In the Netherlands, more than 300,000 people live with a visual impairment. For those facing severe visual problems, Koninklijke Visio – Het Loo Erf in Apeldoorn offers an intensive rehabilitation program. Clients stay there several days a week to work on practical skills, psychological resilience, and overall well-being. While it was already known that this approach is effective, an important question remained: how can this progress best be measured?
This question was central to the VHLE study (Visio Het Loo Erf study), a collaborative project between Amsterdam UMC and Koninklijke Visio. The study explored how clients and healthcare professionals experience progress, which factors influence it, and how progress measurements can be applied in practice.
Progress across seven domains
Interviews with 19 (former) clients and 10 healthcare professionals revealed that progress takes place across seven interrelated domains:
- Mindset: learning to cope with the impairment, accepting changes, and developing a more positive outlook on the future.
- Knowledge and strategies: gaining insight into personal limits, energy management, and new ways of communicating.
- Practical skills: becoming more independent in mobility, self-care, and the use of assistive devices.
- Self-reliance: growing self-confidence and greater control over one’s own life.
- Social participation: remaining active in work, education, or leisure activities.
- Relationships: changing role patterns and support from family members and peers.
- Personal development: a stronger self-image and increased emotional insight.
What determines successful rehabilitation?
The researchers found that progress is influenced by several factors, including:
- Personal characteristics, such as age, energy levels, and cognitive abilities.
- Coping strategies: active, solution-oriented attitudes promote recovery.
- Social support from family and friends.
- Rehabilitation conditions: sufficient practice time, structure, and good coordination within the team.
- Quality of care: a strong relationship with healthcare professionals and needs-based guidance.
- Transition back home: attention to follow-up care and involving relatives helps prevent relapse.
The importance of measurement
Both clients and professionals view measuring progress as a valuable tool for better tailoring treatment to individual needs. A combination of quantitative and qualitative methods appears to be most effective: questionnaires provide reliable data, while conversations and self-reflection add meaning and context.
Ideally, these measurements take place at fixed moments—at the start, midway, at the end, and several months after the program. Measurement instruments should be accessible for people with visual impairments and integrated into existing care moments to minimize burden.
Towards more efficient rehabilitation
The VHLE study represents an important step toward more efficient visual rehabilitation in the Netherlands. Systematic measurement using patient-reported outcome measures (PROMs) makes it possible to better evaluate and improve programs. This not only contributes to more effective treatment, but also helps ensure that available resources are used more carefully.
“By actively involving clients themselves in measuring their progress, greater insight and a sense of ownership over their recovery are created,” the researchers state.
Publication
The full results of the study have been published in the Journal of Patient Reported Outcomes:
Van Munster, E.P.J., Schilderman, A.B.M., Van Nispen, R.M.A., Roelofs, A.A.J., Bootsma, A.M. & Van der Aa, H.P.A. (2025). Exploring patient-reported outcomes to assess progress in inpatient low vision rehabilitation.
Read the publication here.