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The Development of Evidence-Based Classification of Vision Impairment in Judo: A Delphi Study.

ABSTRACT: Objective: Most para-sports group athletes into "classes" to compete against others with similar activity limitations. Judokas with vision impairment (VI) instead all compete in the same class irrespective of their level of impairment. There is considerable controversy whether this approach represents a legitimate way to structure judo competition. The aim of this study was to establish expert opinion on the requirements for an evidence-based classification system for VI judo. Methods: A panel of 18 athletes, coaches, and administrators participated in a three-round Delphi review process. Expert opinions were canvased for a large range of issues related to classification in judo. Between rounds, results were summarized and further questions were asked on topics where consensus was not reached across experts. Results: The panel expressed that: (i) blind and partially sighted athletes should not compete against each other in the same class; (ii) additional measures of visual function might be needed to accurately evaluate an athlete's impairment; (iii) the minimum impairment criteria (MIC) should represent a more severe level of impairment to ensure that all those included possess a level of VI that indeed decreases performance in judo; and (iv) legitimate competition could be undermined by some athletes intentionally underperforming on classification tests. The panel identified six additional measures of visual function which are not currently measured but are likely to impact judo performance, and six aspects of judo performance which are most likely impacted by VI. Conclusion: Experts in the field of VI judo expressed a need to change the manner in which VI judokas are classified. This study outlines a model for establishing the impairment-performance relationship and guides the development of evidence-based classification for VI judo.

SUBMITTER: Krabben KJ

PROVIDER: S-EPMC6384233 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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The Development of Evidence-Based Classification of Vision Impairment in Judo: A Delphi Study.

Krabben Kai J KJ Ravensbergen Rianne H J C RHJC Nakamoto Hiroki H Mann David L DL

Frontiers in psychology 20190215

<b>Objective:</b> Most para-sports group athletes into "classes" to compete against others with similar activity limitations. Judokas with vision impairment (VI) instead all compete in the same class irrespective of their level of impairment. There is considerable controversy whether this approach represents a legitimate way to structure judo competition. The aim of this study was to establish expert opinion on the requirements for an evidence-based classification system for VI judo. <b>Methods: ...[more]

PMID: 30828311

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Project description:The International Paralympic Committee requires their member sports to develop a classification system that is sport-specific, meaning that the specific 'class' in which an athlete competes should be suitable for the degree to which the athlete's impairment affects performance in that particular sport. However, swimmers with vision impairment (VI) currently compete in classes that were developed on the basis of legal definitions of blindness, failing to consider how vision impacts swimming performance. The aim of this study was to establish expert guidance on the specific requirements for a sport-specific system of classification for VI swimming. A three-round Delphi review was conducted with a panel of 16 people with expertise in VI swimming either as an athlete, coach, administrator, or scientist. There was clear consensus (86%) among the panel that the current classification system used for VI swimming fails to fulfill the aim of minimizing the impact of VI on the outcome of competition. Particularly, the panel agreed that there are a range of aspects of visual function (e.g., depth perception and contrast sensitivity) that are important for optimal swimming performance, yet are not assessed using the current classification system. The panel also identified nine performance components of a swimming race that are mostly likely to be affected by VI. Interestingly, these were spread across all four major segments (start, clean swim, turn, and finish), and weren't necessarily those performance determinants generally used by performance analysts and coaches. There was also strong agreement that the age at which VI is acquired will substantially impact the ability of a swimmer to reach their full potential in the pool. The main implication is that changes are required to the way that swimmers with VI are classified for para-sport competition. Clear guidance has been provided for how to further the development of an evidence-based classification system.

Project description:ObjectivesVisual impairment following stroke is common with a reported incidence of visual impairment in 60% of stroke survivors. Screening for visual impairment is neither routine nor standardised. This results in a health inequality where some stroke survivors receive comprehensive vision assessment to identify any existent visual problems while others receive no vision assessment leaving them with unmet needs from undiagnosed visual problems. The aim of this study was to define two core outcome sets (COS), one for vision screening and one for full visual assessment of stroke survivors.DesignA list of potentially relevant visual assessments was created from a review of the literature. The consensus process consisted of an online 3-round Delphi survey followed by a consensus meeting of the key stakeholders.ParticipantsStakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers.SettingUniversity.Outcome measuresCOS.ResultsFollowing the consensus process we recommend the following nine assessments for vision screening: case history, clinical observations of visual signs, visual acuity, eye alignment position, eye movement assessment, visual field assessment, visual neglect assessment, functional vision assessment and reading assessment. We recommend the following 11 assessments for full vision assessment: case history, observations, visual acuity, eye alignment position, eye movement assessment, binocular vision assessment, eye position measurement, visual field assessment, visual neglect assessment, functional vision assessment, reading assessment and quality of life questionnaires.ConclusionsCOS are defined for vision screening and full vision assessment for stroke survivors. There is potential for their use in reducing heterogeneity in routine clinical practice and for improving standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and for further exploration of core outcome measures.

