Musculoskeletal Complaints in Visually Impaired Rehabilitation Patients: An Exploratory Cross-Sectional Study

Musculoskeletal Complaints in Visually Impaired Rehabilitation Patients: An Exploratory Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Musculoskeletal Complaints in Visually Impaired Rehabilitation Patients: An Exploratory Cross-Sectional Study Bernd Brechtelsbauerᵃ, Oliver Kolbeᵇ, Dino Capovillaᶜ, Kathleen S. Kunertᵇ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8858798/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 16 You are reading this latest preprint version Abstract Background: A physiotherapy test battery was implemented at admission to inpatient ophthalmologic rehabilitation to screen musculoskeletal complaints in relation to visual impairment (VI). Aim: To investigate whether onset/duration and type of VI influence musculoskeletal complaints in visually impaired patients. Methods: Exploratory cross-sectional study of 80 participants (median age 58 years; 43 women, 37 men). Outcomes included neck pain (NRS), neck disability (NDI), cervical motor control, fear of falling (FES-I), balance (FABS), and vision-related quality of life (NEI VFQ-25C). Associations were analyzed by VI duration (Group I 3 years; Group III 1–3 years) and VI type (unilateral; unilateral blindness; bilateral; bilateral blindness; other; not classifiable). Results: Acute neck pain was reported by 71.3% (NRS 4.6/10, SD 1.7; NDI 13.5/50, SD 6.0). Participants performed a mean of 2.3/4 motor control tests incorrectly (SD 1.1). Fear of falling was moderate (FES-I 24.8/64, SD 7.7), balance performance was high (FABS 33.2/40, SD 3.6), and NEI VFQ-25C averaged 0.65 logits (SD 1.91). Higher fear of falling was associated with longer-lasting VI (f = 0.31; χ² = 8.94; p = 0.01) and with more severe VI types (f = 0.41; χ² = 10.82; p = 0.03). Conclusion: Routine assessment captures frequent neck pain and impaired cervical motor control in this population. Findings suggest a trend toward greater musculoskeletal complaints with increasing VI severity Registration Details German Clinical Trials Registration-Number: DRKS00035125, registerd on 30.09.2024 Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Signs and symptoms Vision-related Quality of life Visual impairment musculoskeletal complaints neck pain balance Figures Figure 1 Figure 2 Figure 3 Introduction Visual impairment (VI) and blindness are associated with substantial psychological distress, high disability rates, and various comorbid conditions. According to the German Federal Statistical Office, 328,680 individuals were registered in the 2023 severe disability statistics under the category "blindness and visual impairment" (63,425 blind, 41,245 severely visually impaired, and 224,015 visually impaired persons) [ 1 ]. However, the actual number of people suffering from a visual impairment is likely to be much higher, as the statistics only record those who have been classified as severely disabled (degree of disability ≥ 50%). Unilateral and less severe visual impairments are not included in the statistics, even though they can already result in significant limitations in activities of daily living and social participation for those affected—a discrepancy that does not align with the UN Convention on the Rights of Persons with Disabilities (UN-CRPD), which defines disability based on participation barriers rather than severity thresholds. Even mild visual impairments threaten social position and frequently lead to unemployment or employment in low-skilled or poorly paid occupations. The UK Biobank Study demonstrated that impaired vision across the full spectrum—including near-normal vision—is independently associated with adverse social outcomes. Individuals with vision at the legal threshold for driving showed increased risk of unemployment (risk ratio 1.55), lower-status employment (risk ratio 1.24), and mental health problems (risk ratio 1.12) [ 2 ]. This care gap has far-reaching societal and economic consequences: in Europe, productivity losses from approximately 11 million people with visual impairments result in annual costs between 26 and 57 billion euros over 50 years, while substantial untapped workforce potential remains [ 3 ]. Despite the high prevalence and impact of visual impairment, the musculoskeletal dimension in this patient population has received insufficient scientific attention. The literature points to an increased incidence of shoulder and neck complaints in patients with age-related macular degeneration [ 4 ], as well as associations between visual strain and the development of neck pain [ 5 ]. Ocular symptoms such as redness, dryness, itching, or grittiness are also linked to neck pain [ 6 ]. Moreover, there is an interaction between visual strain and the EMG activity of the descending part of the trapezius muscle, whereby deviations in refractive lighting conditions increase muscular activity [ 7 ]. On a psychosocial level, ophthalmic patients frequently experience risk factors that may promote the chronification of neck pain, including stress [ 8 ], anxiety [ 9 ], depression [ 10 ], sleep disturbances [ 8 ], loneliness [ 11 ], lack of social support [ 12 ], and unhealthy dietary habits [ 13 ]. Additionally, both children [ 14 ] and adults [ 15 ] with visual impairments demonstrate reduced balance ability compared to sighted individuals. They are more frequently affected by falls [ 16 ], which more often result in serious consequences such as hip fractures [ 17 ]. The aim of the present study is to investigate the relevance of cervical spine complaints and balance related impairments in individuals with visual impairment, considering both the duration and type of visual impairment. Methods The present study was designed as an exploratory, monocentric cross-sectional study and was conducted at the Henneberg Rehabilitation Clinic for Ophthalmology (Masserberg, Germany) in March 2023. All participants provided written informed consent; the study complied with the Declaration of Helsinki and was approved by the Ethic Commite of the University of Applied Sciences Osnabrück (Germany; wiso_MS-MT _HP-SS-23-02). In- & Exclusion Criterias Inclusion criteria, besides inpatient treatment with a primary ophthalmological referral diagnosis, are only age over 18 and willingness to participate. Exclusion criteria include a history of cervical spine surgery, systemic diseases (multiple sclerosis, amyotrophic lateral sclerosis, rheumatoid arthritis, ankylosing spondylitis, etc.), vertigo, tinnitus, temporomandibular joint dysfunction, combined visual and hearing impairments, and insufficient German language skills. Measurement Instruments To assess the intensity of neck pain and functional limitations of the cervical spine, the Numeric Rating Scale (NRS; 0 = no pain, 10 = maximum pain) and the Neck Disability Index (NDI; 0–4 = no disability, 5–14 = mild, 15–24 = moderate, 25–34 = severe, 35–50 = complete disability) were used [ 18 ]. Fear of falling was measured using the Falls Efficacy Scale International (FES-I; 16–19 = no concern about falling, 20–27 = moderate concern, 28–64 = high concern) [ 19 ]. Balance ability was quantified using the Fullerton Advanced Balance Scale (FABS; 0 = poorest score, 40 = best score, < 22 = increased fall risk) [ 20 ]. Motor control was assessed using a brief screening consisting of four cervical motor tasks [ 21 ]: transverse head protraction and retraction, deep cervical extension, isolated rotation in quadruped position, and an eye-head coordination task. Vision-related quality of life was assessed using validate German version of the National Eye Institute Visual Function Questionnaire NEI VFQ [ 22 ], raw data was Rasch-calibrated to the NEI VFQ-25C according to 23 [ 23 ]. MCID thresholds were additionally calculated as described in the statistical analysis. Group Classification To investigate the multidimensional impact of visual impairment on musculoskeletal and balance-related outcomes, participants were classified according to two clinically relevant dimensions: duration of visual impairment and type and laterality of impairment. Participants were grouped by the duration of visual impairment (Group 1: 3 years; Group 3: between 1–3 Years) to examine potential adaptation and chronification processes. This temporal classification is grounded in the understanding that musculoskeletal complaints and balance impairments may evolve over time as individuals develop compensatory strategies or, conversely, experience progressive deconditioning. Recent visual impairment may be associated with acute postural adaptations and increased fall risk due to lack of compensatory mechanisms, while longer duration may reflect either successful adaptation or chronic musculoskeletal overload from sustained compensatory postures. Additionally, the duration of impairment may influence psychosocial factors such as depression and social isolation, which are known risk factors for chronic pain. A deviation from the standard WHO classification regarding the severity of visual disability was necessary because the rehabilitation population could not be consistently categorized within it. The WHO classification focuses predominantly on bilateral impairments based on the better-seeing eye, thereby systematically excluding individuals with unilateral visual impairment or blindness, despite evidence that even monocular impairment causes significant limitations in activities of daily living, social participation, and occupational function. For these reasons, a multidimensional, consensus-based classification of visual impairment was developed that accounts for both laterality (unilateral vs. bilateral) and functional severity, as follows: I. Unilateral visual impairment (visual acuity between .05 and .3 [WHO grades 1–2]; visual field 10°–20°; Other Eye: V > .3 and Visual Field > 20°) II. Unilateral blindness (visual acuity < .05 [WHO grades 3–5]; visual field .3 and Visual Field > 20°) III. Bilateral visual impairment (visual acuity .05 – .3; visual field 10°–20°) IV. Bilateral blindness (visual acuity < .05; visual field .3; visual field > 20°) VI. Not classifiable (unclear, non-reproducible functional impairments; non-organic visual field deficits; developmental delays; cognitive impairments; non-organic blindness; Posttraumatic Stress Disorder; psychogenic disorders; fibromyalgia, etc.) Participants In March 2023 a total of 80 rehabilitation patients (37 male, 43 female) aged between 27 and 78 years (median 58 years) were recruited. Twenty-six participants had acquired their visual impairment within the past year, 13 within the last 1–3 years, and 41 more than three years ago. The study used a convenience sample. All eligible patients admitted during the recruitment period were invited to