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Dong Y, Wang A. Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review. J Multidiscip Healthc 2024; 17:2239-2250. [PMID: 38751666 PMCID: PMC11095522 DOI: 10.2147/jmdh.s463894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024] Open
Abstract
Background The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Methods Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Results Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. Conclusion In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.
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Affiliation(s)
- Yu Dong
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Aiping Wang
- The First Hospital of China Medical University, Shenyang, People’s Republic of China
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2
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The Basic VRS-Effect Study: Clinical Trial Outcomes and Cost-Effectiveness of Low Vision Rehabilitation in Portugal. Ophthalmol Ther 2022; 12:307-323. [PMID: 36369618 PMCID: PMC9651903 DOI: 10.1007/s40123-022-00600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of this study was twofold: (1) to investigate the clinical impact of vision rehabilitation in patients with vision impairment and (2) to investigate the cost-effectiveness of a basic vision rehabilitation service in Portugal. METHODS The trial recruited patients diagnosed with age-related macular degeneration or diabetic retinopathy (DR) and visual acuity in the range 0.4-1.0logMAR in the better-seeing eye. Participants were randomised to one of the study arms consisting of immediate intervention and delayed intervention. The intervention included: new refractive correction, optical reading aids, in-office training and advice about modifications at home. Visual ability, health-related quality of life and costs were measured. Economic analysis was performed to evaluate whether the intervention was cost-effective. The trial compared the outcomes 12 weeks after the start in both arms. RESULTS Of the 46 participants, 34 (74%) were diagnosed with DR, 25 (54%) were female, and mean age was 70.08 years (SD = 8.74). In the immediate intervention arm visual ability increased a mean of 0.523 logits (SE = 0.11) (p < 0.001). Changes in the delayed intervention arm were not statistically significant (p = 0.95). Acuity in the better-seeing eye, near acuity and critical print size also improved during the study. The mean cost of the intervention was €118.79 (SD = 24.37). The incremental cost-effectiveness ratio using the EQ-5D-5L was 30,421€/QALY and 1186€/QALY when using near acuity. CONCLUSION The current study gives evidence of positive clinical impact of a basic vision rehabilitation intervention and shows that a basic vision rehabilitation service is cost-effective. These findings are important to clinical and rehabilitation practices and for planning vision rehabilitation services. TRIAL REGISTRATION Retrospectively registered, 21/01/2019. ISRCTN10894889, https://www.isrctn.com/ISRCTN10894889.
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FitzGerald J, Wells YD, Ellis JM. Psychosocial modification of general self-efficacy in older adults: A restricted review. Australas J Ageing 2022; 41:e210-e226. [PMID: 35235249 PMCID: PMC9545063 DOI: 10.1111/ajag.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In recent years, the concept of general self-efficacy has increased in popularity. General self-efficacy is positively associated with quality of life and has the potential to act as a psychological buffer against adverse events and circumstances. However, due to the long-term influences that are said to shape general self-efficacy beliefs, they may be resistant to intervention, particularly within the older population. This restricted review aimed to explore whether psychosocial interventions could improve the general self-efficacy of older adults. Aspects of intervention design associated with improvements were also investigated. METHODS A restricted review was undertaken. This included a keyword search of four major health databases (PubMed, CINAHL, PsycINFO and AgeLine). Search terms focused on general self-efficacy and the commonly used measures of this concept and were limited to the older adult population. RESULTS In total, 848 articles were screened, with 20 studies proceeding to data extraction. The modification of general self-efficacy in older adults appears possible, with 7 out of the 20 included studies reporting improvements postintervention. Despite issues relating to the quality of included studies and the generalisability of their results, several aspects of intervention design coincided with intervention success, including intervention duration, and employing sufficiently-qualified staff. CONCLUSIONS Future research must address the generalisability issues identified in this review. Studies comparing the effectiveness of individual- and group-based interventions, the efficacy of remote delivery platforms and the possibility for long-term transfer of any improvements are needed to contribute the high-quality data required for policy and practice decisions in this area.
