title: 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.
authors.affiliation: University of California, San Diego, Department of Ophthalmology, La Jolla 92093-0946, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Brody
authors.forename: R A
authors.initials: RA
authors.lastname: Williams
authors.forename: R G
authors.initials: RG
authors.lastname: Thomas
authors.forename: R M
authors.initials: RM
authors.lastname: Kaplan
authors.forename: R M
authors.initials: RM
authors.lastname: Chu
authors.forename: S I
authors.initials: SI
authors.lastname: Brown
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D007909:Lenses / Q000706:statistics & numerical data; D008268:Macular Degeneration / Q000523:psychology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D016896:Treatment Outcome