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Purpose: This study aims to identify the most important factors that influence the independent bicycle use of visually impaired people in the Netherlands. Materials and methods: Both visually impaired people and professionals participated in a two-round online Delphi study ( n  = 42). In Round 1 the participants identified the factors which they ranked by relevance in Round 2. Results: The participants prioritised environmental factors related to the traffic situation, the characteristics of the infrastructure, and weather and light conditions (Kendall's W  = 0.66). They indicated that the most influencing personal factors are related to personality, traffic experience, and personal background ( W  = 0.58). Glaucoma was ranked as the most relevant ophthalmic condition ( W  = 0.74), while glare was regarded as the most important factor with respect to the visual functions ( W  = 0.78). Conclusions: The factors provided by this study can be used to optimise the independent cycling mobility of visually impaired people. More research is needed to investigate, both, how and to what extent the mentioned factors influence the cycling behaviour.Implications for rehabilitationThe results of this study can be used to set priorities during the rehabilitation and training of visually impaired people who wish to cycle independently.Visually impaired cyclists may compensate for the consequences of their visual impairments by taking alternative routes that suit their individual abilities and limitations.Since gaining and maintaining self-confidence is important for independent cycling with a visual impairment, practitioners such as mobility trainers should not only focus on cycling-related skills and abilities, but also aim to improve the self-confidence of visually impaired people who wish to cycle.

Purpose: To conduct a systematic review of post-traumatic stress reactions among individuals with visual impairment (VI). Materials and methods: Qualitative and quantitative studies were identified through searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Libraries. The literature search was limited to humans, of English and Scandinavian languages and publication year between 1980 and 2017. Study quality was assessed for all the included studies and extracted data were synthesized using narrative analysis. Results: Of 4235 records identified through literature search, eleven were included in the analyses. Results from the qualitative studies illustrated multiple physical, behavioral, emotional, and cognitive manifestations of trauma. Four out of five quantitative studies showed that various types of potentially traumatic events were significantly associated with mental health adversities ( p  < 0.05). The prevalence of post-traumatic mental disorders was 4-21.2% for depression, 0.9% for dysthymia, and 32% for substance misuse. The quality of the reviewed studies was considered low to moderate. Conclusion: Traumatic experiences appear to have a great impact on the mental health in people with visual impairment (VI) and these results highlight their need for mental health care. Future studies with higher methodological rigor are recommended. Implications for rehabilitation Visual impairment entails a greater susceptibility to some types of potentially traumatic events, especially threats in everyday life. This calls for a greater emphasis on safe community environments and universal design in public spaces. In rehabilitation after serious accidents or potentially traumatic events, professionals working with people with vision impairment should be aware of the different manifestations of post-traumatic stress responses and that some stress responses may cause additional disability. The high prevalence of traumatic events and their impact on mental health in individuals with visual impairments highlights a need of mental health care.

Purpose: Scholars agree that effective rehabilitation relies on a bedrock of reciprocity, relational trust, and authenticity. It is therefore essential for practitioners to develop insight into the complex dynamics within helping relationships. This study aims to provide an in-depth understanding of visually impaired students' experience of informal helping relationships. Methods: Ten visually impaired students at a South African university participated in one of two semi-structured focus group interviews (six and four in each group, respectively) wherein we explored their experience of informal helping relationships. Interpretive phenomenological analysis was used to make sense of the data. Results: Help, according to the participants, can militate against visibility and complete acceptance, and has the potential to cause helpers to feel entrapped. By contrast, some students found that help offered benefits to relationships by boosting the helper's self-esteem and affording disabled students the opportunity to make friends. Conclusion: Decisions whether to accept help were mediated more by relationship factors than by the need for help. These findings are important for rehabilitation professionals, as deep relationship can come into being during the course of a rehabilitation process. Although this study was conducted in an informal setting, the relational dynamics that we explore are also applicable to clinical relationships between disabled persons and rehabilitation professionals. Implications for rehabilitation In this paper, we provide an overview of the intricacies involved in care and helping relationships; In order for rehabilitation to be successful, these relationships should ideally be real, trusting, and authentic; Yet, authenticity and spontaneity often get lost in helping relationships, as help-recipients may deny help when they need it, and accept help when perfectly able to cope without it. These decisions are mediated more by relationship factors than by the need for help; In their daily practice, it is essential for health professionals to be mindful of these relational intricacies within care relationships; We recommend that professionals remain motivated to continuously reflect on their own actions and on the emotional investment they might have in their role as a helper; Our last recommendation is for rehabilitation professionals to spend energy on exploring, through open and transparent discussions with their disabled patients, the relational dynamics in their relationship.