participate; no a priori sample size calculation was performed because the study was exploratory. In 52 of the 80 participants, the type of visual impairment could be determined: 10 had unilateral visual impairment, 12 unilateral blindness, 7 bilateral visual impairment, 7 bilateral blindness, and 16 had other visual disorders. For the remaining 28 participants, classification was not possible due to incomplete visual function data. Not all participants had complete ophthalmological assessments available from the department, including missing visual acuity measurements, visual field testing, or laterality information necessary for definitive classification. Statistical Analysis After data collection, tests for homogeneity of variance and normal distribution were performed with respect to the outcome criteria, duration, and type of visual impairment. The NRS, NDI, FES-I, FABS, and MC CS criteria predominantly showed heterogeneity of variance and deviations from normal distribution. Significance testing was performed using the Kruskal-Wallis test as a non-parametric test, with effect size measures reported as f = √(η²H / (1 − η²H)); f ≈ .10/.25/.40 indicating small/medium/large effects. For better comparability with other studies, the data are reported as both mean with standard deviation and median with interquartile ranges. For pairwise post-hoc comparisons, Dunn–Bonferroni tests were used. We report adjusted p-values and effect size r (r = |z|/√n; r ≈ .10/.30/.50 indicating small/medium/large effects). The Rasch-transformed NEI VFQ-25C logits were parametrically tested using ANOVA and reported with the effect size measure η² (> .01 = small effect, > .06 = medium effect, > .14 = large effect). Regarding vision-related quality of life, Goldstein notes that the MCIDs should be considered arbitrarily as a function of distance from the zero point, as well as the value of the standard error. Goldstein refers to MCID thresholds between individuals and not to means. The MCIDs for vision-related quality of life of the subgroups to be compared were calculated using the formula: MCID = 1.96 * √ (Standard error (SE)1²/n1 + SE2²/n2), where SE1 is the mean standard error of the reference group and SE2 is the mean standard error of the subgroup being compared. Correlations are reported with the sample size, significance level, and Pearson or Spearman correlation coefficient, depending on the data scaling. The level of significance was set at p ≤ .05. All analyses were performed using SPSS (version 27.0.0). Incomplete datasets were not excluded; instead, the applicable sample size for each analysis is reported Results Descriptive data All descriptive data are presented in Table 1 . Fifty-seven participants (71.3%) reported experiencing neck pain at the time of assessment. Among them, 50 (87.7%) reported chronic pain, 2 subacute pain, and 5 acute pain. These 57 individuals reported a mean score of 4.7 (SD = 1.7) on the Numeric Pain Rating Scale and 13.5 (SD = 6.0) on the Neck Disability Index. Regarding motor control, 5.3% of these participants performed 0 out of 4 motor control tasks incorrectly, 12.3% performed 1/4 incorrectly, 29.8% 2/4, 40.4% 3/4, and 12.3% 4/4. Across the total sample of 80 participants, the mean FES-I score was 24.8 (SD = 7.7), and the mean score on the Fullerton Advanced Balance Scale was 33.2 (SD = 3.6). Vision-related quality of life on the NEI VFQ-25C logit showed mean scores from .65 (SD = 1.91) on the Composit score, .67 (SD = 2.22) on the Visual Function and .27 (SD = 1.86) on the Social-Emotional subscale. Table 1 Descriptive statistics (Means, standard deviation (SD), Median & interquartil range (IQR) of neck pain (NP) and neck disability, fear of falling, balance ability and vision related quality of life); NRS = Numeric Rating Scale; NDI = Neck Disability Index; MC CS = Motor Control Cervical Spine; FES-I = Falls Efficacy Scale International; FABS = Fullerton Advanced Balance Scale, NEI VFQ-25C = Composit Score, NEI VFQ-VF = Visual Function, NEI VFQ-SE = Social-emotional). n Mean SD Median IQR NP Yes 57 (71.3%) - - - - NP No 23 (28.8%) - - - - Duration of Symptoms - - - - No Symptoms 24 (30%) - - - - 6 Months 50 (62.5%) - - - - NRS 80 3.33 2.59 4.00 5.00 NP Yes 57 (71.3%) 4.57 1.71 4.00 3.00 NP No 23 (28.8%) - - - - NDI 76 10.68 7.09 10.00 10.75 NP Yes 13.54 6.01 12.50 8.25 NP No - - - - MC CS - - - - 0 / 4 not correct 6 (7.5%) - - - - 1 / 4 not correct 15 (18.8%) - - - - 2 / 4 not correct 19 (23.8%) - - - - 3 / 4 not correct 31 (38.8%) - - - - 4 / 4 not correct 9 (11.3%) - - - - MC CS (NP = Yes) - - - - 0 / 4 not correct 3 (5.3%) - - - - 1 / 4 not correct 7 (12.3%) - - - - 2 / 4 not correct 17 (29.8%) - - - - 3 / 4 not correct 23 (40.4%) - - - - 4 / 4 not correct 7 (12.3%) - - - - FES-I 80 24.81 7.68 22.00 10.00 FABS 80 33.21 3.64 33.00 5.75 NEI VFQ-25C 69 .65 1.91 .67 3.24 NEI VFQ-VF 69 .67 2.22 .75 3.74 NEI VFQ-SE 69 .27 1.86 .71 2.88 Influence of the Duration of Visual Impairment on Musculoskeletal Function and Complaints Significant between-group differences were observed in the Falls Efficacy Scale (FES-I), depending on the duration of visual impairment (p = .01; χ² = 8.94, f = .31). Participants with longer-standing visual impairment reported significantly higher levels of fear of falling. Post hoc Bonferroni tests showed that only the group with onset of visual impairment 3 years (mean = 27.02, SD = 8.05) differed significantly, with a small effect size (p = .034, z = -2.53, Effect size r = .28) as shown in Fig. 2 . The duration of 1–3 years and > 3 years narrowly missed the significance level with a small effect size of r = .26 (p = .066). No statistically significant group differences were found for the NRS, NDI, FABS, cervical motor control, or vision-related quality of life when analyzed by duration of impairment as presented in Table 2 for non-parametric and Table A 1 for parametric testing. Table 2 Descriptive statistics of pain intensity (NRS), neck disability (NDI), fear of falling (FES-I), balance ability (FABS), and cervical motor control (MC-CS) stratified by duration of visual impairment. Values are given as mean, standard deviation (SD), median, and interquartile range (IQR). p-values, χ² statistics refer to Kruskal–Wallis tests and effect size f comparing the three duration groups ( 3 years, 1–3 years). N Mean SD Median IQR p (KW) χ² (KW) effect size f NRS 3 Years 41 3.29 2.55 4.00 5.00 Between 1–3 Years 13 3.31 2.81 3.00 4.00 Total 80 3.33 2.59 .97 .06 .00 NDI 3 Years 39 11.79 7.22 10.00 10.00 Between 1–3 Years 12 9.17 6.41 8.00 8.50 Total 76 10.68 7.09 .28 2.52 .08 FES-I 3 Years 41 27.02 8.05 25.00 10.00 Between 1–3 Years 13 22.15 6.96 20.00 5.50 Total 80 24.81 7.68 .01 8.94 .31 FABS 3 Years 41 33.00 3.35 33.00 6.00 Between 1–3 Years 13 33.46 3.80 34.00 5.75 Total 80 33.21 3.64 .78 .50 .00 MC CS 3 Years 41 2.17 1.12 2.00 2.00 Between 1–3 Years 13 2.46 1.13 3.00 2.00 Total 80 2.28 1.12 .61 .97 .00 Regarding vision-related quality of life as a function of the duration of visual impairment, no significant differences were observed between the groups, with only very small effect sizes for NEI VFQ-25C (p = .54, η² = .02), NEI VFQ-VF (p = .52, η² = .02), and NEI VFQ-SE (p = .55, η² = .02) as seen in Table A 1. However, the calculated MCID scores as shown in Table A 2 in show clinically relevant differences between the subgroups. Patients whose visual impairment developed within the first year of life achieved the best results and were clinically superior to the other two groups. The lowest scores were found in the group that acquired the visual impairment between the ages of one and three (see Fig. 1 ). Influence of Type of Visual Impairment on Musculoskeletal Function and Complaints Significant between-group differences by type of visual impairment were observed for the Falls Efficacy Scale – International (FES-I; p = .03, χ² = 10.82, effect size f = .41). Between Group Comparisons of the different types of visual Impairment showed that only unilateral Visual Impairment and bilateral blindness passed the significance level with a high effect (p = .03, z = -2.97, effect size r = .72) as shown in Fig. 2 . Although the Bonferroni-adjusted post-hoc tests did not reveal statistically significant differences between all the other subtypes of visual impairment, several pairwise comparisons showed small to large effect sizes for fear of falling. For example, patients with unilateral VI differed from those with unilateral blindness (p = .80, r = .37), bilateral VI (p = .33, r = .52) and other VI (p = .99, r = .22), indicating small-to-large effects despite non-significant p-values. Similarly, comparisons involving unilaterally blind participants showed small-to-medium effects compared to bilateral VI (p = .99, r = .14), bilaterally blind participants (p = .99, r = .35) and other VI (p = .99, r = .15). Participants with other VI showed medium effects compared to those with bilateral VI (p = .99, r = .28) and a large effect compared to bilaterally blind individuals (p = .24, r = .47). No statistically significant group differences were found for the Numeric Rating Scale (NRS; p = .15, χ² = 6.83, effect size f = .25), the Neck Disability Index (NDI; p = .19, χ² = 6.15, effect size f = .23), the Fullerton Advanced Balance Scale (FABS; p = .16, χ² = 6.57, effect size f = .24), or cervical motor control (p = .43, χ² = 3.82, effect size f = .00), as shown in Table 3 . Table 3 Mean, standard deviation (SD), Median and interquartile Range (IQR), p-values (Kruskal-Wallis), Chi² (χ² Kruskal Wallis) and effect size f for the outcome measures: Numeric Rating Scale (NRS), Neck Disability Index (NDI), Falls Efficacy Scale – International (FES-I), Fullerton Advanced Balance Scale (FABS), cervical motor control (MC CS) divided by Type of Visual Impairment Type of VI n MW SD Median IQR p (KW) χ² (KW) f NRS unilateral VI 10 2.30 2.87 1.00 4.75 unilateral blind 12 2.17 2.25 2.00 4.50 bilateral VI 7 3.71 1.80 4.00 2.00 bilateral blind 7 4.57 2.57 4.00 3.00 other VI 16 3.81 2.43 4.00 3.00 Total 52 .15 6.83 .25 NDI unilateral VI 10 6.60 6.19 6.50 10.00 unilateral blind 12 8.92 7.60 7.50 13.00 bilateral VI 6 10.33 2.58 10.00 4.00 bilateral blind 5 16.20 7.89 17.00 14.00 other VI 16 11.13 7.73 10.50 10.00 Total 49 .19 6.15 .23 FES-I unilateral VI 10 20.10 4.65 18.00 5.75 unilateral blind 12 25.58 9.72 21.50 15.00 bilateral VI 7 28.29 10.73 29.00 13.00 bilateral blind 7 30.43 7.30 29.00 13.00 other VI 16 22.06 5.17 20.50 5.00 Total 52 .03 10.82 .41 FABS unilateral VI 10 34.30 3.02 34.00 4.75 unilateral blind 12 32.00 3.93 31.00 7.50 bilateral VI 7 34.14 3.39 33.00 5.00 bilateral blind 7 30.57 3.10 30.00 3.00 other VI 16 33.63 3.18 34.50 5.50 Total 52 .16 6.57 .24 MC CS unilateral VI 10 2.70 1.25 2.50 2.25 unilateral blind 12 3.50 1.24 4.00 1.75 bilateral