Open Access Study protocol

Effects and feasibility of a standardised orientation and mobility training in using an identification cane for older adults with low vision: design of a randomised controlled trial

GAR Zijlstra12*, GHMB van Rens3, EJA Scherder4, DM Brouwer56, J van der Velde7, PFJ Verstraten8 and GIJM Kempen12

Author Affiliations

1 Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, Maastricht, the Netherlands

2 CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD Maastricht, the Netherlands

3 VU University Medical Center, Department of Ophthalmology, and the Institute for Research in Extramural Medicine (EMGO), P.O. Box 7057, 1007 MB Amsterdam, the Netherlands

4 University of Groningen, Institute of Human Movement Sciences, P.O. Box 72, 9700 AB Groningen, and VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands

5 Bartiméus, Institute for the Blind and Visually Impaired, Oudenoord 325, 3513 EP Utrecht, the Netherlands

6 Rotterdam University of Applied Sciences, School of Healthcare Studies, Museumpark 40, 3015 CX Rotterdam, the Netherlands

7 Royal Visio, National Foundation for the Visually Impaired and Blind, P.O. Box 1180, 1270 BD Huizen, the Netherlands

8 Sensis – Organisation for Blind and Partially Sighted People, Department of Innovation and Expertise, P.O. Box 54, 5360 AB Grave, the Netherlands

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BMC Health Services Research 2009, 9:153  doi:10.1186/1472-6963-9-153

Published: 27 August 2009



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 Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised 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 randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision.


A parallel group randomised controlled trial was designed to compare the standardised 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.


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 standardised 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 NCT00946062