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Affiliation(s)
- Jarrah FitzGerald
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne D Wells
- Lincoln Centre for Research on Ageing, Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, Victoria, Australia
| | - Julie M Ellis
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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Somani N, Beukes E, Latham K, Andersson G, Allen PM. Designing an internet-based intervention for improving wellbeing in people with acquired vision loss: A Delphi consensus study. Ophthalmic Physiol Opt 2021; 41:971-984. [PMID: 34392552 DOI: 10.1111/opo.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Vision impairment (VI) may impact a person's functional ability resulting in a loss of independence, anxiety, depression, social isolation and reduced quality of life. Caregivers also experience similar problems due to the increased burden placed on them. Support to address these difficulties encountered by those with VI and their caregivers may not always be accessible. An internet-based intervention may provide more accessible support. The aim of this study was to obtain consensus regarding the content and accessibility features required to design an internet-based intervention to promote wellbeing for people with VI and their caregivers. METHOD A three-round Delphi review was conducted with a panel of 30 stakeholders. Three stakeholder groups were included, namely individuals with vision loss, experts in the field of vision loss and mental health and carers of individuals with vision loss. Conceptual wellbeing ideas were examined in round 1, the intervention modules and module content were proposed in round 2 and refined in round 3. RESULTS Consensus of 75% or more was reached to include 18 modules into the intervention. These were divided into seven sections: understanding vision loss, emotional wellbeing, functional wellbeing, social wellbeing, physical wellbeing, wellbeing for carers and maintaining wellbeing. The accessibility features deemed most important were font size, colour and contrast options, compatibility with low vision aids and layout of the intervention. CONCLUSIONS The Delphi process positively informed the design of an internet-based intervention for individuals with acquired VI and their caregivers. Suggestions provided by stakeholders should now be incorporated into the intervention. Future evaluation of efficacy and cost-effectiveness of such an intervention are necessary.
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Affiliation(s)
- Nurbanu Somani
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Eldre Beukes
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Keziah Latham
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
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5
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Liu J, Dong J, Chen Y, Zhang W, Tong S, Guo J. Low vision rehabilitation in improving the quality of life for patients with impaired vision: A systematic review and meta-analysis of 52 randomized clinical trials. Medicine (Baltimore) 2021; 100:e25736. [PMID: 34106601 PMCID: PMC8133190 DOI: 10.1097/md.0000000000025736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AIM Low vision rehabilitation optimizes the use of residual vision after severe vision loss, but also teaches skills to improve visual functioning in daily life. These skills promote independence and active participation in society. This meta-analysis was designed to evaluate the efficacy of low vision rehabilitation in improving the quality of life (QoL) in visually impaired adults. METHODS We searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to January 1, 2020. Randomized controlled trials (RCTs) that compared rehabilitation interventions with active or inactive controls were included. The standardized mean difference (SMD) with a 95% confidence interval (CI) was estimated to compare outcomes. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2. RESULTS A total of 52 RCTs with 6,239 participants were included in this meta-analysis. Compared to inactive comparators including waiting list or no care, low vision rehabilitation improved vision-related QoL, visual functioning (QoL: psychological aspect), and self-efficacy or self-esteem (QoL: psychological aspect), with pooled SMDs of -0.61 (95% CI -0.95 to -0.26; P = .0006), -1.14 (95% CI -1.69 to -0.59; P < .0001), and -0.84 (95% CI -1.47 to -0.22; P < .0001), respectively. Compared to active comparators, low vision rehabilitation improved vision-related QoL (SMD -0.26; 95% CI -0.46 to -0.06; P = .01) and activities of daily living (QoL: physical aspect) (SMD -0.39; 95% CI -0.67 to -0.12 P < .0001). However, no significant difference in health-related QoL and adaptation to vision loss (QoL: psychological aspect) was found between low vision rehabilitation and inactive comparators. CONCLUSIONS This meta-analysis indicated that low vision rehabilitation interventions, particularly psychological therapies and methods of enhancing vision, may improve vision-related QoL and visual functioning in people with sight loss compared to usual care. Further studies should explore longer maintenance effects and the costs of several types of low vision rehabilitation. Studies characterizing the mechanisms of rehabilitation interventions in different settings, including low-income countries, are also required.
