Age-related macular degeneration: A randomized clinical trial of a self-management intervention

Abstract

The purpose of this study was to conduct a randomized clinical trial to assess whether a self-management group intervention can improve mood, self-efficacy, and activity in people with central vision loss due to age-related macular degeneration (AMD). Ninety-two elderly patients with AMD (average age = 79) from a university ophthalmology clinic were randomly assigned to the self-management intervention (n = 44) or to a wait-list (n = 48). All patients were legally blind in at least one eye. The intervention consisted of 6 weekly 2-hour group sessions providing education about the disease, group discussion, and behavioral and cognitive skills training to address barriers to independence. All participants eventually completed the intervention allowing pre-post comparisons for all patients. The battery of measures included the Profile of Mood States (POMS); Quality of Well-Being Scale; and assessments of self-efficacy, participation in activities, and use of vision aids. Participants' initial psychological distress was high (mean total POMS = 59.72) and similar to distress experienced by other serious chronic illness populations (e.g. cancer, bone marrow transplant). Analysis of covariance testing the primary hypothesis revealed that intervention participants experienced significantly (p = .04) reduced psychological distress (pre mean = 61.45; post mean = 51.14) in comparison with wait-list controls (pre mean = 57.72; post mean = 62.32). Intervention participants also experienced improved (p = .02) self-efficacy (pre mean = 70.16; post mean = 77.27) in comparison with controls (pre mean = 67.71; post mean = 69.07). Further, intervention participants increased their use of vision aids (p < .001; pre mean = 3.37, post mean = 6.69). This study demonstrates that a relatively brief behavioral intervention can substantially reduce psychological distress and increase self-efficacy in elderly adults experiencing vision loss due to macular degeneration. Self-management intervention appears to improve mood, self-efficacy, and use of vision aids, further enhancing the lives of poorly sighted individuals with AMD.

Effects of a multidisciplinary group rehabilitation programme on participation of the visually impaired elderly: a pilot study

“…The studies of Packer et al [25] and Girdler et al [26] reported a 5-8% increase in the total number of activities as an effect of a vision selfmanagement programme. This partial effect was also found by Brody et al [29]: participation in some activities increased whereas participation in other activities decreased. Although we did not find an increase in the frequency of par ticipation, we did find positive effects on subjective aspects of participation.…”

“…The intervention mapping development procedure [34,35] resulted in a multidisciplinary group rehabilitation programme that consists of components previously described in lowvision rehabilitation interventions [24][25][26][27][28][29][30]45,46]. Similar to psycho social [28] and selfmanagement interventions [25,26,29,46], VIPP is a groupbased programme.…”

“…Similar to psycho social [28] and selfmanagement interventions [25,26,29,46], VIPP is a groupbased programme. Identification with other people with the same visual problems provides the oppor tunity to share experiences and coping strategies on both functional and emotional issues [31].…”

“…A pilot study on a psychosocial intervention pro gramme for the elderly with agerelated macular degeneration indicated an improvement in perceived autonomy in participa tion [28]. In contrast, the study of Brody et al [29] showed mixed results of a selfmanagement group intervention; participation in some activities increased (e.g. gardening) whereas other activities (e.g.…”

Effect of depression on actual and perceived effects of reading rehabilitation for people with central vision loss

“…Brody et al [16] assessed the effects of participation in a self-management group intervention to determine whether moods, self-efficacy, and activity improved in patients with central vision loss as a result [7]. The results of this study showed that patients who received the intervention experienced significantly reduced distress, improved self-efficacy, and increased use of visual aids in comparison with the control patients who did not receive the intervention.…”