Purpose: This study investigates the social capital implications of vision loss among working-age adults in Nigeria. The study explores the challenges of acquiring and maintaining social relationships post-vision loss, and investigates the extent to which visual rehabilitation services support social goals., Method: A qualitative study using a phenomenological approach was undertaken. Eight adults (18-59 years) were recruited from disability service organizations in Nigeria. Telephone interviews were recorded and transcribed, and thematic content analysis was used to analyze the data gathered in this study., Results: Three broad themes were developed from participants' accounts of their experiences: (1) changes to relationships with friends and others; (2) finding strength in family relationships; and (3) rehabilitation and the confidence to interact. The findings indicate that the relationship between participants and their family members improved post vision impairment, enhancing bonding social capital. However, participants experienced reduced bridging and linking social capital due to diminished or broken relationships with managers, coworkers, friends, and others in the community., Conclusions: As social connectedness and relationships are highly valued in Nigeria's diverse society, we suggest that adults with visual impairment would significantly benefit from visual rehabilitation services placing greater emphasis on addressing the social goals of participants. Implications for Rehabilitation Visual impairment in working-age adults can strengthen family relationships (homogenous groups), creating bonding capital that is associated with access to important resources including emotional and moral support, and some financial and material resources. Visual impairment can negatively impact relationships with managers, coworkers, and others in the community (heterogeneous groups), resulting in diminished bridging and linking capital. Visual impairment can reduce access to resources such as an income, social status, and reduces participation in the wider community. Visual Rehabilitation Services could significantly benefit participants by placing greater emphasis on social goals, such as building and maintaining social networks, particularly with diverse (heterogeneous groups), which are valued in Nigeria's diverse cultural climate.

Background: Visual impairment can lead loss of functional ability, necessity of accommodations and assistive technologies or having to rely on others for help. This can bring about feelings of sadness, dependency, inadequacy, and fear, which can put a person at risk for depression and affect one's satisfaction with life., Purpose: The aim of this study was to examine the effects of socio-demographic factors, disability-related factors, optimism, pessimism, self-esteem and social support on depression, and life satisfaction in visually impaired people., Methods: A total of 94 visually impaired people completed the measures of socio-demographic and disability-related characteristics, optimism and pessimism, self-esteem, social support, depression and life satisfaction, administered by the authors. Correlational and hierarchical regression analysis was used to examine the relations and test the model for predicting depression and life satisfaction., Results: The results have shown that depression was negatively related to the level of education, optimism, self-liking, self-competence, support from friends, family and coworkers, and positively related to comorbidity and pessimism. Life satisfaction was positively related to education, socio-economic status, optimism, self-liking, self-competence and support from friends, family and coworkers, and negatively to pessimism. Results have further shown that depression levels were predicted by education, comorbidity, optimism and self-liking, and that self-liking mediated the relationship between optimism and depression. Life satisfaction was predicted by optimism, pessimism, self-liking, friends' support, and depression. Further analysis suggested that the path from optimism to life satisfaction goes through self-liking, friends' support, and depression. Pessimism showed indirect effects through self-liking but also had direct effects on life satisfaction., Conclusions: Focusing on optimism, pessimism, self-esteem, and social functioning of visually impaired is important in preventing depression and promoting life satisfaction, and should be a part of rehabilitation practices. Implications for Rehabilitation Screening for depression and mental health problems should be a part of rehabilitation process. Changes in the perception of future outcomes should be monitored and addressed throughout rehabilitation process in order to boost realistic optimism and prevent discouragement and hopelessness. Frequent feedback and positive reinforcement about a persons' progress and ability should be given throughout rehabilitation process in order to promote positive view of oneself and prevent self-esteem problems. Visually impaired people should be encouraged to socialise outside of their families and participate in social activities. This can be integrated in rehabilitation process as a part of everyday homework.