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Affiliation(s)
- Jianhua Liu
- Department of Physical Therapy, Beijing Bo'ai Hospital, Chinese Rehabilitation Research Centre
| | - Jige Dong
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine
| | - Yaping Chen
- Department of Rehabilitation Medicine, Beijing Tongren Hospital of Capital Medical University
| | - Weidong Zhang
- Department of Rehabilitation Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University
| | - Shuai Tong
- Department of Rehabilitation Medicine, Beijing Haidian Hospital, Beijing
| | - Jiangzhou Guo
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine
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Dillon L, Gandhi S, Tang D, Liew G, Hackett M, Craig A, Mitchell P, Keay L, Gopinath B. Perspectives of people with late age‐related macular degeneration on mental health and mental wellbeing programmes: a qualitative study. Ophthalmic Physiol Opt 2021; 41:255-265. [DOI: 10.1111/opo.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Lisa Dillon
- School of Optometry and Vision Science University of New South Wales Sydney Kensington Australia
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
| | - Sarthak Gandhi
- Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
- Faculty of Medicine and Health The University of Sydney Sydney Australia
| | - Diana Tang
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Gerald Liew
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Maree Hackett
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
- Faculty of Health and Wellbeing University of Central Lancashire Preston United Kingdom
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research Northern Clinical School Faculty of Medicine and Health The University of Sydney St. Leonards Australia
| | - Paul Mitchell
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
| | - Lisa Keay
- School of Optometry and Vision Science University of New South Wales Sydney Kensington Australia
- Faculty of Medicine The George Institute for Global Health The University of New South Wales Sydney The Newtown Australia
| | - Bamini Gopinath
- Centre for Vision Research Department of Ophthalmology The Westmead Institute for Medical Research The University of Sydney Sydney Australia
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Demmin DL, Silverstein SM. Visual Impairment and Mental Health: Unmet Needs and Treatment Options. Clin Ophthalmol 2020; 14:4229-4251. [PMID: 33299297 PMCID: PMC7721280 DOI: 10.2147/opth.s258783] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/06/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose An estimated 2.2 billion people are visually impaired worldwide. Given that age-related vision loss is a primary cause of vision impairment, this number is projected to rise with increases in average lifespan. Vision loss often results in significant disability and is associated with a substantial economic burden, reduced quality-of-life, concurrent medical issues, and mental health problems. In this review, the mental health needs of people with vision impairment are examined. Patients and methods A review of recent literature on mental health outcomes and current treatments in people with visual impairment was conducted. Results Considerable data indicate that rates of depression and anxiety are elevated among people with visual impairments. Moreover, individuals of lower socioeconomic status may be at increased risk for vision impairment and subsequent mental health problems. Existing psychosocial interventions for improving mental health in people with visual impairment show some promise, but are limited by low adherence and lack generalizability. Conclusion In order to improve outcomes, a better understanding of the mechanisms linking visual impairment and poor mental health is needed. It will also be essential to develop more effective interventions and expand access to services to improve the detection and treatment of mental health problems in this population.
