Educational interventions for the prevention of eye injuries New

Abstract

Abstract Background

Ocular injury is a preventable cause of blindness, yet it remains a significant disabling health problem that affects all age groups. Injuries may occur in the home, in the workplace, during recreational activities or as a result of road crashes. Types of injuries vary from closed globe (contusion or lamellar laceration) to an open globe injury, which includes penetration and even perforation of the globe. To date, the main strategy to prevent these injuries has been to educate people to identify high‐risk situations and to take correct action to avoid danger.

Objectives

To assess the evidence for the effectiveness of educational interventions for the prevention of eye injuries.

Search methods

We searched the Cochrane Injuries and the Cochrane Eyes & Vision Group Specialised Registers, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, Current Controlled Trials metaRegister (now includes National Research Register), AgeInfo, HMIC Health Management Information Consortium, WHOLIS (World Health Organization Library Information System), LILACS (Latin American and Caribbean Health Sciences), MEDCARIB (Caribbean Health Sciences Literature), ISI Web of Science: (Science Citation Index Expanded (SCI‐EXPANDED), Social Sciences Citation Index (SSCI) Conference Proceedings Citation Index‐Science (CPCI‐S)), ERIC, ZETOC and SPORTdiscus. We also checked reference lists of relevant papers and contacted study authors in an effort to identify published, unpublished and ongoing trials. Searches were last updated in August 2008.

Selection criteria

We included any randomised controlled trials (RCTs) and controlled before‐and‐after studies which evaluated any educational intervention aimed at preventing eye injuries.

Data collection and analysis

Four authors independently screened the electronic search results and data extracted. Three authors entered data into RevMan 5. As we judged there to be substantial heterogeneity between participants and interventions, we did not pool the studies' results, but have reviewed the results narratively.

Main results

We included two RCTs and three controlled before‐and‐after studies in this review. One study reported eye injuries as an outcome and four studies reported change in behaviour or knowledge.

Authors' conclusions

The included studies do not provide reliable evidence that educational interventions are effective in preventing eye injuries. There is a need for well‐conducted RCTs with adequate allocation concealment and masking (blinding). Studies should have a longer follow‐up time and more studies need to be conducted in low and middle‐income countries.

Author(s)

Anupa Shah, Karen Blackhall, Katharine Ker, Daksha Patel

Abstract

Plain language summary

Educational interventions for preventing eye injuries 

Eye injuries are a preventable cause of blindness, yet remain a significant disabling health problem that affects all age groups. Despite health and safety requirements and widespread legislation, injuries can still occur at home, in the workplace, during recreational activities or as a result of road crashes.

The authors of this review searched for randomised controlled trials and controlled before‐and‐after studies looking at the effectiveness of educational interventions, such as written materials, video or audio tapes, for the prevention of eye injuries. The authors found five studies involving different types of people, using various educational interventions and based in different countries, that met the inclusion criteria. Due to the low quality of the studies identified, the authors concluded that there is no reliable evidence that educational interventions are effective in preventing eye injuries.

The review authors recommend that further high quality randomised controlled trials, with longer follow‐up periods are conducted. More trials should be based in low and middle‐income countries in order to carry out a comparison with those in high‐income countries.

Author(s)

Anupa Shah, Karen Blackhall, Katharine Ker, Daksha Patel

Reviewer's Conclusions

Authors' conclusions

Implications for practice

This review found no evidence to support the idea that educational interventions help to prevent eye injuries. Although there is no evidence of harm, it fails to confirm whether educational interventions bring about a sustained decline in ocular injury rates and outcomes. One of the studies included in the review does show that educational interventions can bring about change in knowledge which leads to change in behaviour but it is unclear how this could translate to a change in injury rate or have a sustained effect on behaviour.

The review does highlight the variety of educational tools available, but their effectiveness and replicability for different population groups and environments is inconclusive. It is also not possible to conclude on the impact of educational effectiveness by age, gender, occupation or environment.

Implications for research

Future research in this area should concentrate on well‐conducted randomised trials with adequate allocation concealment and masking (blinding). Studies should have a longer follow‐up time to better understand the sustainability of behaviour change through an educational intervention. Exposure to risks varies by age, gender, profession and environmental safety factors and which must be evaluated before and after an intervention.

Appropriate studies need to be carried out in low and middle‐income countries where poor conditions/work environments and lack of appropriate legislation dictate a greater risk of injury. These studies must also evaluate the cost to individuals and the practical implications of employing interventions that aim to influence behaviour and prevent ocular injuries.

Studies should look at eye injury rates as the primary outcome. Secondary outcomes, such as behaviour changes and effectiveness of the educational tool, should be collected independently of those taking part. Statistically feasible methods (judgement analysis) and interrupted time series over several years could be applied.

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