VI 7 3.14 1.07 3.00 2.00 bilateral blind 7 3.71 .756 4.00 1.00 other VI 16 3.38 1.20 4.00 1.00 Total 52 .43 3.82 .00 Even with the parametrically tested outcome criteria NEI VFQ-25C (p = .79, effect size η² = .04), as well as their subscores VF (p = .7, η² = .05) and SE (p = .75, η² = .05) no significant between-group differences were found, subdivided by type of visual impairment and mean effects of group membership on vision-related quality of life as shown in Table A 3 and Figure 3 . Regarding the type of visual impairment, the MCID scores were also calculated using the formula described above and are presented in Table A 4. It is noticeable that patients with unilateral blindness more frequently reported a lower vision-related quality of life than the other groups. This is particularly evident in the NEI VFQ-25C and NEI VFQ-VF scores. Correlation of Parameters A bivariate correlation matrix is presented in Table A 5. Significant correlations were found between age and reduced balance ability (r p = − .294; p = .01; Pearson), as well as between female sex and higher pain intensity on the NRS (r s = .299; p < .001; Spearman). The duration of visual impairment did not correlate with any of the measured parameters. However, the type of visual impairment showed a significant correlation with neck pain intensity NRS (r s = .286; p = .04; Spearman), as well as with duration of Neck Pain (r s = .324; p = .02; Spearman). Duration of neck pain was significantly correlated with other neck-related variables: NRS (r s = .765; p ≤ .001; Spearman), NDI (r s = .719; p ≤ .001; Spearman) and cervical motor control (r s = .234; p = .04; Spearman). Pain intensity showed strong associations with the NDI (r p = .724; p ≤ .001; Pearson), and the NDI total score was further correlated with fear of falling (r p = .511; p ≤ .001; Pearson). Balance ability was significantly associated not only with age, but also with cervical motor control (r p = − .357; p ≤ .001; Pearson) and fear of falling (r p = − .29; p = .01; Pearson). Discussion This study is the first to examine the dimensions of neck pain and balance in relation to both the duration and type of visual impairment. According to the WHO, the severity of visual impairment is currently defined by visual acuity. In this study, classification of impairment included visual acuity, the extent of visual field restriction, and whether one or both eyes were affected. This categorization was defined in advance by an interdisciplinary team of ophthalmologists, optometrists, and special educators for visual impairment. The goal was to include individuals not classified as visually impaired according to the WHO definition - such as patients who had undergone enucleation due to uveal melanoma. Classification was performed as part of the low vision aid consultation, which was not prescribed for all inpatient participants, explaining the reduced subsample size of n = 52, which is a major limitation of this study. The findings highlight the relevance of neck pain and balance as clinical dimensions. In Germany, 45.7% of the general population reported experiencing neck pain at least once in the previous year [ 24 ], compared to 71.3% reporting acute neck pain in this study’s sample. The results of the FABS test further indicate that the balance performance of individuals with visual impairment does not correspond to age-appropriate levels but instead resembles that of 70- to 79-year-olds [ 25 ], even though the median age of the patients in this study was 58 years. When grouped by duration of visual impairment, fear of falling showed significant between-group differences, suggesting that fear of falling increases with longer-standing impairment. However, no direct correlation was found between fear of falling and duration of impairment. Interestingly, participants with recent-onset visual impairment were more likely to fall into the unilateral visual impairment group, particularly due to cases of choroidal melanoma resulting in enucleation. This indicates that the type of impairment, not just its duration, may explain between-group differences due to overlapping subgroup characteristics. No evidence could be found that prolonged visual impairment leads to adaptations in musculoskeletal conditions. The analysis by type of visual impairment also revealed significant differences in fear of falling. A limiting factor besides the small sample size is the use of a non-validated classification of visual impairment, as mentioned above. Notably, medium to large (f ≈ .25–.41) effect sizes were consistently observed across most group comparisons, and there was a descriptive trend showing that musculoskeletal complaints and performance tend to deteriorate as impairment shifts from unilateral to bilateral, and from impaired vision to blindness. No significant between-group differences were found regarding the type of visual impairment and NEI VFQ-25C, VF und SE however, average MCID threshold as defined by Goldstein et. al. exceedances were observed. The differences were primarily highlighted in the distinction between monocular and binocular involvement. Individuals with bilateral VI reported the highest scores on the NEI VFQ 25C and its sub scores. The differences were primarily highlighted in the distinction between monocular and binocular involvement. Individuals with bilateral visual impairment (VI) reported the highest scores on the NEI VFQ-25C and its sub scores. The lowest scores were found in patients with unilateral blindness. This frequently affects people with choroidal melanoma. The survival probability for patients with choroidal melanoma in the first year after metastasis is 50%. Overarching effects of this psychological stress on the NEI VFQ-25C & VF scores cannot be ruled out. The substantial differences in subgroup sizes (e.g. n = 7 vs. n = 16) limit the robustness of the Kruskal–Wallis and post-hoc tests. Although the effect sizes suggest small to large between-group differences, these findings are based on small subgroups and should therefore be regarded as exploratory and hypothesis-generating. Post-hoc analysis revealed an effect size of f = .15, which would require a sample size of 620 individuals to demonstrate significant differences regarding the type of visual impairment based on a priori power calculations for a six-group ANOVA (α = .05, 1-β = .8). A more severe form of visual impairment is associated with more intense and longer-lasting neck pain. This finding is not observed regarding motor control, which may indicate that factors other than motor ones, such as psychosocial or reflex mechanisms (e.g., cervico-occlusive reflex connections), are more responsible for the high prevalence of neck pain in people with VI. Similarly, fear of falling was associated with cervical dysfunction, underscoring the psychosocial dimensions of illness perception. These findings underscore the complex biopsychosocial interplay between visual impairment and musculoskeletal health outlined in the International Classification of Functioning, Disability and Health (ICF). Visual impairment does not occur in isolation but affects multiple body functions (cervical spine, balance), activities (mobility, postural control), and participation domains (quality of life, social functioning). The documented associations between declining visual function and musculoskeletal complaints demonstrate that visual rehabilitation cannot be limited to ophthalmological interventions alone. Rather, a multiprofessional rehabilitation approach, as required by German social law (SGB IX) is essential to address the full spectrum of functional limitations experienced by individuals with visual impairment. Conclusion Individuals with visual impairment are more frequently affected by balance and neck-related complaints. There is a clear trend indicating that declining visual function is associated with reduced cervical and balance performance. Interestingly, no significant correlations were found between any of the key variables and the duration of visual impairment, suggesting that these comorbidities may develop independently of the chronicity of visual impairment. Further research with larger sample sizes is needed to confirm these findings, investigate potential causal pathways between visual impairment and musculoskeletal disorders, and evaluate the effectiveness of integrated multiprofessional rehabilitation interventions in this population. Effective rehabilitation for visually impaired individuals should integrate allied health professionals to address balance and neck-related complaints. This addition to the multiprofessional approach aligns with the principles of the UN-CRPD, which emphasizes the removal of participation barriers through comprehensive, individualized support. Abbreviations ANOVA Analysis of Variance CI Confidence Interval EMG Electromyography FABS Fullerton Advanced Balance Scale FES-I Falls Efficacy Scale – International IQR Interquartil-Range MCID Minimal Clinical Important Difference MC CS Motor Control Cervical Spine NDI Neck Disability Index NEIVFQ-25C Rasch-calibrated composite Score of National Eye Institute Visual Function Questionnaire NEIVFQ-SE Socio-Emotional Subscale of Rasch-calibrated National Eye Institute Visual Function Questionnaire NEIVFQ-VF Visual Function Subscale of Rasch-calibrated National Eye Institute Visual Function Questionnaire NRS Numeric Pain Ratin Scale RR Risk Ratio SD Standard Deviation SE Standard Error UN-CRPD United Nations Convention on the Rights of Persons with Disability VI Visual Impairment WHO World Health Organization Declarations Consent to publish Declaration Not applicable. This manuscript does not contain any individual person’s data in any form (including individual details, images, or videos). Ethics and Consent to Participate The study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the University of Applied Sciences Osnabrück, Germany (wiso_MS-MT_HP-SS-23-02). Written informed consent to participate was obtained from all participants. Declaration of interests ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ☒ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bernd Brechtelsbauer reports financial support was provided by German Pension Insurance. Bernd Brechtelsbauer reports a relationship with German Pension Insurance that includes: funding grants. The other authors they declare, that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Statement: This Study was funded by the German Pension Fund Declaration of Generative AI and AI-assisted technologies in the writing process During the preparation of this work the author(s) used ChatGPT 5 and Perplexity to improve English language. After using this tool/service, the author(s) reviewed and edited the content as needed and take full responsibility for the content of the publication. CRediT authorship contribution statement Bernd Brechtelsbauer: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Validation, Writing – original draft, Oliver Kolbe: Conceptualization, Methodology, Supervision, Writing – review & editing; Dino Capovilla: Conceptualization, Methodology, Writing – review & editing; Kathleen S Kunert: Conceptualization, Methodology, Supervision, Writing – review & editing; References Statistisches Bundesamt (Destatis). Qualitätsbericht - Statistik der schwerbehinderten Menschen 2023. (2025). https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Behinderte-Menschen/Publikationen/Downloads-Behinderte-Menschen/statistischer-bericht-schwerbehinderte-2130510239005.html Cumberland, P. M. & Rahi, J. S. Visual Function, Social Position, and Health and Life Chances: The UK Biobank Study. JAMA Ophthalmol. 