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Affiliation(s)
- Docia L Demmin
- Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester, Rochester, NY, USA
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Rees G, McCabe M, Xie J, Constantinou M, Gan A, Holloway E, Man RE, Jackson J, Fenwick EK, Lamoureux E. High vision-related quality of life indices reduce the odds of depressive symptoms in aged care facilities. Aging Ment Health 2020; 24:1596-1604. [PMID: 31392896 DOI: 10.1080/13607863.2019.1650889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To examine the association between vision-related quality of life (VRQoL) and depressive symptoms in residents with vision impairment (VI) in aged care facilities.Methods: In this cross-sectional study using baseline data from a cluster-randomized controlled trial (ACTRN12615000587505) assessing the effectiveness of a novel eye care model, 186 English-speaking residents (mean age 84 years, SD[standard deviation] = 8.7; 33.9% male) with VI and moderate cognitive functioning or better were recruited from 38 facilities across Victoria, Australia. VRQoL was measured using Rasch-transformed scores from the 'Reading'; 'Mobility', and 'Emotional' scales of the Impact of Vision Impairment for Residential Care (IVI-RC) questionnaire. Outcomes were presence of depressive symptoms (binary score: Cornell Scale for Depression in Dementia [CSDD] > 0 vs. CSDD = 0) and severity of depressive symptoms (continuous CSDD score; sample range 1-21). Independent associations with presence and severity of depressive symptoms were examined using zero-inflated logistic and linear multivariable models, respectively.Results: Of the 186 participants, n = 79 (42.5%), n = 94 (50.5%) and n = 13 (7%) reported no, mild (scores 1-7), and clinically significant depressive symptoms (score ≥8), respectively. Better vision-related Mobility (OR = 0.64; 95% CI: 0.44, 0.95, p = 0.02) was associated with reduced odds of depressive symptoms. With every unit improvement in vision-related Reading (β=-0.48; 95% CI: -0.94, -0.01, p = 0.04) and Emotional (β=-0.56; 95% CI: -1.09, -0.02, p = 0.04), severity of depressive symptoms reduced, independent of sociodemographic and medical issues.Conclusion: Better VRQoL was independently associated with reduced depressive symptoms. Supporting older people in aged care to maintain optimal levels of vision-specific functioning, independence, and emotional well-being may protect their mental health.
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Affiliation(s)
- Gwyneth Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Marita McCabe
- Institute for Health and Aging, Australian Catholic University, Australia
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Marios Constantinou
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Alfred Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Edith Holloway
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Ryan Ek Man
- Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jonathon Jackson
- Department of Ophthalmology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom.,Australian College of Optometry, Victoria, Australia
| | - Eva K Fenwick
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia.,Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Victoria, Australia.,University of Melbourne, Department of Surgery, Melbourne, Australia.,Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, National University of Singapore and National University Health System, Singapore
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9
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E JY, Li T, McInally L, Thomson K, Shahani U, Gray L, Howe TE, Skelton DA. Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual impairment. Cochrane Database Syst Rev 2020; 9:CD009233. [PMID: 32885841 PMCID: PMC8095028 DOI: 10.1002/14651858.cd009233.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Impairment of vision is associated with a decrease in activities of daily living. Avoidance of physical activity in older adults with visual impairment can lead to functional decline and is an important risk factor for falls. The rate of falls and fractures is higher in older people with visual impairment than in age-matched visually normal older people. Possible interventions to reduce activity restriction and prevent falls include environmental and behavioral interventions. OBJECTIVES We aimed to assess the effectiveness and safety of environmental and behavioral interventions in reducing physical activity limitation, preventing falls and improving quality of life amongst visually impaired older people. SEARCH METHODS We searched CENTRAL (including the Cochrane Eyes and Vision Trials Register) (Issue 2, 2020), Ovid MEDLINE, Embase and eight other databases to 4 February 2020, with no language restrictions. SELECTION CRITERIA Eligible studies were randomized controlled trials (RCTs) and quasi-randomized controlled trials (Q-RCTs) that compared environmental interventions, behavioral interventions or both, versus control (usual care or no intervention); or that compared different types of environmental or behavioral interventions. Eligible study populations were older people (aged 60 and over) with irreversible visual impairment, living in their own homes or in residential settings. To be eligible for inclusion, studies must have included a measure of physical activity or falls, the two primary outcomes of interest. Secondary outcomes included fear of falling, and quality of life. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included six RCTs (686 participants) conducted in five countries (Australia, Hungary, New Zealand, UK, US) with follow-up periods ranging from two to 12 months. Participants in these trials included older adults (mean age 80 years) and were mostly female (69%), with visual impairments of varying severity and underlying causes. Participants mostly lived in their homes and were physically independent. We classified all trials as having high risk of bias for masking of participants, and three trials as having high or unclear risk of bias for all other domains. The included trials evaluated various intervention strategies (e.g. an exercise program versus home safety modifications). Heterogeneity of study characteristics, including interventions and outcomes, (e.g. different fall measures), precluded any meta-analysis. Two trials compared the home safety modification by occupational therapists versus social/home visits. One trial (28 participants) reported physical activity at six months and showed no evidence of a difference in mean estimates between groups (step counts: mean difference (MD) = 321, 95% confidence interval (CI) -1981 to 2623; average walking time (minutes): MD 1.70, 95% CI -24.03 to 27.43; telephone questionnaire for self-reported physical activity: MD -3.68 scores, 95% CI -20.6 to 13.24; low-certainty of evidence for each outcome). Two trials reported the proportion of participants who fell at six months (risk ratio (RR) 0.76, 95% CI 0.38 to 1.51; 28 participants) and 12 months (RR 0.59, 95% CI 0.43 to 0.80, 196 participants) with low-certainty of evidence for each outcome. One trial (28 participants) reported fear of falling at six months, using the Short Falls Efficacy Scale-International, and found no evidence of a difference in mean estimates between groups (MD 2.55 scores, 95% CI -0.51 to 5.61; low-certainty of evidence). This trial also reported quality of life at six months using 12-Item Short Form Health Survey, and showed no evidence of a difference in mean estimates between groups (MD -3.14 scores, 95% CI -10.86 to 4.58; low-certainty of evidence). Five trials compared a behavioral intervention (exercise) versus usual activity or social/home visits. One trial (59 participants) assessed self-reported physical activity at six months and showed no evidence of a difference between groups (MD 9.10 scores, 95% CI -13.85 to 32.5; low-certainty of evidence). Three trials investigated different fall measures at six or 12 months, and found no evidence of a difference in effect estimates (RRs for proportion of fallers ranged from 0.54 (95% CI 0.29 to 1.01; 41 participants); to 0.93 (95% CI 0.61 to 1.39; 120 participants); low-certainty of evidence for each outcome). Three trials assessed the fear of falling using Short Falls Efficacy Scale-International or the Illinois Fear of Falling Measure from two to 12 months, and found no evidence of a difference in mean estimates between groups (the estimates ranged from -0.88 score (95% CI -2.72 to 0.96, 114 participants) to 1.00 score (95% CI -0.13 to 2.13; 59 participants); low-certainty of evidence). One trial (59 participants) assessed the European Quality of Life scale at six months (MD -0.15 score, 95% CI -0.29 to -0.01), and found no evidence of a clinical difference between groups (low-certainty of evidence). AUTHORS' CONCLUSIONS There is no evidence of effect for most of the environmental or behavioral interventions studied for reducing physical activity limitation and preventing falls in visually impaired older people. The certainty of evidence is generally low due to poor methodological quality and heterogeneous outcome measurements. Researchers should form a consensus to adopt standard ways of measuring physical activity and falls reliably in older people with visual impairments. Fall prevention trials should plan to use objectively measured or self-reported physical activity as outcome measures of reduced activity limitation. Future research should evaluate the acceptability and applicability of interventions, and use validated questionnaires to assess the adherence to rehabilitative strategies and performance during activities of daily living.
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Affiliation(s)
- Jian-Yu E
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Uma Shahani
- Department of Visual Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lyle Gray
- Life Sceince, Glasgow Caledonian University, Glasgow, UK
| | | | - Dawn A Skelton
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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10
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Wong AKC, Wong FKY. The psychological impact of a nurse-led proactive self-care program on independent, non-frail community-dwelling older adults: A randomized controlled trial. Int J Nurs Stud 2020; 110:103724. [PMID: 32777605 DOI: 10.1016/j.ijnurstu.2020.103724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Poor mental health is common later in life and is a crucial factor in determining older adults' ability to live independently in the community. Existing nurse-led proactive self-care programs for older adults focus on physical health, since many are living with chronic diseases. Little is known about their effectiveness on the psychological outcomes of independent, non-frail community-dwelling older adults. AIM The aim of this study was to examine the impact of a nurse-led proactive self-care program with a health-social partnership model for community-dwelling older adults on depressive symptoms, life satisfaction, and the mental component of health-related quality of life. DESIGN AND METHODS This was a single-blinded, randomized controlled trial. Adults aged 60 or over who lived within the service areas and scored ≥ 18 in the Mini-Mental Status Examination were included. Data were collected using questionnaires pre- (T1), post- (T2), and three month after the intervention (T3). The program provided a comprehensive assessment, health and self-management information, and empowerment, and promoted the accessibility of community services by building a health-social partnership network in the community. Generalized Estimating Equation was used to calculate the group, time, and interaction effects. Intention-to-treat was employed as the primary analysis in this study. RESULTS Of the 843 potential community-dwelling older adults who were assessed for eligibility, 457 eligible participants were randomized into the intervention (n = 230) or control group (n = 227). Among them, 175 (76.0%) participants in the intervention group and 190 (83.7%) participants in the control group completed data collection at T3, 6 months after T2 at the completion of the program. The results showed a significant time effect between T1 and T2 (Wald χ2 = 25.7, p < .001) and T1 and T3 (Wald χ2 = 7.40, p = .007) in terms of the presence of depressive symptoms. CONCLUSIONS Interprofessional care addressing health and social needs improves the depressive symptoms among older adults dwelling in the community.