Purpose: Low vision rehabilitation (LVR) is a pertinent context for integrating early, evidence-based psychological interventions given the high prevalence of untreated depression in adults with vision impairment. This study aims to identify the perceived barriers and facilitators to staff-delivered telephone-based problem-solving treatment for primary care (PST-PC) offered as an integrated component of LVR., Methods: Qualitative semi-structured interviews, developed using the theoretical domains framework (TDF) and Consolidated Framework for Implementation Research (CFIR), were conducted with 21 LVR professionals and a clinical psychologist involved in the delivery of PST-PC. Barriers and facilitators at the practitioner, client, intervention, and organizational level were identified with thematic analysis using a "theoretical" approach., Results: Prominent barriers were a lack of role recognition for PST-PC practitioners (n = 32), unmet client expectation with PST-PC (n = 28), dissatisfaction with telephone delivery (n = 27), and limited organizational awareness of PST-PC (n = 39). Facilitating factors included a recognized need for evidence-based psychological services (n = 28), clients experiencing benefits in early sessions (n = 38), PST-PC promoting practical skills (n = 26), and comprehensive PST-PC training (n = 36)., Conclusions: PST-PC may provide an accessible early intervention for LVR clients with depressive symptoms. Ongoing practitioner training, clinical support, and screening potential LVR clients for treatment suitability are likely to enhance delivery in this setting. Implications for rehabilitation Depression is highly prevalent in adults engaged in low vision rehabilitation (LVR) programs, yet few receive support. Clinical guidelines recommend integrated models of care be offered within rehabilitation settings as early intervention for mild to moderate levels of depressive symptoms. Integrated telephone-based problem-solving treatment for primary care (PST-PC) delivered by trained LVR practitioners is a practical, skills-based model that has potential to increase access to an early psychological intervention in LVR clients with depressive symptoms. LVR clients are often older in age, have multiple comorbid health conditions and a significant level of functional disability, requiring flexibility in the delivery of PST-PC and specialized staff training, and support in working with older and more complex clients.

Purpose: Adaptation to blindness can lead to the enhancement of the attentional capacities and working memory in young people. However, although the effects of ageing on the cognition of sighted people and people with age-related visual impairments are well-documented, no study seems to have investigated the age-related changes of these cognitive processes in people who are blind. The aim of this study was to assess the effects of age on the attentional processes and working memory in blind people., Method: A cross-sectional study was conducted on 43 blind participants and 42 sighted participants. The participants performed auditory computerized tests assessing selective, sustained and divided attention, attentional switching, and working memory., Results: Two-way analysis of variance revealed significant visual status effect and age effect on most of the variables studied. No interaction was found between visual status and age effects., Conclusions: These results suggest that the trajectories of cognitive age-related change are similar in blind people and in sighted people. This study has implications for rehabilitation, such as cognitive intervention. Implications for Rehabilitation Blind people show improved attentional capacities compared to sighted people, even in old blind people. Old blind people have lower performances than younger blind people in tests assessing selective, sustained and divided attention, and working memory. Cognitive approaches to rehabilitation may help people who are blind to deal with age-related cognitive decline and its effects on everyday functioning. A high level of cognitive stimulation, provided by a cognitive training or a developed social participation, might reduce the age-related effects in people who are blind.

