Concussion-Related Vision Disorder Practice Patterns in OT

PURPOSE: Occupational therapists are among some of the first providers to initiate care after a concussion and visual issues are commonly reported as a symptom. Evidence within occupational therapy is limited regarding current concussion-related vision disorder evaluation, referrals, and treatment. This information is imperative due to vision's impact on occupational performance and return to life roles. The aim of this study was to identify concussion-related vision disorder practice patterns of occupational therapists across various settings to establish a basis for standards of care.

DESIGN: This was a descriptive study using a mixed methodology survey design. Participants were obtained via state licensing boards of the states with the largest populations of occupational therapists with email addresses, and from a list of practitioners participating in a previous study at Salus University. Inclusion criteria included being on this list or being an occupational therapist with a license in Texas, Florida, Wisconsin or New York, who identified treating concussion in the first survey question.

METHODS: A 41-item survey was administered to occupational therapists via Survey Monkey about how they screen, refer, and treat concussion-related vision disorders and if they felt treatment falls within the role of occupational therapy. Quantitative data analysis was mostly descriptive in nature. Percentages were calculated, and both a trend test using logistic regression and a chi-square test of independence were performed. Fisher’s exact test of independence was used when the expected value for any cell in a contingency table was less than 5. The significance level was set to 0.05. Qualitative data analysis included the creation of metadata, including both codes and concept maps using computer software and verified manually by two experienced occupational therapists.

RESULTS: Of the 23, 910 surveys that were emailed, 2,278 (10%) therapists participated, and 1,187 (52%) completed the survey. Twenty-nine percent reported attending continuing education courses in concussion rehabilitation, and 57% courses in vision. Twenty-nine percent reported screening for concussion-related vision disorders during their evaluation, and the following areas were screened always or frequently: visual acuity (71%), visual information processing (44%), convergence (43%), saccades (31%), and accommodation (8%). Visual field loss was most commonly identified (16%) of all disorders. The most helpful professional to diagnose concussion-related vision disorders was identified as neurologists (48%), ophthalmologists (30%), and optometrists (11%). Of the therapists who reported treating concussion-related vision disorders, the most common treatments were for visual perception (14%), pursuits (12%), and saccades (10%). Significant influences on care included years of practice and additional continuing education courses in concussion and vision. The roles of occupational therapy identified included I/ADLs, compensation/adaptation and identification/treatment. Themes identified regarding treatment difficulty included resources like optometrists to refer for diagnosis, knowledge and evidence for remediation.

CONCLUSION: Occupational therapists indicate a need to be involved in screening and managing concussion-related vision disorders. There appears to be inconsistencies in evaluation and treatment across various settings and to whom to refer to for diagnosis. Years of practice and continuing education seem to add to the discrepancies in practice patterns. Therapists are identifying different frequency rates than shown in the literature and report frustration about a lack of optometric resources. These findings indicate a need for standardization of care.

References

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Centers for Disease Control and Prevention. (2016). Percent distributions of TBI-related emergency department visits by age group and injury mechanism. Retrieved from https://www.cdc.gov/traumaticbraininjury/data/dist_ed.html

Finn, C., & Waskiewicz, M. (2015). The role of occupational therapy in managing post- concussion syndrome. Special interest section quarterly: Physical disabilities, 38 (1), 1- 4.

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