On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

What is the efficacy of occupational therapy for visual motor and visual perceptive problems in school age children?

It was difficult to find recent articles that evaluated the overall efficacy with children. The librarian and I "explored" the possibilities of Medline, so the search was quite lengthy.

1     "VISUAL MOTOR PROBLEMS".mp.    results= 1   
2     exp Vision disorders/pc,di,rh,th [Prevention & Control,    results= 2918   
Diagnosis, Rehabilitation, Therapy]
3     limit 2 to (preschool child < 2 to 5 years > or child < 6    results= 963   
to 12 years > or adolescence < 13 to 18 years >)
4     exp Occupational therapy/    results= 1387   
5     2 and 4    results= 19   
6     3 or 5    results= 981   
7     3 and 4    results= 1   
8     exp Rehabilitation/    results= 27001   
9     3 and 8    results= 29   
10    from 9 keep 1-29    results= 29   
11     from 9 keep 21    results= 1   
12     exp Optometry/    results= 881   
13     3 and 12    results= 25   
14     from 13 keep 4-5,13,24-25    results= 5   
15     from 5 keep 4,7-9,14    results= 5   

Reference Librarian comments

First of all -- you did a fine job. Thanks for participating in the assignment.

Now, about the question itself. (I have an interest in this, because I worked for a few years with reading-problem children...)

The question is easily understood, but it's a toughie to pose to MEDLINE. It's hard to know in advance what those kinds of questions are (the toughies), but it is this kind of question that -- when it comes up in the future in your work -- you should probably seek help from your favorite medical reference librarian. We would be willing to "play" online a lot, and look hither and yon for some good results, whereas you might be too busy to pursue this too much further.

The problems with MEDLINE and this particular question is partly a problem of vocabulary, and even a little "politics." What is the difference between an ophthalmologist and an optometrist? What do they do that is essentially different? Is the field of optometry covered nicely in MEDLINE?

Why am I talking about optometry, when you came to the question with the term "occupational therapy?" Well, I think sometimes "OT" is considered a professional discipline, and sometimes a "department," and sometimes simply an odd grouping, a grab-bag, of manual and lifestyle and "activities-of-daily-living" therapeutic tricks that are distinguished rather vaguely (in the physician's mind and in MEDLINE vocabulary) from whatever goes on in physical therapy, speech therapy, nursing, neuropsychology, and home-visits.

When I think of a healthy 2nd grader with some minor visual-perceptual difficulties, I don't see him engaging, in any significant long-term way, in ANY of those delivery vehicles. You're probably not going to see a 2nd grader visiting the department of "occupational therapy" three times a week for three years, right?

(I'm supposed to be simply making small comments on your MEDLINE strategy, which was FINE, and here I am ranting about the subject. The reason I'm doing this, is because I'm all opinionated about the subject itself, and I know MEDLINE well. Sorry!)

ANYWAY: to get a GOOD bead on this subject is not at all easy. In my vision (!) of what really happens with these kids -- I see them going to an "eye doctor" (hopefully a 'developmentally oriented' optometrist) and he might prescribe some "exercises" -- and the kiddo will also see the reading specialist IN SCHOOL. So that means we need to ferret out the literature in optometry and education. And maybe we'd use "PSCYINFO" (the "Medline" for psychology, psychiatry, neuropsychology, etc.). We'd certainly find all sorts of stuff in ERIC (for education). (I don't know right off hand just where the optometry literature is best indexed...)

You don't have to agree with all this, of course, but my perception is that though doctors might care about this and have sympathy and be approached for advice, this isn't quite a medical problem. An ophthalmologist will pronounce the eye "healthy" and the OT department will cost too much and be located in a hospital. The optometrist has a different approach to vision, and will work with the child, teacher, parents, and reading specialist.

I wish all kids taking ritalin would go see the optometrist*, because I suspect some 'hyperactivity' is related to a problem of focusing at near-point, keeping an image still, strabismus, visual stress, eyes competing for dominance, nystagmus, inability to converge, etc. etc. etc.

*the individual optometrist has to be chosen carefully. They frequently specialize, like "dentists" -- and we don't want a "contact-lens" or "low-vision" or "mall/chain/pearle lackey" or a child-hating grump. Working with these kids is tricky, from all sorts of angles...