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Guo J, Dong J, Chen Y, Zhang W, Tong S, Liu J. WITHDRAWN:The efficacy of low vision rehabilitation in improving the quality of life for patients with impaired vision: a systematic review and meta-analysis of 46 randomized clinical trials. Int J Surg 2020:S1743-9191(20)30519-7. [PMID: 32650120 DOI: 10.1016/j.ijsu.2020.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/06/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Jiangzhou Guo
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, 100102
| | - Jige Dong
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, 100102
| | - Yaping Chen
- Department of Rehabilitation Medicine, Beijing Tongren Hospital of Capital Medical University, Beijing, 100073
| | - Weidong Zhang
- Department of Rehabilitation Medicine, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, 101149
| | - Shuai Tong
- Department of Rehabilitation Medicine, Beijing Haidian Hospital, Beijing, 100080
| | - Jianhua Liu
- Department of Physical Therapy, Beijing Bo'ai Hospital, Chinese Rehabilitation Research Centre, Beijing, 100068
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SARS-CoV-2 self-isolation: recommendations for people with a vision impairment. Eye (Lond) 2020; 34:1183-1184. [PMID: 32350453 PMCID: PMC7189829 DOI: 10.1038/s41433-020-0917-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/08/2022] Open
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Liu CJ, Chang MC. Interventions Within the Scope of Occupational Therapy Practice to Improve Performance of Daily Activities for Older Adults With Low Vision: A Systematic Review. Am J Occup Ther 2020; 74:7401185010p1-7401185010p18. [PMID: 32078506 PMCID: PMC7018463 DOI: 10.5014/ajot.2020.038372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The prevalence of low vision increases with age. Low vision has detrimental effects on older adults' independence. OBJECTIVE To identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities for older adults with low vision. DATA SOURCES Literature published between 2010 and 2017 was searched in CINAHL, Cochrane Databases, MEDLINE, OTseeker, and PsycINFO. STUDY SELECTION AND DATA COLLECTION The authors screened and appraised studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Studies were eligible if the participants' mean age was 55 yr or older, the level of evidence was Level III or higher, the intervention was within the scope of occupational therapy practice, and the outcome measures assessed the performance of daily activities. FINDINGS Fourteen studies met the review criteria. Three intervention themes were identified: low vision rehabilitation services (n = 6), self-management approach (n = 6), and tango (n = 2). Moderate evidence was found for low vision rehabilitation services. Low evidence was found for using the self-management approach or adding the self-management approach to existing low vision rehabilitation services. Low evidence was found for tango. CONCLUSION AND RELEVANCE This systematic review supports the use of low vision rehabilitation services as an effective approach. Occupational therapy practitioners are encouraged to be part of multidisciplinary teams that offer comprehensive low vision evaluations and multicomponent services. WHAT THIS ARTICLE ADDS Low vision rehabilitation that offers multidisciplinary services, including occupational therapy, is effective in promoting independence among older adults with low vision.
