Occupational therapists perceptions and understanding of vision assessment for adults with complex needs

Introduction: Vision is crucial to occupation and environmental adaptation. Literature reveals a poor understanding of the complexity of vision assessment for adults with complex needs, and limited detail on factors relating to occupational therapist’s decision making. This study aimed to explore occupational therapists’ perceptions and understanding of vision assessment for adult clients with complex needs, as well as the barriers and facilitators to this process.

Methodology: Using an Interpretive Phenomenological Analysis (IPA) approach, 7 occupational therapists were purposefully recruited from a set geographical area in England and participated in semi structured interviews. IPA guided the thematic analysis.

Findings: 3 themes were identified; Working with clients with complex needs, assessment methods, and factors affecting the process. Sub themes included the complexity of the client’s presentation, and how client’s deficits interconnect, affecting the clinical reasoning process. There was variation in approaches to vision assessment, with a preference for a top down functional approach, with some vigilance for visual function deficits. Findings revealed limited use of standardised assessments, and reliance on questioning clients about their visual difficulties. The value of a supportive interdisciplinary team was noted, but with little evidence of working with vision specialists. Most occupational therapists learnt through peer support. Challenging systems of work, concerns around continuity of care and environmental limitations, including the effect of remote working and isolation, were found to have an impact on the vision assessment process and professional development.

Conclusion: Occupational therapists need to adopt a multimodal approach to vision assessment. Standardised assessments and structured tools should guide effective interventions using appropriate clinical reasoning. Interdisciplinary learning could be enriched by using digital platforms and forums. Successful vision assessment for adults with complex needs would be enhanced by working with other relevant professionals. There are implications for occupational therapy practice in this specialist field.