134 , 959–966. 10.1001/jamaophthalmol.2016.1778 (2016). Chakravarthy, U. et al. The Economic Impact of Blindness in Europe. Ophthalmic Epidemiol. 24 , 239–247. 10.1080/09286586.2017.1281426 (2017). Lundqvist, L-O., Zetterlund, C. & Richter, H. O. Effects of Feldenkrais method on chronic neck/scapular pain in people with visual impairment: a randomized controlled trial with one-year follow-up. Arch. Phys. Med. Rehabil . 95 , 1656–1661. 10.1016/j.apmr.2014.05.013 (2014). Zetterberg, C., Forsman, M. & Richter, H. O. Neck/shoulder discomfort due to visually demanding experimental near work is influenced by previous neck pain, task duration, astigmatism, internal eye discomfort and accommodation. PLoS One . 12 , e0182439. 10.1371/journal.pone.0182439 (2017). Radulović, B. & Huršidić-Radulović, A. Frequency of musculoskeletal and eye symptoms among computer users at work. Arh Hig Rada Toksikol . 63 , 215–218. 10.2478/10004-1254-63-2012-2197 (2012). Richter, H. O., Bänziger, T. & Forsman, M. Eye-lens accommodation load and static trapezius muscle activity. Eur. J. Appl. Physiol. 111 , 29–36. 10.1007/s00421-010-1629-x (2011). Choi, S. & Harrison, T. The Roles of Stress, Sleep, and Fatigue on Depression in People with Visual Impairments. Biol. Res. Nurs. 25 , 550–558. 10.1177/10998004231165022 (2023). Binder, K. W., Wrzesińska, M. A. & Kocur, J. Lęk u osób z dysfunkcją wzroku. [Anxiety in persons with visual impairment]. Psychiatr Pol. 54 , 279–288. 10.12740/PP/OnlineFirst/85408 (2020). Zhang, X. et al. Association between depression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005–2008. JAMA Ophthalmol. 131 , 573–581. 10.1001/jamaophthalmol.2013.2597 (2013). Rokach, A., Berman, D. & Rose, A. Loneliness of the Blind and the Visually Impaired. Front. Psychol. 12 , 641711. 10.3389/fpsyg.2021.641711 (2021). Huurre, T. M., Komulainen, E. J. & Aro, H. M. Social Support and Self-esteem among Adolescents with Visual Impairments. J. Visual Impairment Blindness . 93 , 26–37. 10.1177/0145482X9909300104 (1999). Jones, N. & Bartlett, H. E. Comparison of the eating behaviour and dietary consumption in older adults with and without visual impairment. Br. J. Nutr. 123 , 712–720. 10.1017/S000711451900312X (2020). Rutkowska, I. et al. Balance Functional Assessment in People with Visual Impairment. J. Hum. Kinet . 48 , 99–109. 10.1515/hukin-2015-0096 (2015). Lee, H. K. M. & Scudds, R. J. Comparison of balance in older people with and without visual impairment. Age Ageing . 32 , 643–649. 10.1093/ageing/afg110 (2003). Dhital, A., Pey, T. & Stanford, M. R. Visual loss and falls: a review. Eye (Lond) . 24 , 1437–1446. 10.1038/eye.2010.60 (2010). Ivers, R. Q., Norton, R., Cumming, R. G., Butler, M. & Campbell, A. J. Visual impairment and risk of hip fracture. Am. J. Epidemiol. 152 , 633–639. 10.1093/aje/152.7.633 (2000). MacDermid, J. C. et al. Measurement properties of the neck disability index: a systematic review. J. Orthop. Sports Phys. Ther. 39 , 400–417. 10.2519/jospt.2009.2930 (2009). Delbaere, K. et al. The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing . 39 , 210–216. 10.1093/ageing/afp225 (2010). Jeon, Y-J. & Kim, G-M. Comparison of the Berg Balance Scale and Fullerton Advanced Balance Scale to predict falls in community-dwelling adults. J. Phys. Ther. Sci. 29 , 232–234. 10.1589/jpts.29.232 (2017). Luomajoki, H. Bewegungskontrolldysfunktion der HWS. manuelletherapie 22 , 241–247. 10.1055/a-0764-5187 (2018). Franke, G. H., Esser, J., Voigtländer, A., Mähner, N. & NEI-VFQ - National Eye Institute Visual Function Questionnaire - deutsche Adaptation. (2009). https://www.psycharchives.org/en/item/511def18-691f-418e-b157-1af09ac217da Goldstein, J. E. et al. The NEI VFQ-25C: Calibrating Items in the National Eye Institute Visual Function Questionnaire-25 to Enable Comparison of Outcome Measures. Transl Vis. Sci. Technol. 11 , 10. 10.1167/tvst.11.5.10 (2022). von der Lippe, E. et al. Prevalence of back and neck pain in Germany. Results from the BURDEN 2020 Burden of Disease Study. J. Health Monit. 6 , 2–14. 10.25646/7855 (2021). Schott, N. Erfassung der Gleichgewichtsfähigkeit bei selbstständig lebenden Erwachsenen: Reliabilität und Validität der deutschsprachigen Version der Fullerton Advanced Balance Scale. [Assessment of balance in community dwelling older adults: reliability and validity of the German version of the Fullerton Advanced Balance Scale]. Z. Gerontol. Geriatr. 44 , 417–428. 10.1007/s00391-011-0236-8 (2011). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8858798","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":627543953,"identity":"6ddd59dd-af33-4b0c-8be6-60be447b4d31","order_by":0,"name":"Bernd Brechtelsbauerᵃ","email":"data:image/png;base64,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","orcid":"","institution":"Martin Luther University Halle-Wittenberg","correspondingAuthor":true,"prefix":"","firstName":"Bernd","middleName":"","lastName":"Brechtelsbauerᵃ","suffix":""},{"id":627543954,"identity":"820a11fd-a3ca-4fea-bf38-213cff4038c3","order_by":1,"name":"Oliver Kolbeᵇ","email":"","orcid":"","institution":"Henneberg Rehabilitation Clinic for Ophthalmology","correspondingAuthor":false,"prefix":"","firstName":"Oliver","middleName":"","lastName":"Kolbeᵇ","suffix":""},{"id":627543955,"identity":"81a1c1a0-d9f1-4d2f-9598-119de2833c51","order_by":2,"name":"Dino Capovillaᶜ","email":"","orcid":"","institution":"University of Würzburg","correspondingAuthor":false,"prefix":"","firstName":"Dino","middleName":"","lastName":"Capovillaᶜ","suffix":""},{"id":627543956,"identity":"d91f196b-0bc4-4b49-9b66-a801b8846c95","order_by":3,"name":"Kathleen S. Kunertᵇ","email":"","orcid":"","institution":"Henneberg Rehabilitation Clinic for Ophthalmology","correspondingAuthor":false,"prefix":"","firstName":"Kathleen","middleName":"S.","lastName":"Kunertᵇ","suffix":""}],"badges":[],"createdAt":"2026-02-12 07:23:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8858798/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8858798/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107675996,"identity":"b2a84f58-2773-4afc-a8ed-51e7935700f7","added_by":"auto","created_at":"2026-04-24 00:48:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24077,"visible":true,"origin":"","legend":"\u003cp\u003eMeans and 95 % CIs of vision related quality of life access with NEI VFQ-VF (visual function), NEI VFQ-SE (socioemotional), NEI VFQ-25C \u0026amp; onset of visual impairment. No significant differences were observed.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8858798/v1/be1ba7a9ef49745f56a42278.png"},{"id":107707849,"identity":"c9bfaf51-fcd6-4192-b223-143c41538989","added_by":"auto","created_at":"2026-04-24 09:21:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36518,"visible":true,"origin":"","legend":"\u003cp\u003eMedian with IQR and mean of Falls Efficacy Scale – International (FES-I) for (A) onset of Visual Impairment (VI) and (B) type of VI; * = p \u0026lt; .05\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8858798/v1/dd8dbc8afb640c854f228f35.png"},{"id":107675999,"identity":"c3da81c2-68ae-4f9f-a297-cdf4c6cba36f","added_by":"auto","created_at":"2026-04-24 00:48:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28814,"visible":true,"origin":"","legend":"\u003cp\u003eMeans and 95 % CIs of vision related quality of life access with NEI VFQ-VF (visual function), NEI VFQ-SE (socioemotional), NEI VFQ-25C \u0026amp; on type visual impairment. No significant differences were observed.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8858798/v1/b5591485d61d1cd27244605e.png"},{"id":107709410,"identity":"de091941-9423-4a37-ade4-0bf2a9dd22c6","added_by":"auto","created_at":"2026-04-24 09:35:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":727015,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8858798/v1/a6ab994c-d913-4068-9848-2d23854fc87a.pdf"},{"id":107707866,"identity":"3d4b3479-0e68-43aa-b0f5-08cd3cd0f2ca","added_by":"auto","created_at":"2026-04-24 09:21:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":50371,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-8858798/v1/e1624af629513bf461d7bc1a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Musculoskeletal Complaints in Visually Impaired Rehabilitation Patients: An Exploratory Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVisual impairment (VI) and blindness are associated with substantial psychological distress, high disability rates, and various comorbid conditions. According to the German Federal Statistical Office, 328,680 individuals were registered in the 2023 severe disability statistics under the category \"blindness and visual impairment\" (63,425 blind, 41,245 severely visually impaired, and 224,015 visually impaired persons) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, the actual number of people suffering from a visual impairment is likely to be much higher, as the statistics only record those who have been classified as severely disabled (degree of disability\u0026thinsp;\u0026ge;\u0026thinsp;50%). Unilateral and less severe visual impairments are not included in the statistics, even though they can already result in significant limitations in activities of daily living and social participation for those affected\u0026mdash;a discrepancy that does not align with the UN Convention on the Rights of Persons with Disabilities (UN-CRPD), which defines disability based on participation barriers rather than severity thresholds.