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Melbourne Low-Vision ADL Index

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Purpose

The Melbourne Low-Vision ADL Index (MLVAI) is a desk based assessment comprising 16 observed items on complex ADLs in part (a) and 9 self-reported questions on broad self-care ADLs in part (b). MLVAI is designed to be administered under standardized conditions for the purpose of assessing an individual’s ability to perform ADLs with low vision.

Acronym MLVAI

Area of Assessment

Activities of Daily Living
Life Participation
Quality of Life
Self-efficacy

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

CDE Status

Not a CDE -- last searched 7/8/2023.

Populations

Sensory Disorders

Key Descriptions

  • Composed of 25 standardized items that are divided into two sections.
    ○ Part (A) comprises of 16 observed items on complex ADLs
    ○ Part (B) comprises of 9 questions on broad self-care ADLs
  • In part A, the clinician observes and grades a person’s performance as they engage in 16 instrumental activities of daily living (ADLs), such as writing a check, reading an account, or using the telephone.
  • In part B, the person completes a 9-item questionnaire pertaining to their perceived ability to engage in ADLs such as preparing meals, shopping, doing housework, and grooming.
  • Each item of the MLVAI is rated on a 5-level descriptive scale from 0 to 4.
  • The total score is derived by summing each item with a maximum possible score of 100 with higher scores suggesting more impairment.
    ○ Maximum possible scores are 64 for part A
    ○ Maximum possible scores are 36 for part B

Number of Items

Total of 25 items:
● Part (a) comprises of 16 observed items on complex ADLs
● Part (b) comprises of 9 questions on broad self-care ADLs

Equipment Required

  • Standard illumination conditions of 240 lux
  • Tape measure (to ensure client is performing items at specific distance)
  • Habitual spectacles
  • All instructions, items, and score sheets are kept in an A4 ring binder, which is stored in a portable plastic container along with objects required for some of the items.
  • Desk

Time to Administer

20 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Ander Lyon, Carissa Mathison, Kiyomi Mozley, Stephanie Lam, and Tiffani Teng (Master of Occupational Therapy students) and Danbi Lee, PhD, OTD, OTR/L (faculty mentor), Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA

Body Part

Head

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living
Sensory

Professional Association Recommendation

None found -- last searched 7/8/2023.

Considerations

Available in English and Canadian-French.

A Weighted Melbourne Low-Vision ADL Index (Haymes et al., 2001b) is available and measures disability impact by weighting each item by the importance of that item to the person being tested.

Using Rasch modeling, researchers found that clinical measures of vision were more strongly correlated with observed task performance (part a) than with the self-reported items (part b). (Ehrlich 2016).

All results indicated a difference between part (a) and part (b) of the assessment so the author suggest that the total score for the MLVAI should be interpreted with caution. They suggest that it would be clearest to consider the scores for part (a) and part (b) separately (Haymes, 2001a).

Sensory Disorders

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Standard Error of Measurement (SEM)

Low Vision: (Haymes et al., 2001a; n = 122, mean age = 70 (16) years, central vision loss n = 85, peripheral vision loss n = 20, combined causes n = 15, media opacities only n = 4, uncertain n = 2)

  • SEM for entire group (n = 122): 4.5

 

Low Vision: (Haymes et al., 2001b; n = 97, mean age = 71 (16) years, various causes of vision impairment; weighted version of MLVAI)

  • SEM for entire group (n = 97):  24.7 

 

Vision Impairment: (Duquette et al., 2020; n = 100, mean age = 71 (14) years; Canadian French translation)

Part A*

Performance: SEM = 1.09

Importance: SEM = 1.86

Handicap: SEM = 6.09

Part B

Performance: SEM= 0.77

Importance: SEM= 1.31

Handicap: SEM= 2.78

Total

Performance: SEM= 1.29

Importance: SEM= 2.29

Handicap: SEM= 6.32

*Calculated with original scale from 0 to 16

Minimal Detectable Change (MDC)

Low Vision: (Haymes et al., 2001a)

  • MDC: 12.47 (Calculated from Haymes et al., 2001a)

Minimally Clinically Important Difference (MCID)

Vision Impairment: (Duquette et. al, 2020; based on clinical judgment and from a reached consensus of the researchers and low-vision therapists)

  • MCID of the performance rating: >1 point
  • MCID for the Importance dimension: >1 point.
  • MCID for the Handicap score: >4 points

Normative Data

Low Vision: (Haymes et al., 2001a)

  • Mean (SD) of total raw score = 63.9 (19.5).

Low Vision: (Haymes et al., 2001b; weighted version of MLVAI)

Mean (SD) ability ratings, importance ratings, and disability impact scores for the Weighted Melbourne Low-Vision ADL Index

Item No.

Ability Rating

Importance Rating

Disability

Impact Score

Part (a) total

35.3 (16.2)

49.4 (10.0)

83.3 (52.9)

Part (b) total

27.8 (4.8)

32.2 (4.4)

28.9 (17.7)

Total score

63.0 (19.8)

81.6 (13.2)

(67.2)

 

Low Vision: (Haymes et al., 2002; n = 120, mean age = 70 (16) years, vision impaired (57% due to age-related macular degeneration) 

  • Mean (SD) of total score = 64.4 (19.3)
  • Mean (SD) of part (a) score = 36.3 (15.9)
  • Mean (SD) of part (b) score = 28.1 (4.2)

Test/Retest Reliability

Low Vision: (Haymes et al., 2001a; median (IQR) duration between the two sessions = 2 weeks (1.5 and 3 weeks)) 

