0.002; control group ρ=0.59, P=0.004; both groups together ρ=0.50 P<0.001]. Stepwise multiple regression analysis supported the hypothesized effect of vision (Visual complaints + Minimum readable typefaces) on musculoskeletal complaints, (r2=0.42, P<0.05). CONCLUSIONS: The results in this study support the hypothesis that a relationship exists between visual and musculoskeletal problems.

Place, publisher, year, edition, pages
Barcelona: , 2009
Keywords
low vision, age related maculopathy, musculoskeletal complaints
National Category
Medical and Health Sciences Ophthalmology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-12394 (URN)10.3921/joptom.2009.127 (DOI)
Available from: 2010-11-02 Created: 2010-11-02 Last updated: 2017-10-18Bibliographically approved
5. Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study
Open this publication in new window or tab >>Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study
2016 (English)In: Journal of Ophthalmology, ISSN 2090-004X, E-ISSN 2090-0058, article id 2707102Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate whether patients with age-related macular degeneration (AMD) run a potentially higher risk of developing visual, musculoskeletal, and balance complaints than age-matched controls with normal vision.

Methods: Visual assessments, self-rated visual function, self-rated visual, musculoskeletal, and balance complaints, and perceived general health were obtained in 37 AMD patients and 18 controls, at baseline and after an average of 3.8 years later.

Results: At follow-up both groups reported decreased visual acuity (VA) and visual function, but only AMD patients reported significantly increased visual, musculoskeletal, and balance complaints. Decreased VA, need for larger font size when reading, need for larger magnification, and decreased self-rated visual function were identified as risk markers for increased complaints in AMD patients. These complaints were also identified as risk markers for decreased health. For controls, decreased VA and self-reported visual function were associated with increased visual and balance complaints.

Conclusions: Visual deterioration was a risk marker for increased visual, musculoskeletal, balance, and health complaints in AMD patients. Specifically, magnifying visual aids, such as CCTV, were a risk marker for increased complaints in AMD patients. This calls for early and coordinated actions to treat and prevent visual, musculoskeletal, balance, and health complaints in AMD patients.

Place, publisher, year, edition, pages
New York, USA: Hindawi Publishing Corporation, 2016
National Category
Ophthalmology
Identifiers
urn:nbn:se:oru:diva-53647 (URN)10.1155/2016/2707102 (DOI)000386813600001 ()2-s2.0-84994403329 (Scopus ID)
Note

Funding Agency:

Research Committee of Region Örebro County

Available from: 2016-11-28 Created: 2016-11-25 Last updated: 2017-11-29Bibliographically approved

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