\u003c/p\u003e \u003cp\u003eEven mild visual impairments threaten social position and frequently lead to unemployment or employment in low-skilled or poorly paid occupations. The UK Biobank Study demonstrated that impaired vision across the full spectrum\u0026mdash;including near-normal vision\u0026mdash;is independently associated with adverse social outcomes. Individuals with vision at the legal threshold for driving showed increased risk of unemployment (risk ratio 1.55), lower-status employment (risk ratio 1.24), and mental health problems (risk ratio 1.12) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This care gap has far-reaching societal and economic consequences: in Europe, productivity losses from approximately 11\u0026nbsp;million people with visual impairments result in annual costs between 26 and 57\u0026nbsp;billion euros over 50 years, while substantial untapped workforce potential remains [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the high prevalence and impact of visual impairment, the musculoskeletal dimension in this patient population has received insufficient scientific attention. The literature points to an increased incidence of shoulder and neck complaints in patients with age-related macular degeneration [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], as well as associations between visual strain and the development of neck pain [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Ocular symptoms such as redness, dryness, itching, or grittiness are also linked to neck pain [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, there is an interaction between visual strain and the EMG activity of the descending part of the trapezius muscle, whereby deviations in refractive lighting conditions increase muscular activity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn a psychosocial level, ophthalmic patients frequently experience risk factors that may promote the chronification of neck pain, including stress [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], anxiety [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], depression [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], sleep disturbances [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], loneliness [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], lack of social support [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and unhealthy dietary habits [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, both children [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and adults [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] with visual impairments demonstrate reduced balance ability compared to sighted individuals. They are more frequently affected by falls [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which more often result in serious consequences such as hip fractures [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of the present study is to investigate the relevance of cervical spine complaints and balance related impairments in individuals with visual impairment, considering both the duration and type of visual impairment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe present study was designed as an exploratory, monocentric cross-sectional study and was conducted at the Henneberg Rehabilitation Clinic for Ophthalmology (Masserberg, Germany) in March 2023. All participants provided written informed consent; the study complied with the Declaration of Helsinki and was approved by the Ethic Commite of the University of Applied Sciences Osnabr\u0026uuml;ck (Germany; wiso_MS-MT _HP-SS-23-02).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eIn- \u0026amp; Exclusion Criterias\u003c/h2\u003e \u003cp\u003eInclusion criteria, besides inpatient treatment with a primary ophthalmological referral diagnosis, are only age over 18 and willingness to participate. Exclusion criteria include a history of cervical spine surgery, systemic diseases (multiple sclerosis, amyotrophic lateral sclerosis, rheumatoid arthritis, ankylosing spondylitis, etc.), vertigo, tinnitus, temporomandibular joint dysfunction, combined visual and hearing impairments, and insufficient German language skills.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurement Instruments\u003c/h3\u003e\n\u003cp\u003eTo assess the intensity of neck pain and functional limitations of the cervical spine, the Numeric Rating Scale (NRS; 0\u0026thinsp;=\u0026thinsp;no pain, 10\u0026thinsp;=\u0026thinsp;maximum pain) and the Neck Disability Index (NDI; 0\u0026ndash;4\u0026thinsp;=\u0026thinsp;no disability, 5\u0026ndash;14\u0026thinsp;=\u0026thinsp;mild, 15\u0026ndash;24\u0026thinsp;=\u0026thinsp;moderate, 25\u0026ndash;34\u0026thinsp;=\u0026thinsp;severe, 35\u0026ndash;50\u0026thinsp;=\u0026thinsp;complete disability) were used [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Fear of falling was measured using the Falls Efficacy Scale International (FES-I; 16\u0026ndash;19\u0026thinsp;=\u0026thinsp;no concern about falling, 20\u0026ndash;27\u0026thinsp;=\u0026thinsp;moderate concern, 28\u0026ndash;64\u0026thinsp;=\u0026thinsp;high concern) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBalance ability was quantified using the Fullerton Advanced Balance Scale (FABS; 0\u0026thinsp;=\u0026thinsp;poorest score, 40\u0026thinsp;=\u0026thinsp;best score, \u0026lt; 22\u0026thinsp;=\u0026thinsp;increased fall risk) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Motor control was assessed using a brief screening consisting of four cervical motor tasks [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]: transverse head protraction and retraction, deep cervical extension, isolated rotation in quadruped position, and an eye-head coordination task. Vision-related quality of life was assessed using validate German version of the National Eye Institute Visual Function Questionnaire NEI VFQ [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], raw data was Rasch-calibrated to the NEI VFQ-25C according to 23 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. MCID thresholds were additionally calculated as described in the statistical analysis.\u003c/p\u003e\n\u003ch3\u003eGroup Classification\u003c/h3\u003e\n\u003cp\u003eTo investigate the multidimensional impact of visual impairment on musculoskeletal and balance-related outcomes, participants were classified according to two clinically relevant dimensions: duration of visual impairment and type and laterality of impairment.\u003c/p\u003e \u003cp\u003eParticipants were grouped by the duration of visual impairment (Group 1: \u0026lt;1 year; Group 2: \u0026gt; 3 years; Group 3: between 1\u0026ndash;3 Years) to examine potential adaptation and chronification processes. This temporal classification is grounded in the understanding that musculoskeletal complaints and balance impairments may evolve over time as individuals develop compensatory strategies or, conversely, experience progressive deconditioning. Recent visual impairment may be associated with acute postural adaptations and increased fall risk due to lack of compensatory mechanisms, while longer duration may reflect either successful adaptation or chronic musculoskeletal overload from sustained compensatory postures. Additionally, the duration of impairment may influence psychosocial factors such as depression and social isolation, which are known risk factors for chronic pain.\u003c/p\u003e \u003cp\u003eA deviation from the standard WHO classification regarding the severity of visual disability was necessary because the rehabilitation population could not be consistently categorized within it. The WHO classification focuses predominantly on bilateral impairments based on the better-seeing eye, thereby systematically excluding individuals with unilateral visual impairment or blindness, despite evidence that even monocular impairment causes significant limitations in activities of daily living, social participation, and occupational function.\u003c/p\u003e \u003cp\u003eFor these reasons, a multidimensional, consensus-based classification of visual impairment was developed that accounts for both laterality (unilateral vs. bilateral) and functional severity, as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eI. Unilateral visual impairment (visual acuity between .05 and .3 [WHO grades 1\u0026ndash;2]; visual field 10\u0026deg;\u0026ndash;20\u0026deg;; Other Eye: V \u0026gt; .3 and Visual Field\u0026thinsp;\u0026gt;\u0026thinsp;20\u0026deg;)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eII. Unilateral blindness (visual acuity \u0026lt; .05 [WHO grades 3\u0026ndash;5]; visual field\u0026thinsp;\u0026lt;\u0026thinsp;10\u0026deg;; Other Eye: V \u0026gt; .3 and Visual Field\u0026thinsp;\u0026gt;\u0026thinsp;20\u0026deg;)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIII. Bilateral visual impairment (visual acuity .05 \u0026ndash; .3; visual field 10\u0026deg;\u0026ndash;20\u0026deg;)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIV. Bilateral blindness (visual acuity \u0026lt;\u0026thinsp;.05; visual field\u0026thinsp;\u0026lt;\u0026thinsp;10\u0026deg;)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eV. Other visual impairments (visual acuity \u0026gt; .3; visual field\u0026thinsp;\u0026gt;\u0026thinsp;20\u0026deg;)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eVI. Not classifiable (unclear, non-reproducible functional impairments; non-organic visual field deficits; developmental delays; cognitive impairments; non-organic blindness; Posttraumatic Stress Disorder; psychogenic disorders; fibromyalgia, etc.)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eIn March 2023 a total of 80 rehabilitation patients (37 male, 43 female) aged between 27 and 78 years (median 58 years) were recruited. Twenty-six participants had acquired their visual impairment within the past year, 13 within the last 1\u0026ndash;3 years, and 41 more than three years ago. The study used a convenience sample. All eligible patients admitted during the recruitment period were invited to participate; no a priori sample size calculation was performed because the study was exploratory.\u003c/p\u003e \u003cp\u003eIn 52 of the 80 participants, the type of visual impairment could be determined: 10 had unilateral visual impairment, 12 unilateral blindness, 7 bilateral visual impairment, 7 bilateral blindness, and 16 had other visual disorders. For the remaining 28 participants, classification was not possible due to incomplete visual function data. Not all participants had complete ophthalmological assessments available from the department, including missing visual acuity measurements, visual field testing, or laterality information necessary for definitive classification.