title: Clinically Meaningful Rehabilitation Outcomes of Low Vision Patients Served by Outpatient Clinical Centers.
abstract: OBJECTIVE
  To facilitate comparative clinical outcome research in low vision rehabilitation, we must use patient-centered measurements that reflect clinically meaningful changes in visual ability.
  
  
  OBJECTIVE
  To quantify the effects of currently provided low vision rehabilitation (LVR) on patients who present for outpatient LVR services in the United States.
  
  
  METHODS
  Prospective, observational study of new patients seeking outpatient LVR services. From April 2008 through May 2011, 779 patients from 28 clinical centers in the United States were enrolled in the Low Vision Rehabilitation Outcomes Study. The Activity Inventory, a visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline and 6 to 9 months after usual LVR care. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaires were also administered to measure patients' psychological, cognitive, and physical health states, respectively, and clinical findings of patients were provided by study centers.
  
  
  METHODS
  Mean changes in the study population and minimum clinically important differences in the individual in overall visual ability and in visual ability in 4 functional domains as measured by the Activity Inventory.
  
  
  RESULTS
  Baseline and post-rehabilitation measures were obtained for 468 patients. Minimum clinically important differences (95% CIs) were observed in nearly half (47% [95% CI, 44%-50%]) of patients in overall visual ability. The prevalence rates of patients with minimum clinically important differences in visual ability in functional domains were reading (44% [95% CI, 42%-48%]), visual motor function (38% [95% CI, 36%-42%]), visual information processing (33% [95% CI, 31%-37%]), and mobility (27% [95% CI, 25%-31%]). The largest average effect size (Cohen d = 0.87) for the population was observed in overall visual ability. Age (P = .006) was an independent predictor of changes in overall visual ability, and logMAR visual acuity (P = .002) was predictive of changes in visual information processing.
  
  
  CONCLUSIONS
  Forty-four to fifty percent of patients presenting for outpatient LVR show clinically meaningful differences in overall visual ability after LVR, and the average effect sizes in overall visual ability are large, close to 1 SD.
authors: Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Judith E
authors: JE
authors: Goldstein
authors: Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston.
authors: Mary Lou
authors: ML
authors: Jackson
authors: San Antonio Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio4Lions Low Vision Center of Texas, The University of Texas Health Science Center School at San Antonio.
authors: Sandra M
authors: SM
authors: Fox
authors: Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: James T
authors: JT
authors: Deremeik
authors: Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Robert W
authors: RW
authors: Massof
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010045:Outpatients / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States; D015354:Vision, Low / Q000175:diagnosis / Q000534:rehabilitation*; D019987:Persons with Visual Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data