***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Orientation and mobility training ( O&M-training ) in using an identification cane , also called symbol cane , is provided to people with low vision to facilitate independent participation in the community . In The Netherl and s this training is mainly practice -based because a st and ardised and validly evaluated O&M-training in using the identification cane is lacking . Recently a st and ardised O&M-training in using the identification cane was developed . This training consists of two face-to-face sessions and one telephone session during which , in addition to usual care , the client 's needs regarding mobility are prioritised , and cognitive restructuring techniques , action planning and contracting are applied to facilitate the use of the cane . This paper presents the design of a r and omised controlled trial aim ed to evaluate this st and ardised O&M-training in using the identification cane in older adults with low vision . Methods / design A parallel group r and omised controlled trial was design ed to compare the st and ardised O&M-training with usual care , i.e. the O&M-training commonly provided by the mobility trainer . Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial ( N = 190 ) . The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility . Secondary outcomes include quality of life , feelings of anxiety , symptoms of depression , fear of falling , and falls history . Data for the effect evaluation are collected by means of telephone interviews at baseline , and at 5 and 17 weeks after the start of the O&M-training . In addition to an effect evaluation , a process evaluation to study the feasibility of the O&M-training is carried out . Discussion The screening procedure for eligible participants started in November 2007 and will continue until October 2009 . Preliminary findings regarding the evaluation are expected in the course of 2010 . If the st and ardised O&M-training is more effective than the current O&M-training or , in case of equal effectiveness , is considered more feasible , the training will be embedded in the Dutch national instruction for mobility trainers . Trial registration Clinical Trials.gov Background : Ageing with visual impairment is associated with a high degree of disability whereby age-related macular degeneration in particular causes dependence in activities of daily living ( ADL ) even at an early stage . Aims : To compare an activity-based , health-promotion programme with an individual programme , targeting the elderly with age-related macular degeneration concerning the effect on the development of dependence in ADL , general health , and self-reported health problems . Methods : A r and omized controlled study with a 28-month follow-up . A total of 229 persons were r and omized to the study and 131 ( 57 % ) were followed up ( individual intervention n=69 , health-promotion programme n=62 ) at 28-month . Results : The health-promotion group maintained their ADL level despite a significant decrease in visual acuity , while the individual intervention group increased its dependence in ADL . General health systematic ally dropped to a lower level in both groups , but participants from the health-promotion group reported fewer health problems . There were significantly fewer reports of tiredness and dizziness among the health-promotion participants . Conclusion : The health-promotion programme seems to have slowed down the disablement process among elderly with decreased vision by enabling them to maintain their ADL level and by reducing self-reported health problems for at least 28 months following intervention Background : Visual impairment and blindness are common in older people in Britain . It is important to know the causes of visual impairment to develop health service and research priorities . The authors aim ed to identify the causes of visual impairment in people aged 75 years and older in Britain . Methods : In the MRC Trial of the Assessment and Management of Older People in the Community , trial nurses tested visual acuity in everyone aged 75 years and older in 53 general practice s. For all visually impaired patients in 49 of the 53 medical practice s , data regarding the cause of vision loss were extracted from the general practice medical notes . Additional follow up question naires were also sent to the hospital ophthalmologist to confirm the cause of vision loss . Visual impairment was defined as a binocular acuity of less than 6/18 . Results : There were 1742 ( 12.5 % ) people visually impaired in the 49 participating practice s. Of these , 450 ( 26 % ) achieved a pinhole visual acuity in either eye of 6/18 or better . In these people , the principal reason for visual loss was considered to be refractive error . The cause of visual loss was available for 976 ( 76 % ) of the remaining 1292 visually impaired people identified . The main cause of visual loss was age related macular degeneration ( AMD ) ; 52.9 % ( 95 % confidence interval 49.2 to 56.5 ) of people had AMD as a main or contributory cause . This was followed by cataract ( 35.9 % ) , glaucoma ( 11.6 % ) , myopic degeneration ( 4.2 % ) , and diabetic eye disease ( 3.4 % ) . Conclusions : A substantial proportion of visual impairment in our sample of older people in Britain can be attributed to remediable causes — refractive error and cataract . There is considerable potential for visual rehabilitation in this age group . For the large proportion with macular degeneration , low vision services will be important Background / aims Ageing of the population will result in unprecedented numbers of older adults living with age-related vision loss ( ARVL ) .  Self-management models improve health outcomes and reduce healthcare costs ; however , the principles have rarely been applied in low vision services . Methods A two-armed r and omised controlled trial of older adults ( n=77 ) with ARVL compared ‘ usual care ’ provided by a not-for-profit community agency with an extended model of care ( usual care+self-management group intervention ) . The primary outcome variable ( participation in life situations ) was measured using the Activity Card Sort . Secondary outcome measures examined general health and vision-specific domains . Results The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group . Gains were made regardless of whether participants were , or were not , depressed at baseline . The addition of the self-management group was also successful in significantly reducing depression , increasing physical and mental health , generalised and domain-specific self-efficacy , and adjustment to ARVL . With the exception of adjustment and mental health , differences were still apparent at 12 weeks ' follow-up . Conclusion Addition of self-management  significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL OBJECTIVE To evaluate the effectiveness of a low-vision rehabilitation program . METHODS A multicenter r and omized clinical trial was conducted from November 2004 to November 2006 with a 4-month follow-up . A total of 126 patients were included , 98 % of whom were white and male . The patients were referred from eye or low-vision clinics and blind rehabilitation centers with a visual acuity in the better-seeing eye worse than 20/100 and better than 20/500 and were eligible for Veterans Affairs ( VA ) services .  