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAfter data collection, tests for homogeneity of variance and normal distribution were performed with respect to the outcome criteria, duration, and type of visual impairment. The NRS, NDI, FES-I, FABS, and MC CS criteria predominantly showed heterogeneity of variance and deviations from normal distribution. Significance testing was performed using the Kruskal-Wallis test as a non-parametric test, with effect size measures reported as f = \u0026radic;(η\u0026sup2;H / (1\u0026thinsp;\u0026minus;\u0026thinsp;η\u0026sup2;H)); f \u0026asymp; .10/.25/.40 indicating small/medium/large effects. For better comparability with other studies, the data are reported as both mean with standard deviation and median with interquartile ranges. For pairwise post-hoc comparisons, Dunn\u0026ndash;Bonferroni tests were used. We report adjusted p-values and effect size r (r = |z|/\u0026radic;n; r \u0026asymp; .10/.30/.50 indicating small/medium/large effects). The Rasch-transformed NEI VFQ-25C logits were parametrically tested using ANOVA and reported with the effect size measure η\u0026sup2; (\u0026gt;\u0026thinsp;.01\u0026thinsp;=\u0026thinsp;small effect, \u0026gt; .06\u0026thinsp;=\u0026thinsp;medium effect, \u0026gt; .14\u0026thinsp;=\u0026thinsp;large effect).\u003c/p\u003e \u003cp\u003eRegarding vision-related quality of life, Goldstein notes that the MCIDs should be considered arbitrarily as a function of distance from the zero point, as well as the value of the standard error. Goldstein refers to MCID thresholds between individuals and not to means. The MCIDs for vision-related quality of life of the subgroups to be compared were calculated using the formula: MCID\u0026thinsp;=\u0026thinsp;1.96 * \u0026radic; (Standard error (SE)1\u0026sup2;/n1\u0026thinsp;+\u0026thinsp;SE2\u0026sup2;/n2), where SE1 is the mean standard error of the reference group and SE2 is the mean standard error of the subgroup being compared.\u003c/p\u003e \u003cp\u003eCorrelations are reported with the sample size, significance level, and Pearson or Spearman correlation coefficient, depending on the data scaling. The level of significance was set at p \u0026le; .05. All analyses were performed using SPSS (version 27.0.0). Incomplete datasets were not excluded; instead, the applicable sample size for each analysis is reported\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive data\u003c/h2\u003e \u003cp\u003eAll descriptive data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Fifty-seven participants (71.3%) reported experiencing neck pain at the time of assessment. Among them, 50 (87.7%) reported chronic pain, 2 subacute pain, and 5 acute pain. These 57 individuals reported a mean score of 4.7 (SD\u0026thinsp;=\u0026thinsp;1.7) on the Numeric Pain Rating Scale and 13.5 (SD\u0026thinsp;=\u0026thinsp;6.0) on the Neck Disability Index. Regarding motor control, 5.3% of these participants performed 0 out of 4 motor control tasks incorrectly, 12.3% performed 1/4 incorrectly, 29.8% 2/4, 40.4% 3/4, and 12.3% 4/4. Across the total sample of 80 participants, the mean FES-I score was 24.8 (SD\u0026thinsp;=\u0026thinsp;7.7), and the mean score on the Fullerton Advanced Balance Scale was 33.2 (SD\u0026thinsp;=\u0026thinsp;3.6). Vision-related quality of life on the NEI VFQ-25C logit showed mean scores from .65 (SD\u0026thinsp;=\u0026thinsp;1.91) on the Composit score, .67 (SD\u0026thinsp;=\u0026thinsp;2.22) on the Visual Function and .27 (SD\u0026thinsp;=\u0026thinsp;1.86) on the Social-Emotional subscale.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics (Means, standard deviation (SD), Median \u0026amp; interquartil range (IQR) of neck pain (NP) and neck disability, fear of falling, balance ability and vision related quality of life); NRS\u0026thinsp;=\u0026thinsp;Numeric Rating Scale; NDI\u0026thinsp;=\u0026thinsp;Neck Disability Index; MC CS\u0026thinsp;=\u0026thinsp;Motor Control Cervical Spine; FES-I\u0026thinsp;=\u0026thinsp;Falls Efficacy Scale International; FABS\u0026thinsp;=\u0026thinsp;Fullerton Advanced Balance Scale, NEI VFQ-25C\u0026thinsp;=\u0026thinsp;Composit Score, NEI VFQ-VF\u0026thinsp;=\u0026thinsp;Visual Function, NEI VFQ-SE\u0026thinsp;=\u0026thinsp;Social-emotional).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedian\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eIQR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNP Yes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (71.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNP No\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNo Symptoms\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;3 Months\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3\u0026ndash;6 Months\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;6 Months\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNRS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNP Yes\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (71.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNP No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNDI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNP Yes\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNP No\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMC CS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e0 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMC CS (NP\u0026thinsp;=\u0026thinsp;Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e0 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e1 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e2 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e3 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (40.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e4 / 4 not correct\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFES-I\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFABS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNEI VFQ-25C\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNEI VFQ-VF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNEI VFQ-SE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInfluence of the Duration of Visual Impairment on Musculoskeletal Function and Complaints\u003c/h3\u003e\n\u003cp\u003eSignificant between-group differences were observed in the Falls Efficacy Scale (FES-I), depending on the duration of visual impairment (p = .01; χ\u0026sup2; = 8.94, f = .31). Participants with longer-standing visual impairment reported significantly higher levels of fear of falling. Post hoc Bonferroni tests showed that only the group with onset of visual impairment\u0026thinsp;\u0026lt;\u0026thinsp;1 year (mean\u0026thinsp;=\u0026thinsp;22.65, SD\u0026thinsp;=\u0026thinsp;6.55) and \u0026gt;\u0026thinsp;3 years (mean\u0026thinsp;=\u0026thinsp;27.02, SD\u0026thinsp;=\u0026thinsp;8.05) differed significantly, with a small effect size (p = .034, z = -2.53, Effect size r = .28) as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The duration of 1\u0026ndash;3 years and \u0026gt;\u0026thinsp;3 years narrowly missed the significance level with a small effect size of r = .26 (p = .066). No statistically significant group differences were found for the NRS, NDI, FABS, cervical motor control, or vision-related quality of life when analyzed by duration of impairment as presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for non-parametric and Table A 1 for parametric testing.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of pain intensity (NRS), neck disability (NDI), fear of falling (FES-I), balance ability (FABS), and cervical motor control (MC-CS) stratified by duration of visual impairment. Values are given as mean, standard deviation (SD), median, and interquartile range (IQR). p-values, χ\u0026sup2; statistics refer to Kruskal\u0026ndash;Wallis tests and effect size \u003cb\u003ef\u003c/b\u003e comparing the three duration groups (\u0026lt;\u0026thinsp;1 year, \u0026gt; 3 years, 1\u0026ndash;3 years).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eMedian\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eIQR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep (KW)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003eχ\u0026sup2; (KW)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003eeffect size f\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eNRS\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;1 Year\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBetween 1\u0026ndash;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eNDI\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;1 Year\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBetween 1\u0026ndash;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eFES-I\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;1 Year\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBetween 1\u0026ndash;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eFABS\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;1 Year\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBetween 1\u0026ndash;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003eMC CS\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;1 Year\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBetween 1\u0026ndash;3 Years\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding vision-related quality of life as a function of the duration of visual impairment, no significant differences were observed between the groups, with only very small effect sizes for NEI VFQ-25C (p = .54, η\u0026sup2; = .02), NEI VFQ-VF (p = .52, η\u0026sup2; = .02), and NEI VFQ-SE (p = .55, η\u0026sup2; = .02) as seen in Table A 1. However, the calculated MCID scores as shown in Table A 2 in show clinically relevant differences between the subgroups. Patients whose visual impairment developed within the first year of life achieved the best results and were clinically superior to the other two groups. The lowest scores were found in the group that acquired the visual impairment between the ages of one and three (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eInfluence of Type of Visual Impairment on Musculoskeletal Function and Complaints\u003c/h2\u003e \u003cp\u003eSignificant between-group differences by type of visual impairment were observed for the Falls Efficacy Scale \u0026ndash; International (FES-I; p = .03, χ\u0026sup2; = 10.82, effect size f = .41). Between Group Comparisons of the different types of visual Impairment showed that only unilateral Visual Impairment and bilateral blindness passed the significance level with a high effect (p = .03, z = -2.97, effect size r = .72) as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Although the Bonferroni-adjusted post-hoc tests did not reveal statistically significant differences between all the other subtypes of visual impairment, several pairwise comparisons showed small to large effect sizes for fear of falling. For example, patients with unilateral VI differed from those with unilateral blindness (p = .80, r = .37), bilateral VI (p = .33, r = .52) and other VI (p = .99, r = .22), indicating small-to-large effects despite non-significant p-values. Similarly, comparisons involving unilaterally blind participants showed small-to-medium effects compared to bilateral VI (p = .99, r = .14), bilaterally blind participants (p = .99, r = .35) and other VI (p = .99, r = .15). Participants with other VI showed medium effects compared to those with bilateral VI (p = .99, r = .28) and a large effect compared to bilaterally blind individuals (p = .24, r = .47).