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Affiliation(s)
- Chiung-Ju Liu
- Chiung-ju Liu, PhD, OTR/L, FGSA, was Associate Professor, School of Human and Health Sciences, Indiana University, Indianapolis, at the time of the study. She is now Associate Professor, College of Public Health and Health Professions, University of Florida, Gainesville;
| | - Megan C Chang
- Megan C. Chang, PhD, OTR/L, is Associate Professor, College of Health and Human Sciences, San Jose State University, San Jose, CA
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Kaldenberg J, Smallfield S. Occupational Therapy Practice Guidelines for Older Adults With Low Vision. Am J Occup Ther 2020; 74:7402397010p1-7402397010p23. [DOI: 10.5014/ajot.2020.742003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision.
Objective: This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation.
Method: We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research.
Results: Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice.
Conclusions and Recommendations: Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation.
What This Article Adds: This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Clinical Assistant Professor and Academic Fieldwork and Capstone Coordinator, Department of Occupational Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA;
| | - Stacy Smallfield
- Stacy Smallfield, DrOT, OTR/L, BCG, FAOTA, is Associate Professor of Occupational Therapy and Medicine and Assistant Director of Entry-Level Programs, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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van Nispen RMA, Virgili G, Hoeben M, Langelaan M, Klevering J, Keunen JEE, van Rens GHMB. Low vision rehabilitation for better quality of life in visually impaired adults. Cochrane Database Syst Rev 2020; 1:CD006543. [PMID: 31985055 PMCID: PMC6984642 DOI: 10.1002/14651858.cd006543.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in daily life. Other aims include helping people to adapt to permanent vision loss and improving psychosocial functioning. These skills promote independence and active participation in society. Low vision rehabilitation should ultimately improve quality of life (QOL) for people who have visual impairment. OBJECTIVES To assess the effectiveness of low vision rehabilitation interventions on health-related QOL (HRQOL), vision-related QOL (VRQOL) or visual functioning and other closely related patient-reported outcomes in visually impaired adults. SEARCH METHODS We searched relevant electronic databases and trials registers up to 18 September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating HRQOL, VRQOL and related outcomes of adults, with an irreversible visual impairment (World Health Organization criteria). We included studies that compared rehabilitation interventions with active or inactive control. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 44 studies (73 reports) conducted in North America, Australia, Europe and Asia. Considering the clinical diversity of low vision rehabilitation interventions, the studies were categorised into four groups of related intervention types (and by comparator): (1) psychological therapies and/or group programmes, (2) methods of enhancing vision, (3) multidisciplinary rehabilitation programmes, (4) other programmes. Comparators were no care or waiting list as an inactive control group, usual care or other active control group. Participants included in the reported studies were mainly older adults with visual impairment or blindness, often as a result of age-related macular degeneration (AMD). Study settings were often hospitals or low vision rehabilitation services. Effects were measured at the short-term (six months or less) in most studies. Not all studies reported on funding, but those who did were supported by public or non-profit funders (N = 31), except for two studies. Compared to inactive comparators, we found very low-certainty evidence of no beneficial effects on HRQOL that was imprecisely estimated for psychological therapies and/or group programmes (SMD 0.26, 95% CI -0.28 to 0.80; participants = 183; studies = 1) and an imprecise estimate suggesting little or no effect of multidisciplinary rehabilitation programmes (SMD -0.08, 95% CI -0.37 to 0.21; participants = 183; studies = 2; I2 = 0%); no data were available for methods of enhancing vision or other programmes. Regarding VRQOL, we found low- or very low-certainty evidence of imprecisely estimated benefit with psychological therapies and/or group programmes (SMD -0.23, 95% CI -0.53 to 0.08; studies = 2; I2 = 24%) and methods of enhancing vision (SMD -0.19, 95% CI -0.54 to 0.15; participants = 262; studies = 5; I2 = 34%). Two studies using multidisciplinary rehabilitation programmes showed beneficial but inconsistent results, of which one study, which was at low risk of