Vision self-management for older adults: a randomised controlled trial

Abstract

Background/aims Ageing of the population will result in unprecedented numbers of older adults living with agerelated vision loss (ARVL). Self-management models improve health outcomes and reduce healthcare costs; however, the principles have rarely been applied in low vision services. Methods A two-armed randomised controlled trial of older adults (n¼77) with ARVL compared 'usual care' provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains.Results The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the selfmanagement group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks' follow-up. Conclusion Addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL.

How Effective is Low Vision Service Provision? A Systematic Review

“…143 This RCT included a waiting list control, full details of randomisation and masking (with a specified protocol for avoiding the disclosure by patients of their intervention group), the use of a range of well-validated outcome measures, and full details of results. It may be that the publication of this report, and others with a similarly rigorous protocol development (Girdler et al 60 …”

“…The intention to treat analysis showed that the extended model produced significantly improved participation levels and the belief in the ability to manage every day tasks. 60 Other studies have evaluated the effects of more specialised services. For example, Engel et al and Kuyk et al demonstrated significant improvements in mobility-related ADLs after specific orientation and mobility training programmes, although it was not possible to calculate effect sizes from the data presented.…”

“…41,48,49 Self-management programs are becoming increasingly popular, adopting a group-based approach, with the aim of helping participants to take control in managing the consequences of visual impairment and developing problem solving skills through sharing experiences and coping strategies. 22,23,60,109,114 Given the wealth of different strategies employed in providing vision rehabilitation, there is a real need for evidence-based studies evaluating the effectiveness and cost-effectiveness of the various types of rehabilitation.…”

“…60 The latter intervention involved an 8 week (24 hour) programme delivered in a group environment with 6 to 10 participants. Seventy-seven subjects were randomised and outcomes from a 12 week follow up were reported.…”

“…Outcomes have included participation levels in ADLs, 60 confidence in performance of ADLs, 116 dependence or independence in performing ADLs, 48 activity levels, 102 and perceived security/insecurity in performing ADLs, 41,49 as well as assessing basic ability in performance. 55,66,68,72,75,104,110,118,129,137,138,143,144 Despite the disparity in evaluation tools used, there is very good evidence that low vision service provision improves functional ability.…”