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNo statistically significant group differences were found for the Numeric Rating Scale (NRS; p = .15, χ\u0026sup2; = 6.83, effect size f = .25), the Neck Disability Index (NDI; p = .19, χ\u0026sup2; = 6.15, effect size f = .23), the Fullerton Advanced Balance Scale (FABS; p = .16, χ\u0026sup2; = 6.57, effect size f = .24), or cervical motor control (p = .43, χ\u0026sup2; = 3.82, effect size f = .00), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean, standard deviation (SD), Median and interquartile Range (IQR), p-values (Kruskal-Wallis), Chi\u0026sup2; (χ\u0026sup2; Kruskal Wallis) and effect size f for the outcome measures: Numeric Rating Scale (NRS), Neck Disability Index (NDI), Falls Efficacy Scale \u0026ndash; International (FES-I), Fullerton Advanced Balance Scale (FABS), cervical motor control (MC CS) divided by Type of Visual Impairment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eType of VI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMW\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eMedian\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eIQR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep (KW)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003eχ\u0026sup2; (KW)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003ef\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cem\u003eNRS\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eother VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cem\u003eNDI\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eother VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cem\u003eFES-I\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eother VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e10.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cem\u003eFABS\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eother VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cem\u003eMC CS\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eunilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ebilateral blind\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.756\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eother VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eEven with the parametrically tested outcome criteria NEI VFQ-25C (p = .79, effect size η\u0026sup2; = .04), as well as their subscores VF (p = .7, η\u0026sup2; = .05) and SE (p = .75, η\u0026sup2; = .05) no significant between-group differences were found, subdivided by type of visual impairment and mean effects of group membership on vision-related quality of life as shown in Table A 3 and Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding the type of visual impairment, the MCID scores were also calculated using the formula described above and are presented in Table A 4. It is noticeable that patients with unilateral blindness more frequently reported a lower vision-related quality of life than the other groups. This is particularly evident in the NEI VFQ-25C and NEI VFQ-VF scores.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation of Parameters\u003c/h2\u003e \u003cp\u003eA bivariate correlation matrix is presented in Table A 5. Significant correlations were found between age and reduced balance ability (r\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.294; p = .01; Pearson), as well as between female sex and higher pain intensity on the NRS (r\u003csub\u003es\u003c/sub\u003e = .299; p \u0026lt; .001; Spearman). The duration of visual impairment did not correlate with any of the measured parameters. However, the type of visual impairment showed a significant correlation with neck pain intensity NRS (r\u003csub\u003es\u003c/sub\u003e = .286; p =\u0026thinsp;.04; Spearman), as well as with duration of Neck Pain (r\u003csub\u003es\u003c/sub\u003e = .324; p = .02; Spearman). Duration of neck pain was significantly correlated with other neck-related variables: NRS (r\u003csub\u003es\u003c/sub\u003e = .765; p \u0026le; .001; Spearman), NDI (r\u003csub\u003es\u003c/sub\u003e = .719; p \u0026le; .001; Spearman) and cervical motor control (r\u003csub\u003es\u003c/sub\u003e = .234; p = .04; Spearman). Pain intensity showed strong associations with the NDI (r\u003csub\u003ep\u003c/sub\u003e = .724; p \u0026le; .001; Pearson), and the NDI total score was further correlated with fear of falling (r\u003csub\u003ep\u003c/sub\u003e = .511; p \u0026le; .001; Pearson). Balance ability was significantly associated not only with age, but also with cervical motor control (r\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.357; p \u0026le; .001; Pearson) and fear of falling (r\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.29; p = .01; Pearson).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is the first to examine the dimensions of neck pain and balance in relation to both the duration and type of visual impairment. According to the WHO, the severity of visual impairment is currently defined by visual acuity. In this study, classification of impairment included visual acuity, the extent of visual field restriction, and whether one or both eyes were affected. This categorization was defined in advance by an interdisciplinary team of ophthalmologists, optometrists, and special educators for visual impairment. The goal was to include individuals not classified as visually impaired according to the WHO definition - such as patients who had undergone enucleation due to uveal melanoma. Classification was performed as part of the low vision aid consultation, which was not prescribed for all inpatient participants, explaining the reduced subsample size of n\u0026thinsp;=\u0026thinsp;52, which is a major limitation of this study.\u003c/p\u003e \u003cp\u003eThe findings highlight the relevance of neck pain and balance as clinical dimensions. In Germany, 45.7% of the general population reported experiencing neck pain at least once in the previous year [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], compared to 71.3% reporting acute neck pain in this study\u0026rsquo;s sample.\u003c/p\u003e \u003cp\u003eThe results of the FABS test further indicate that the balance performance of individuals with visual impairment does not correspond to age-appropriate levels but instead resembles that of 70- to 79-year-olds [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], even though the median age of the patients in this study was 58 years.\u003c/p\u003e \u003cp\u003eWhen grouped by duration of visual impairment, fear of falling showed significant between-group differences, suggesting that fear of falling increases with longer-standing impairment. However, no direct correlation was found between fear of falling and duration of impairment.\u003c/p\u003e \u003cp\u003eInterestingly, participants with recent-onset visual impairment were more likely to fall into the unilateral visual impairment group, particularly due to cases of choroidal melanoma resulting in enucleation. This indicates that the type of impairment, not just its duration, may explain between-group differences due to overlapping subgroup characteristics. No evidence could be found that prolonged visual impairment leads to adaptations in musculoskeletal conditions.\u003c/p\u003e \u003cp\u003eThe analysis by type of visual impairment also revealed significant differences in fear of falling. A limiting factor besides the small sample size is the use of a non-validated classification of visual impairment, as mentioned above. Notably, medium to large (f \u0026asymp; .25\u0026ndash;.41) effect sizes were consistently observed across most group comparisons, and there was a descriptive trend showing that musculoskeletal complaints and performance tend to deteriorate as impairment shifts from unilateral to bilateral, and from impaired vision to blindness.\u003c/p\u003e \u003cp\u003eNo significant between-group differences were found regarding the type of visual impairment and NEI VFQ-25C, VF und SE however, average MCID threshold as defined by Goldstein et. al. exceedances were observed. The differences were primarily highlighted in the distinction between monocular and binocular involvement. Individuals with bilateral VI reported the highest scores on the NEI VFQ 25C and its sub scores. The differences were primarily highlighted in the distinction between monocular and binocular involvement. Individuals with bilateral visual impairment (VI) reported the highest scores on the NEI VFQ-25C and its sub scores. The lowest scores were found in patients with unilateral blindness. This frequently affects people with choroidal melanoma. The survival probability for patients with choroidal melanoma in the first year after metastasis is 50%. Overarching effects of this psychological stress on the NEI VFQ-25C \u0026amp; VF scores cannot be ruled out. The substantial differences in subgroup sizes (e.g. n\u0026thinsp;=\u0026thinsp;7 vs. n\u0026thinsp;=\u0026thinsp;16) limit the robustness of the Kruskal\u0026ndash;Wallis and post-hoc tests. Although the effect sizes suggest small to large between-group differences, these findings are based on small subgroups and should therefore be regarded as exploratory and hypothesis-generating. Post-hoc analysis revealed an effect size of f = .15, which would require a sample size of 620 individuals to demonstrate significant differences regarding the type of visual impairment based on a priori power calculations for a six-group ANOVA (α\u0026thinsp;=\u0026thinsp;.05, 1-β\u0026thinsp;=\u0026thinsp;.8).\u003c/p\u003e \u003cp\u003eA more severe form of visual impairment is associated with more intense and longer-lasting neck pain. This finding is not observed regarding motor control, which may indicate that factors other than motor ones, such as psychosocial or reflex mechanisms (e.g., cervico-occlusive reflex connections), are more responsible for the high prevalence of neck pain in people with VI. Similarly, fear of falling was associated with cervical dysfunction, underscoring the psychosocial dimensions of illness perception.