Purpose: To explore the types of risks and hazards that visually impaired individuals face, how they manage potential threats and how reactions to traumatic events are manifested and coped with., Method: Participants were 17 visually impaired individuals who had experienced some kind of potentially traumatic event. Two focus groups and 13 individual interviews were conducted., Results: The participants experienced a variety of hazards and potential threats in their daily life. Fear of daily accidents was more pronounced than fear of disasters. Some participants reported avoiding help-seeking in unsafe situations due to shame at not being able to cope. The ability to be independent was highlighted. Traumatic events were re-experienced through a variety of sense modalities. Fear of labelling and avoidance of potential risks were recurring topics, and the risks of social withdrawal and isolation were addressed., Conclusions: Visual impairment causes a need for predictability and adequate information to increase and prepare for coping and self-efficacy. The results from this study call for greater emphasis on universal design in order to ensure safety and predictability. Fear of being labelled may inhibit people from using assistive devices and adequate coping strategies and seeking professional help in the aftermath of a trauma. Implications for Rehabilitation Visual impairment entails a greater susceptibility to a variety of hazards and potential threats in daily life. This calls for a greater emphasis on universal design in public spaces to ensure confidence and safety. Visual impairment implies a need for predictability and adequate information to prepare for coping and self-efficacy. Rehabilitation professionals should be aware of the need for independence and self-reliance, the possible fear of labelling, avoidance of help-seeking or reluctance to use assistive devices. In rehabilitation after accidents or potential traumatizing events, professionals' knowledge about the needs for information, training and predictability is crucial. The possibility of social withdrawal or isolation should be considered.

Purpose: To pilot test the newly developed multidisciplinary group rehabilitation programme Visually Impaired elderly Persons Participating (VIPP)., Method: A single group pretest-posttest design pilot study included 29 visually impaired persons (≥ 55 years). The intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counselling and training of problem-solving skills; individual and group goal setting; home-based exercise programme). Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) and the Impact on Participation and Autonomy (IPA) questionnaire at baseline, immediately and 6 months after the intervention., Results: At scale level, no statistical significant changes over time were found whereas the effect size indicated small effects for restrictions and satisfaction with participation, and a medium effect for autonomy outdoors. At item level, improvements tended to occur in frequency of housekeeping, in restrictions in housekeeping and outdoor activities and in satisfaction with the partner relationship. Satisfaction with leisure indoors and autonomy regarding using leisure time tended to increase as well., Conclusions: The tentative conclusion of this small-scale pilot study is that the VIPP programme modestly benefits perceived restrictions in participation, satisfaction with participation and autonomy outdoors of the visually impaired elderly. These preliminary findings warrant further investigation.

Purpose: To assess the degree of participation of the visually impaired elderly and to make a comparison with population-based reference data., Method: This cross-sectional study included visually impaired elderly persons (≥55 years; n = 173) who were referred to a low-vision rehabilitation centre. Based on the International Classification of Functioning, Disability and Health (ICF) participation in: (1) domestic life, (2) interpersonal interactions and relationships, (3) major life areas, and (4) community, social and civic life was assessed by means of telephone interviews. In addition, we assessed perceived participation restrictions., Results: Comparison with reference data of the elderly showed that visually impaired elderly persons participated less in heavy household activities, recreational activities and sports activities. No differences were found for the interpersonal interactions and relationships domain. Participants experienced restrictions in household activities (84%), socializing (53%), paid or voluntary work (92%), and leisure activities (88%)., Conclusions: Visually impaired elderly persons participate in society, but they participate less than their peers. They experience restrictions as a result of vision loss. These findings are relevant, since participation is an indicator for successful aging and has a positive influence on health and subjective well-being.

Purpose: This study represents, to our knowledge, the first examination of the joint influence of cognitive coping strategies and goal-related coping on depressive symptoms in people with severe visual impairments with the aim of finding targets for intervention., Method: In total, data of 67 individuals with visual impairments were assembled by telephone interviews. Depressive symptomatology, cognitive coping strategies, and goal-related coping processes were measured. Relationships between these variables were statistically analyzed by Pearson correlations and multiple regression analyses., Results: It was shown that a ruminative way of responding to visual impairments was related to more depressive symptoms among the study participants. In contrast, refocusing attention by seeking and re-engaging in alternative, meaningful goals was related to less depressive symptoms., Conclusions: On the basis of the results, it was concluded that both cognitive and goal-related coping could be important targets for intervention. Main components of treatment should include a combination of (1) teaching patients to decrease a ruminative way of thinking in response to their disabilities and (2) actively assisting patients in the search for and the re-engagement in new personal goals, when existing goals are obstructed by their impairments.