The Effectiveness of Low-Vision Rehabilitation in 2 Cohorts Derived From the Veterans Affairs Low-Vision Intervention Trial

Stelmack, Joan A.; Tang, Xiaoyin; Wei, Yongliang; Massof, Robert W.

doi:10.1001/archophthalmol.2012.1820

Cited by 36 publications

(36 citation statements)

References 28 publications

(39 reference statements)

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“…The added effects of occupational therapy were greater for patients with less severe visual impairments (≥20/70) than they were for patients with more severe visual impairments (<20/70). This result was unexpected because, as shown in the LOVIT study, 13 patients with better visual function at baseline have less room to improve.…”

Section: Discussionmentioning

confidence: 92%

“…The significant improvements in visual ability we saw in the ST group can be interpreted as concurring with previous studies that concluded that conventional low vision services alone are effective at improving visual function. 12–19 However, those results also could be interpreted as indicative of a response-biasing effect of supportive therapy.…”

Section: Discussionmentioning

confidence: 97%

“…7–11 Clinical research studies demonstrate that outpatient low vision rehabilitation services can improve functional ability. 12–19 A recently completed clinical trial, the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration (VITAL), demonstrated that behavioral activation (BA) plus low vision rehabilitation delivered by an occupational therapist (OT-LVR) in the patients' home reduced the incidence of severe depression in high-risk AMD patients with low vision. 20 …”

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confidence: 99%

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Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration

Deemer

Massof

Rovner

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PurposeTo compare the efficacy of behavioral activation (BA) plus low vision rehabilitation with an occupational therapist (OT-LVR) with supportive therapy (ST) on visual function in patients with age-related macular degeneration (AMD).MethodsSingle-masked, attention-controlled, randomized clinical trial with AMD patients with subsyndromal depressive symptoms (n = 188). All subjects had two outpatient low vision rehabilitation optometry visits, then were randomized to in-home BA + OT-LVR or ST. Behavioral activation is a structured behavioral treatment aiming to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. Functional vision was assessed with the activity inventory (AI) in which participants rate the difficulty level of goals and corresponding tasks. Participants were assessed at baseline and 4 months.ResultsImprovements in functional vision measures were seen in both the BA + OT-LVR and ST groups at the goal level (d = 0.71; d = 0.56 respectively). At the task level, BA + OT-LVR patients showed more improvement in reading, inside-the-home tasks and outside-the-home tasks, when compared to ST patients. The greatest effects were seen in the BA + OT-LVR group in subjects with a visual acuity ≥20/70 (d = 0.360 reading; d = 0.500 inside the home; d = 0.468 outside the home).ConclusionsBased on the trends of the AI data, we suggest that BA + OT-LVR services, provided by an OT in the patient's home following conventional low vision optometry services, are more effective than conventional optometric low vision services alone for those with mild visual impairment. (ClinicalTrials.gov number, NCT00769015.)

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

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Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration

Deemer

Massof

Rovner

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…2 Psychometric techniques, such as Rasch analysis, 3 convert rating scales (e.g., degree of difficulty reported by a given respondent for a particular visual activity) into interval scales. Thus, the VFQ has become a measurement tool that assigns an ability score (Person Measure; PM) to each respondent, and a difficulty score (Item Measure; IM) to each question.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the ULV-VFQ for Clinical Use Through Item Set Reduction: Psychometric Properties and Trade-Offs

Dagnelie

Jeter

Adeyemo

2017

Trans. Vis. Sci. Tech.

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PurposeWe examine the dimensionality of the 150-item visual functioning questionnaire for individuals with ultralow vision (ULV-VFQ) and develop representative abbreviated versions, facilitating clinical use, while retaining compatibility with a 17-item performance assessment.MethodsSubsets with 50 and 23 items covering the full difficulty range were selected, with evenly spaced item measures (IMs) and good representation of visual aspects and functional domains. Person measures (PMs) for the anchored subsets were derived through Rasch analysis of data from 80 respondents.ResultsFit statistics for the reduced item sets were similar to those for the full set, with reliabilities at or above 95%. Mean PMs in the reduced sets were within 0.8 standard errors (SEs) of those in the full set. SEs of the PMs increased from the SE for 150 items, roughly in inverse proportion with the square root of the set size. Unexplained variance levels (24%–27%) and variance of the first unexplained factor (3.3%–3.9%) were close to those (30% and 2.6%) for 150 items. Differential item functions for omitted items were negligible. Aspects and domains are adequately represented in the reduced sets.ConclusionsSelf-reported visual ability can be measured accurately using appropriately chosen anchored subsets of the ULV-VFQ. Functional ability of individuals with ULV is characterized adequately by a single dimension.Translational RelevanceThe ULV-VFQ50 and ULV-VFQ23, using anchored IMs from the 150-item ULV-VFQ, provide an efficient and reliable self-report assessment of visual ability in individuals whose visual impairment is too severe for assessment with VFQs currently in use.

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“…It is also important to recognise that these instruments have been developed to measure the consequences of VI without sufficiently taking into account the influence of environmental and personal factors as defined by the ICF. However, selected personal and environmental factors (e.g., age, gender, use of assistive devices) have often been assessed as potential confounders in intervention studies focusing on rehabilitation in PVI or in cohort studies [33]. …”

Section: Introductionmentioning

confidence: 99%

What explains health in persons with visual impairment?

Leißner

Coenen

Froehlich³

et al. 2014

Health Qual Life Outcomes

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BackgroundVisual impairment is associated with important limitations in functioning. The International Classification of Functioning, Disability and Health (ICF) adopted by the World Health Organisation (WHO) relies on a globally accepted framework for classifying problems in functioning and the influence of contextual factors. Its comprehensive perspective, including biological, individual and social aspects of health, enables the ICF to describe the whole health experience of persons with visual impairment. The objectives of this study are (1) to analyze whether the ICF can be used to comprehensively describe the problems in functioning of persons with visual impairment and the environmental factors that influence their lives and (2) to select the ICF categories that best capture self-perceived health of persons with visual impairment.MethodsData from 105 persons with visual impairment were collected, including socio-demographic data, vision-related data, the Extended ICF Checklist and the visual analogue scale of the EuroQoL-5D, to assess self-perceived health. Descriptive statistics and a Group Lasso regression were performed. The main outcome measures were functioning defined as impairments in Body functions and Body structures, limitations in Activities and restrictions in Participation, influencing Environmental factors and self-perceived health.ResultsIn total, 120 ICF categories covering a broad range of Body functions, Body structures, aspects of Activities and Participation and Environmental factors were identified. Thirteen ICF categories that best capture self-perceived health were selected based on the Group Lasso regression. While Activities-and-Participation categories were selected most frequently, the greatest impact on self-perceived health was found in Body-functions categories. The ICF can be used as a framework to comprehensively describe the problems of persons with visual impairment and the Environmental factors which influence their lives.ConclusionsThere are plenty of ICF categories, Environmental-factors categories in particular, which are relevant to persons with visual impairment, but have hardly ever been taken into consideration in literature and visual impairment-specific patient-reported outcome measures.

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The Effectiveness of Low-Vision Rehabilitation in 2 Cohorts Derived From the Veterans Affairs Low-Vision Intervention Trial

Abstract: Visual ability improved significantly in both groups from baseline to 1 year. The Low-Vision Intervention Trial treatment effect is robust and well maintained for patients with macular diseases.

Cited by 36 publications

References 28 publications

Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration

Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration

Optimizing the ULV-VFQ for Clinical Use Through Item Set Reduction: Psychometric Properties and Trade-Offs

What explains health in persons with visual impairment?

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