\u003c/p\u003e \u003cp\u003eThese findings underscore the complex biopsychosocial interplay between visual impairment and musculoskeletal health outlined in the International Classification of Functioning, Disability and Health (ICF). Visual impairment does not occur in isolation but affects multiple body functions (cervical spine, balance), activities (mobility, postural control), and participation domains (quality of life, social functioning). The documented associations between declining visual function and musculoskeletal complaints demonstrate that visual rehabilitation cannot be limited to ophthalmological interventions alone. Rather, a multiprofessional rehabilitation approach, as required by German social law (SGB IX) is essential to address the full spectrum of functional limitations experienced by individuals with visual impairment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIndividuals with visual impairment are more frequently affected by balance and neck-related complaints. There is a clear trend indicating that declining visual function is associated with reduced cervical and balance performance. Interestingly, no significant correlations were found between any of the key variables and the duration of visual impairment, suggesting that these comorbidities may develop independently of the chronicity of visual impairment.\u003c/p\u003e \u003cp\u003eFurther research with larger sample sizes is needed to confirm these findings, investigate potential causal pathways between visual impairment and musculoskeletal disorders, and evaluate the effectiveness of integrated multiprofessional rehabilitation interventions in this population.\u003c/p\u003e \u003cp\u003eEffective rehabilitation for visually impaired individuals should integrate allied health professionals to address balance and neck-related complaints. This addition to the multiprofessional approach aligns with the principles of the UN-CRPD, which emphasizes the removal of participation barriers through comprehensive, individualized support.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eANOVA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnalysis of Variance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eCI\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eConfidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eEMG\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eElectromyography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eFABS\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eFullerton Advanced Balance Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eFES-I\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eFalls Efficacy Scale \u0026ndash; International\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eIQR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eInterquartil-Range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eMCID\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eMinimal Clinical Important Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eMC CS\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eMotor Control Cervical Spine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eNDI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eNeck Disability Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eNEIVFQ-25C\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eRasch-calibrated composite Score of National Eye Institute Visual Function Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eNEIVFQ-SE\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eSocio-Emotional Subscale of Rasch-calibrated National Eye Institute Visual Function Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eNEIVFQ-VF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eVisual Function Subscale of Rasch-calibrated National Eye Institute Visual Function Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eNRS\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eNumeric Pain Ratin Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eRR\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eRisk Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eStandard Error\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eUN-CRPD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eUnited Nations Convention on the Rights of Persons with Disability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eVI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eVisual Impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cem\u003eWHO\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent to publish Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person\u0026rsquo;s data in any form (including individual details, images, or videos).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the University of Applied Sciences Osnabr\u0026uuml;ck, Germany (wiso_MS-MT_HP-SS-23-02). Written informed consent to participate was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e☒ \u0026nbsp;The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e☒ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:\u003c/p\u003e\n\u003cp\u003eBernd Brechtelsbauer reports financial support was provided by German Pension Insurance. Bernd Brechtelsbauer reports a relationship with German Pension Insurance that includes: funding grants. The other authors they declare, that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis Study was funded by the German Pension Fund\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Generative AI and AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the preparation of this work the author(s) used ChatGPT 5 and Perplexity to improve English language. After using this tool/service, the author(s) reviewed and edited the content as needed and take full responsibility for the content of the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBernd Brechtelsbauer: \u0026nbsp;\u0026nbsp;Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Validation, Writing \u0026ndash; original draft,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOliver Kolbe: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Conceptualization, Methodology, Supervision, Writing \u0026ndash; review \u0026amp; editing;\u003c/p\u003e\n\u003cp\u003eDino Capovilla: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Conceptualization, Methodology, Writing \u0026ndash; review \u0026amp; editing;\u003c/p\u003e\n\u003cp\u003eKathleen S Kunert: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Conceptualization, Methodology, Supervision, Writing \u0026ndash; review \u0026amp; editing;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStatistisches Bundesamt (Destatis). 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Geriatr.\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e, 417\u0026ndash;428. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00391-011-0236-8\u003c/span\u003e\u003cspan address=\"10.1007/s00391-011-0236-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2011).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Vision-related Quality of life, Visual impairment, musculoskeletal complaints, neck pain, balance","lastPublishedDoi":"10.21203/rs.3.rs-8858798/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8858798/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA physiotherapy test battery was implemented at admission to inpatient ophthalmologic rehabilitation to screen musculoskeletal complaints in relation to visual impairment (VI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate whether onset/duration and type of VI influence musculoskeletal complaints in visually impaired patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExploratory cross-sectional study of 80 participants (median age 58 years; 43 women, 37 men). Outcomes included neck pain (NRS), neck disability (NDI), cervical motor control, fear of falling (FES-I), balance (FABS), and vision-related quality of life (NEI VFQ-25C). Associations were analyzed by VI duration (Group I \u0026lt; 1 year; Group II \u0026gt; 3 years; Group III 1–3 years) and VI type (unilateral; unilateral blindness; bilateral; bilateral blindness; other; not classifiable).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcute neck pain was reported by 71.3% (NRS 4.6/10, SD 1.7; NDI 13.5/50, SD 6.0). Participants performed a mean of 2.3/4 motor control tests incorrectly (SD 1.1). Fear of falling was moderate (FES-I 24.8/64, SD 7.7), balance performance was high (FABS 33.2/40, SD 3.6), and NEI VFQ-25C averaged 0.65 logits (SD 1.91). Higher fear of falling was associated with longer-lasting VI (f = 0.31; χ² = 8.94; p = 0.01) and with more severe VI types (f = 0.41; χ² = 10.82; p = 0.03).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRoutine assessment captures frequent neck pain and impaired cervical motor control in this population. Findings suggest a trend toward greater musculoskeletal complaints with increasing VI severity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGerman Clinical Trials Registration-Number: DRKS00035125, registerd on 30.09.2024\u003c/p\u003e","manuscriptTitle":"Musculoskeletal Complaints in Visually Impaired Rehabilitation Patients: An Exploratory Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 00:48:43","doi":"10.21203/rs.3.rs-8858798/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T06:35:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-25T04:30:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T12:01:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T07:33:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T05:58:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298907918488018203705321332257907187770","date":"2026-04-21T05:26:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T16:42:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133817289775924873334599997836359013435","date":"2026-04-19T16:30:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311034833812086302327244430859321193682","date":"2026-04-19T15:25:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"91832807914129387509928491747160468471","date":"2026-04-18T04:34:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65635892351251944334312311571698525477","date":"2026-04-16T03:30:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T03:26:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-18T07:16:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T13:48:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T13:48:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-12T07:19:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5ffe82d7-85db-4a54-96e4-3c7eb83c55b9","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T06:35:51+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":66790083,"name":"Health sciences/Diseases"},{"id":66790084,"name":"Health sciences/Health care"},{"id":66790085,"name":"Health sciences/Medical research"},{"id":66790086,"name":"Health sciences/Signs and symptoms"}],"tags":[],"updatedAt":"2026-05-07T06:40:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 00:48:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8858798","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8858798","identity":"rs-8858798","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}