Project description:PurposeThe purpose of this study was to design and evaluate an instrument for assessing vision-related quality of life appropriate for the specific visual impairment characteristic for all stages of age-related macular degeneration (AMD), with a focus on the low luminance deficit in early/intermediate stages.MethodsA standardized questionnaire was developed in three steps with participants with early, intermediate, and late AMD: (1) based on in-depth interviews (n = 19) and two focus group discussions (n = 5 each), content was developed followed by 2. (2) The questionnaire development using cognitive debriefing interviews (n = 3) and leading to a preliminary version of the questionnaire. (3) This version was then administered to 127 participants with early, intermediate, and late AMD. Psychometric properties, such as response category functioning (floor and ceiling effects) and targeting of item difficulty to patient ability of the pilot Vision Impairment in Low Luminance (VILL) questionnaire were evaluated using Rasch analysis.ResultsThe preliminary VILL questionnaire consisted of 68 items with a 5-step response scale. Several items were removed based on floor/ceiling effects or misfit and a final pool of 37 items remained. The response scale was collapsed to four categories as one category was underutilized. The targeting of the instrument was good with minimal difference in person and item means (0.52 logits). Precision was also good with a person separation index of 3.55 and reliability of 0.93. There was evidence of multidimensionality (eigenvalue of the first contrast = 5.95) in the scale, which could be resolved by splitting the items into subscales including a reading, mobility, and emotional well-being subscale.ConclusionsIndividuals with AMD report difficulties with vision-related activities and functioning under visually challenging conditions at all stages of the disease. These aspects were considered when developing the 37-item VILL, which demonstrates promising psychometric characteristics. Further assessments of reliability and validity are warranted.Translational relevanceThe VILL questionnaire is a new patient-reported outcome (PRO) measure developed for future use in AMD studies.

Project description:Providing quality cardiovascular disease (CVD) care in low resource setting requires understanding of priority and effective interventions. This study aimed to identify and prioritize evidence-based quality improvement strategies for CVD care in India using a modified two-round Delphi process in which, we asked 46 experts (clinicians, researchers, program implementers and policy makers) to rate 25 proven CVD care strategies grouped into: (1) patient support, (2) information communication technology (ICT) for health, (3) group problem solving, (4) training, and (5) multicomponent strategy on a scale of 1 (highest/best)-5 (lowest/worst) on priority, relative advantage, and feasibility. Subsequently, we convened an expert consensus panel of 32 members to deliberate and achieve consensus regarding the prioritized set of strategies for CVD care. The Delphi study found that group problem solving strategies achieved the best score for priority (1.80) but fared poorly on feasibility (2.88). Compared to others, multicomponent strategies were rated favorably across all domains (priority = 1.84, relative advantage = 1.94, and feasibility = 2.40). The ICT for health strategies achieved the worst scores for priority = 2.01, relative advantage = 2.31, and feasibility = 2.85. Training and patient support strategies scored moderately across all domains. The expert panel narrowed the selection of a multicomponent strategy consisting of (1) electronic health records with clinical decision-support system, (2) non-physician health worker facilitated care, (3) patient education materials, (4) text-message based reminders for healthy lifestyle, and (5) audit and feedback report for providers. Future research will evaluate the real-world feasibility and effectiveness of the multicomponent strategy in patients with CVD in a low- and middle-income country setting.Supplementary informationThe online version contains supplementary material available at 10.1007/s43477-023-00087-2.

Project description:BackgroundFace-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease. However, these programs have low participation rates, especially among patients who live rural or remote. Hence, there is a need to develop OCR programs that provide an alternative to face-to-face contact such as by using the Internet. Only a very limited number of Internet-based OCR programs have been developed and evaluated. Therefore, the purpose of this study was to identify issues that are relevant to the development of an Internet-based OCR intervention.MethodsA three-round Delphi study among cardiac rehabilitation experts was conducted. In the first round, 43 experts outlined opinions they had on the development of an online ORC platform into an open-ended electronic questionnaire. In the second round, 42 experts completed a structured (five-point scale) electronic questionnaire based on first round results, in which they scored items on their relevance. In the third round, the same experts were asked to re-rate the same items after feedback was given about the group median relevance score to establish a level of consensus.ResultsAfter the third round, high consensus was reached in 120 of 162 (74%) questionnaire items, of which 93 (57% of 162 items) also had high relevance according to the experts. The results indicate that experts strongly agreed on desired website content, data obtained from the patient, and level of interaction with patients that should be part of an Internet-based OCR intervention.ConclusionThe high rates of consensus and relevance observed among cardiac rehabilitation experts are an indication that they perceived the development and implementation of an Internet-based ORC intervention as feasible, and as a valuable alternative to face-to-face programs. In many ways the experts indicated that an Internet-based ORC program should mimic a traditional face-to-face program, and emphasize the crucial role of the cardiac rehabilitation manager who interacts with patients from a distance. The present study revealed practical insights into how Internet OCR interventions should be designed and opens the door for the development of such an intervention to be subsequently examined in a longitudinal and experimental study.

Dataset Information

The Development of Evidence-Based Classification of Vision Impairment in Judo: A Delphi Study.

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The Development of Evidence-Based Classification of Vision Impairment in Judo: A Delphi Study.

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