1 Oxford Eye Hospital, Oxford,
² Vision Impairment Research Group, Heriot-Watt University, Edinburgh,
United Kingdom.
³ Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom

The initial stage of the low vision rehabilitation process is to identify goals and tasks that are both achievable and of value to the visually impaired person. In so doing, identifying goals that are realistic is often difficult both for the patient and the rehabilitation practitioner. These goals need to take account of both practical and psychosocial factors if a successful outcome of rehabilitation is to be achieved.

The objectives of the study were to evaluate the feasibility of eliciting value and difficulty associated with rehabilitation tasks and to determine the effectiveness of patient participation for identifying priorities using analytical decision analysis procedures for comparing alternative rehabilitation options.

This pilot study comprised a small sample of visually impaired people aged 60 years or over. All were attending a hospital low vision service.

Patients were asked to identify eight or more daily activities of personal relevance (i.e. "personal projects"), to which were added two "standard" target activities for their rehabilitation programme. The value and difficulty associated with these activities or tasks were then explored using the sixteen dimensions identified by Little (1983) as the key discriminators of a person’s lifestyle. As well as addressing a person’s affective response to different activities or tasks, this approach permits the assessment of a daily task within the context of a person’s lifestyle and is, therefore, likely to deliver a meaningful and relevant evaluation of priorities in daily activities.

The "personal projects" evaluations were then placed within the hierarchical activity breakdown structure model as proposed by Massof (1995). This model sets rehabilitation tasks within specific goals that are the components of a larger objective. Using the Massof model in conjunction with the analytical hierarchy process of decision analysis permitted an evaluation of rehabilitation priorities both within and between levels in the hierarchy. The task most appropriate to be addressed initially for rehabilitation is that with the maximum expected utility.

The results demonstrated that a hierarchical decision analytical approach to prioritising rehabilitation tasks and goals is an effective and efficient way of identifying both the physical, social and psychological needs of visually impaired people.