Telephone interviews of patients were conducted in their homes before and after participation in an outpatient low-vision program at a VA medical care facility or a ( waiting list ) control group . The interviewer administering question naires by telephone was masked to patients ' assignments . Interventions included low-vision examination , counseling , and prescription and provision of low-vision devices and 6 weekly sessions provided by a low-vision therapist to teach use of assistive devices and adaptive strategies to perform daily living tasks independently . MAIN OUTCOME MEASURE Change in patients ' visual reading ability estimated from participant responses to the Veterans Affairs Low-Vision Visual Functioning Question naire ( LV VFQ-48 ) reading items completed at baseline compared with 4 months after enrollment for the treatment and control groups . The secondary outcomes were changes in other visual ability domains ( mobility , visual information processing , visual motor skills ) and overall visual ability from baseline to 4 months estimated from VA LV VFQ-48 difficulty ratings for subsets of items . RESULTS The treatment group demonstrated significant improvement in all aspects of visual function compared with the control group . The difference in mean changes was 2.43 logits ( 95 % confidence interval [ CI ] , 2.07 - 2.77 ; P < .001 ; effect size , 2.51 ) for visual reading ability ; 0.84 logit ( 95 % CI , 0.58 - 1.10 ; P < .001 ; effect size , 1.14 ) for mobility ; 1.38 logits ( 95 % CI , 1.15 - 1.62 ; P < .001 ; effect size , 2.03 ) for visual information processing ; 1.51 logits ( 95 % CI , 1.22 - 1.80 ; P < .001 ; effect size , 1.82 ) for visual motor skills ; and 1.63 logits ( 95 % CI , 1.40 - 1.86 ; P < .001 ; effect size , 2.51 ) for overall visual function . CONCLUSION The program effectively provided low-vision rehabilitation for patients with macular diseases . APPLICATIONS TO CLINICAL PRACTICE : At least 10 hours of low-vision therapy , including a home visit and assigned homework to encourage practice , is justified for patients with moderate and severe vision loss from macular diseases . Because the waiting-list control patients demonstrated a decline in functional ability , low-vision services should be offered as early as possible . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00223756 Background : In a r and omized controlled trial testing a home safety program design ed to prevent falls in older people with severe visual impairment , it was shown that the program , delivered by an experienced occupational therapist , significantly reduced the numbers of falls both at home and away from home . Objectives : To investigate whether the success of the home safety assessment and modification intervention in reducing falls result ed directly from modification of home hazards or from behavioral modifications , or both . Methods : Participants were 391 community living women and men aged 75 years and older with visual acuity 6/24 meters or worse ; 92 % ( 361 of 391 ) completed one year of follow up . Main outcome measures were type and number of hazards and risky behavior identified in the home and garden of those receiving the home safety program , compliance with home safety recommendations reported at six months , location of all falls for all study participants during the trial , and environmental hazards associated with each fall . Results : The numbers of falls at home related to an environmental hazard and those with no hazard involved were both reduced by the home safety program ( n = 100 participants ) compared with the group receiving social visits ( n = 96 ) ( incidence rate ratios = 0.40 ( 95 % confidence interval , 0.21 to 0.74 ) and 0.43 ( 0.21 to 0.90 ) , respectively ) . Conclusions : The overall reduction in falls by the home safety program must result from some mechanism in addition to the removal or modification of hazards or provision of new equipment Abstract Objective : To test the effectiveness of , and explore interactions between , three interventions to prevent falls among older people . Design : A r and omised controlled trial with a full factorial design . Setting : Urban community in Melbourne , Australia . Participants : 1090 aged 70 years and over and living at home . Most were Australian born and rated their health as good to excellent ; just over half lived alone . Interventions : Three interventions ( group based exercise , home hazard management , and vision improvement ) delivered to eight groups defined by the presence or absence of each intervention . Main outcome measure : Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques . Changes to targeted risk factors were assessed by using measures of quadriceps strength , balance , vision , and number of hazards in the home . Results : The rate ratio for exercise  was 0.82 ( 95 % confidence interval 0.70 to 0.97 , P=0.02 ) , and a significant effect ( P<0.05 ) was observed for the combinations of interventions that involved exercise . Balance measures improved significantly among the exercise group . Neither home hazard management nor treatment of poor vision showed a significant effect . The strongest effect was observed for all three interventions combined ( rate ratio 0.67 ( 0.51 to 0.88 , P=0.004 ) ) , producing an estimated 14.0 % reduction in the annual fall rate . The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined . Conclusions : Group based exercise was the most potent single intervention tested , and the reduction in falls among this group seems to have been associated with improved balance . Falls were further reduced by the addition of home hazard management or reduced vision management , or both of these . Cost effectiveness is yet to be examined . These findings are most applicable to Australian born adults aged 70–84 years living at home who rate their health as good Purpose The purpose of this study was to investigate the effect of  residential blind rehabilitation  on patients ’ vision-targeted health-related quality of life ( HRQOL ) and general physical and mental function . Method The National Eye Institute 25-item Visual Function Question naire ( NEI VFQ ) plus appendix questions , the 12-item Short-Form Health Survey ( SF-12 ) , Hope Scale and Coopersmith self-esteem inventory were administered to 206 legally blind veterans prior to their entering a residential ( in-patient ) blind rehabilitation program and again to 185 and 176 of the original cohort at 2 and 6 months after completion of the rehabilitation 
    Output:
    
Although behavioural interventions delivered by occupational therapists have been shown to reduce the rate of falls , we are unable to conclude if this is due to reduced activity restriction ( increased mobility ) or reduced activity ( lessening exposure to risk ) .
There are inconclusive and conflicting results from trials evaluating the effectiveness of behavioural and environmental interventions aim ed at improving quality of life .