  • Excellent test-retest reliability (ICC = 0.95)

 

Vision Impairment: (Duquette, 2020; mean interval = 15.4 (4.7) days)

  • Excellent test-retest reliability (ICC values ranged from 0.80 to 0.92)

Interrater/Intrarater Reliability

Low Vision: (Haymes et al., 2001a)

  • Adequate to Excellent inter-rater reliability (six pairs of practitioners): r >= 0.90 for five pairs and r = 0.68 for one pair
  • Excellent intra-rater reliability (15 occupational therapists): ICC = 0.97

                                                           

Low Vision: (Haymes et al., 2001b)

  • Excellent inter-rater reliability: ICC = 0.88

 

Age-Related Macular Disease: (Smith et al., 2005; n = 225, median age = 81 years,

  • Excellent: Intraclass correlation coefficients across all items = mean, 0.97; range, 0.85-1.00

 

Vision Impairment: (Duquette et al., 2020; each pair of low vision therapists rated 11-12 subjects)

  • Excellent inter-rater reliability for the 9 composite scores (ICC=0.96 to 1.00).

 

Internal Consistency

Low Vision: (Haymes et al., 2001a) 

  • Excellent: Cronbach’s alpha = 0.96*

 

Low Vision: (Haymes et al., 2001b)

  • Excellent: Cronbach’s alpha = 0.94*

 

Vision Impairment: (Duquette et al., 2020)

  • Excellent internal consistency for part (a) (Cronbach’s alpha = 0.80-0.84)
  • Adequate internal consistency for part (b) (Cronbach’s alpha = 0.71-0.79)
  • Excellent internal consistency for the total test (Cronbach’s alpha = 0.82-0.88)

*Scores higher than .9 may indicate redundancy in the scale questions.

Construct Validity

Low Vision: (Haymes et al., 2001a)

  • Excellent construct validity between visual acuity with complex IADLS (r = - 0.80)
  • Adequate construct validity between visual acuity and basic self-care tasks (r = -0.49)
  • Excellent construct validity between the test score and level of vision impairment (r = -0.68)
  • Construct validity supported: scores of people with central vision impairment and peripheral vision impairment were significantly different (p = 0.02)

Vision Impairment: (Duquette et al., 2020)

  • Excellent construct validity between total test and contrast sensitivity (r = -0.66)
  • Adequate construct validity between Performance and Handicap total test scores and age, Contrast Sensitivity, Visual Acuity, Visual Field Score, Functional Acuity Score, Functional Field Score, and Functional Vision Score (r = -0.31 to -0.57)

Content Validity

Using Rasch analysis, content validity was demonstrated by good separation indexes (4.70 and 9.88) and high reliability scores (0.96 and 0.99) for the person and items parameters, respectively..However, the difference between parts (a) and (b) was again evident, with the separation index indicating greater content validity for part (a) than for part (b) (Haymes et al., 2001a).

“First, we evaluated vision-related ADL instruments. Second, we evaluated ADL instruments used to assess the aged, because several instruments in this area have been extensively researched and have gained wide acceptance. We considered the frequency with which various ADLs appeared as items on these ADL instruments and whether they were consistent with research on the daily living problems reported by people with vision impairment.” (Haymes et al., 2001a)

Floor/Ceiling Effects

Low Vision: (Haymes et al., 2001a)

  • Adequate ceiling effects: part (a) <10%; part (b) <20% and total scores <5%

Responsiveness

Low Vision: (Haymes et al., 2001c)

  • Large Change: effect size = 0.78

Bibliography

Duquette, J., Loiselle, J., Fréchette, C., Déry, L., Senécal, M., Wittich, W., & Wanet-Defalque, M. (2020). Reliability and validity of the Canadian–French ecological adaptation of the weighted version of the Melbourne Low-Vision ADL Index. Disability and Rehabilitation, 42(7), 1021-1030, DOI: 10.1080/09638288.2018.1516813

Ehrlich, J. R., Spaeth, G. L., Carlozzi, N. E., & Lee, P. P. (2016). Patient-centered outcome measures to assess functioning in randomized controlled trials of low-vision rehabilitation: A review. The Patient - Patient-Centered Outcomes Research, 10(1), 39–49. https://doi.org/10.1007/s40271-016-0189-5

Smith, H. J. (2005). A randomized controlled trial to determine the effectiveness of prism spectacles for patients with age-related macular degeneration. Archives of Ophthalmology, 123(8), 1042. https://doi.org/10.1001/archopht.123.8.1042

Haymes, S. A., Johnston, A. W., & Heyes, A. D. (2002). Relationship between vision impairment and ability to perform activities of daily living. Ophthalmic and Physiological Optics, 22(2), 79–91. https://doi.org/10.1046/j.1475-1313.2002.00016.x

Haymes, S. A., Johnston, A. W., & Heyes, A. D. (2001a). The development of the Melbourne Low-Vision ADL Index: A measure of vision disability. Investigative Ophthalmology & Visual Science, 42(6). https://doi.org/iovs.arvojournals.org

Haymes, S. A., Johnston, A. W., & Heyes, A. D. (2001b). A weighted version of the Melbourne Low-Vision ADL Index: A measure of disability impact. Optometry and Vision Science, 78(8), 565–579. https://doi.org/10.1097/00006324-200108000-00008

Haymes, S. A., Johnston, A. W., & Heyes, A. D.  (2001c). Preliminary investigation of the responsiveness of the Melbourne Low Vision ADL Index to low-vision rehabilitation. Optometry and Vision Science, 78(6), 373–380. https://doi.org/10.1097/00006324-200106000-00008