Research Article: Psychological well-being and quality of life in visually impaired baseball players: An Italian national survey

Date Published: June 6, 2019

Publisher: Public Library of Science

Author(s): Daniela Mirandola, Marco Monaci, Guido Miccinesi, Alessia Vannuzzi, Eleonora Sgambati, Mirko Manetti, Mirca Marini, Stefano Federici.


Italian baseball played by visually impaired and blind athletes is an adapted team sport which maintains the peculiar fast-moving features of this popular sport. It is also a mixed team game played together with sighted subjects. Here, we performed a national survey aimed at assessing the differences in psychological well-being (PWB) and quality of life (QoL) between visually impaired baseball players from Italian teams and non-players using a structured online questionnaire. Forty-three visually impaired baseball players and thirty-four visually impaired sedentary individuals completed a structured self-report survey including the validated 18-item Italian versions of the PWB (PWB-18) scale and the Short Form-12 (SF-12) questionnaire to assess the QoL. PWB-18 and SF-12 reference data from the Italian normally sighted population were also employed for comparison with the visually impaired baseball player group. Visually impaired baseball players reported better scores in all dimensions of the PWB-18 scale and significant higher scores in both physical and mental QoL evaluated by SF-12 than the non-player group. In addition, PWB-18 scale findings revealed significant differences between visually impaired baseball players and the reference normally sighted population consisting in lower scores for autonomy, environmental mastery, positive relations with others and purpose in life dimensions. Conversely, the mean scores for PWB-18 personal growth and self-acceptance dimensions were not significantly different between the two groups. The SF-12 questionnaire results demonstrated a significantly higher physical score in visually impaired players compared with the reference population. Instead, the SF-12 mental score of visually impaired athletes tended to be lower, though this difference was not statistically significant. Collectively, our findings suggest that the practice of Italian baseball may have a positive impact on PWB and QoL of visually impaired individuals.

Partial Text

Quality of life (QoL) is multidimensional and includes factors such as health, physical functioning, life satisfaction, sense of happiness and social well-being amongst others [1–3]. Increasing evidence supports the positive effects deriving from the participation in regular physical activity to achieve psychophysical health with an overall improvement of QoL [4]. In particular, regular physical activity is the mainstay of chronic disease prevention and health maintenance in both people with and those without disabilities, and clear evidence exists of its psychophysical benefits in visually impaired people [5–11]. Despite the importance of an active lifestyle, only a minority of the population is currently meeting the recommended levels of regular physical activity to achieve health and QoL benefits [12]. People with a disability, such as blind and visually impaired individuals, are on average even more inactive than the general population [10]. Visual impairment is one of the most common disabilities, and there are different levels of this dysfunction. ‘Low vision’, which refers to both moderate and severe visual impairments, and blindness collectively represent all visual impairments according to the International Classification of Diseases [13]. These conditions heavily compromise QoL and are associated with a decreased mobility. As a matter of fact, subjects with visual impairment have a more sedentary lifestyle respect to those with other disabilities [9]. In addition, the health-related fitness level of individuals with visual impairment results generally lower than that of sighted individuals [8, 9]. The absence of the sense of vision clearly can affect motor skills, though this does not prevent individuals who have a visual impairment from being physically active [3].

Out of 43 visually impaired baseball players (aged 38.1 ± 12 years) who took part in this study by answering the self-administered questionnaire, 36 (83.7%) were male and 7 (16.3%) female. The control group consisted of 34 visually impaired sedentary individuals (20 (58.8%) male and 14 (42.2%) female; mean age 42.2 ± 11.6 years) who did not practice any sport or physical activity in their leisure time. The characteristics of study participants are detailed in Table 2. No significant difference between the two groups was observed for the different variables taken into account (Table 2). Focusing on the group of visually impaired subjects playing baseball, 34 (79.1%) subjects were visually impaired from birth while 9 (20.9%) had acquired vision loss. In particular, 8 (88.9%) subjects were blind from over 10 years and 1 (11.1%) subject from 5 to 10 years. According to the classification of the International Blind Sports Federation (IBSA), B1 (blind) level was the most common type of reported visual disability (74.4%), followed by B2 (severely sight-impaired) (16.3%) and B3 (mildly sight-impaired) (9.3%) levels (Table 2). Information on the educational level, employment status and general health conditions collected by athlete interview is reported in Table 2. In particular, the educational level was classified into four categories based on the Italian school system, namely primary school, middle school, high school and university. Regarding the employment status, the majority of participants were employees (41.9%), followed by students (18.6%) and health professionals (11.6%). Moreover, 74.4% of athletes referred no pathology in addition to visual impairment. Forty (93%) baseball players had practiced other sports in the past. In addition, 23 (53.5%) athletes were practicing other sports at the time of the interview (i.e. torball, archey, swimming, athletics, showdown, skiing, fencing, 5-a-side football, judo, dancesport).

To the best of our knowledge, this is the first study assessing the PWB and QoL of visually impaired baseball players. Our findings demonstrate that baseball players with visual impairment have a better PWB than visually impaired non-sportive individuals. Similar results were reported in a previous study assessing the effect of playing Torball [18]. Moreover, we clearly detected a significantly greater QoL in the sportive group as testified by higher mean values of both SF-12 physical and mental scores in baseball players than in the sedentary group. Overall, these results highlight a positive relationship between the practice of baseball and PWB/QoL of visually impaired people.

In summary, despite the aforementioned limitations, the herein reported positive PWB and QoL outcomes suggest that visually impaired individuals could reach a personal growth and improve their self-acceptance, purpose in life and social skills through the practice of Italian baseball. Given its peculiar features, baseball participation might indeed favor an increase in self-esteem, social contacts and PWB, with consequent improvement of QoL of visually impaired people. Therefore, we believe that subjects with visual impairment should be encouraged to play this team sport. Our study may also contribute to promote and popularize worldwide the practice of Italian baseball for visually impaired subjects.