bias and used intensive rehabilitation, recorded a very large and significant effect (SMD: -1.64, 95% CI -2.05 to -1.24), and the other a small and uncertain effect (SMD -0.42, 95%: -0.90 to 0.07). Compared to active comparators, we found very low-certainty evidence of small or no beneficial effects on HRQOL that were imprecisely estimated with psychological therapies and/or group programmes including no difference (SMD -0.09, 95% CI -0.39 to 0.20; participants = 600; studies = 4; I2 = 67%). We also found very low-certainty evidence of small or no beneficial effects with methods of enhancing vision, that were imprecisely estimated (SMD -0.09, 95% CI -0.28 to 0.09; participants = 443; studies = 2; I2 = 0%) and multidisciplinary rehabilitation programmes (SMD -0.10, 95% CI -0.31 to 0.12; participants = 375; studies = 2; I2 = 0%). Concerning VRQOL, low-certainty evidence of small or no beneficial effects that were imprecisely estimated, was found with psychological therapies and/or group programmes (SMD -0.11, 95% CI -0.24 to 0.01; participants = 1245; studies = 7; I2 = 19%) and moderate-certainty evidence of small effects with methods of enhancing vision (SMD -0.24, 95% CI -0.40 to -0.08; participants = 660; studies = 7; I2 = 16%). No additional benefit was found with multidisciplinary rehabilitation programmes (SMD 0.01, 95% CI -0.18 to 0.20; participants = 464; studies = 3; I2 = 0%; low-certainty evidence). Among secondary outcomes, very low-certainty evidence of a significant and large, but imprecisely estimated benefit on self-efficacy or self-esteem was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -0.85, 95% CI -1.48 to -0.22; participants = 456; studies = 5; I2 = 91%). In addition, very low-certainty evidence of a significant and large estimated benefit on depression was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -1.23, 95% CI -2.18 to -0.28; participants = 456; studies = 5; I2 = 94%), and moderate-certainty evidence of a small benefit versus usual care (SMD -0.14, 95% CI -0.25 to -0.04; participants = 1334; studies = 9; I2 = 0%). ln the few studies in which (serious) adverse events were reported, these seemed unrelated to low vision rehabilitation. AUTHORS' CONCLUSIONS In this Cochrane Review, no evidence of benefit was found of diverse types of low vision rehabilitation interventions on HRQOL. We found low- and moderate-certainty evidence, respectively, of a small benefit on VRQOL in studies comparing psychological therapies or methods for enhancing vision with active comparators. The type of rehabilitation varied among studies, even within intervention groups, but benefits were detected even if compared to active control groups. Studies were conducted on adults with visual impairment mainly of older age, living in high-income countries and often having AMD. Most of the included studies on low vision rehabilitation had a short follow-up, Despite these limitations, the consistent direction of the effects in this review towards benefit justifies further research activities of better methodological quality including longer maintenance effects and costs of several types of low vision rehabilitation. Research on the working mechanisms of components of rehabilitation interventions in different settings, including low-income countries, is also needed.
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Affiliation(s)
- Ruth MA van Nispen
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
| | - Gianni Virgili
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Palagi, 1FlorenceItaly50134
| | - Mirke Hoeben
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
| | - Maaike Langelaan
- Netherlands institute for health services, NIVEL researchP.O. Box 1568UtrechtNetherlands3500 BN
| | - Jeroen Klevering
- Radboud University Medical CenterDepartment of OphthalmologyNijmegenNetherlands
| | - Jan EE Keunen
- Radboud University Medical CenterDepartment of OphthalmologyNijmegenNetherlands
| | - Ger HMB van Rens
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
- Elkerliek HospitalDepartment of OphthalmologyHelmondNetherlands
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Optimizing measurement of vision-related quality of life: a computerized adaptive test for the impact of vision impairment questionnaire (IVI-CAT). Qual Life Res 2019; 29:765-774. [PMID: 31707693 DOI: 10.1007/s11136-019-02354-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the results from a simulated computerized adaptive test (CAT) for the 28-item Impact of Vision Impairment (IVI) questionnaire and the original paper-pencil version in terms of efficiency (main outcome), defined as percentage item reduction. METHODS Using paper-pencil IVI data from 832 participants across the spectrum of vision impairment, item calibrations of the 28-item IVI instrument and its associated 20-item vision-specific functioning (VSF) and 8-item emotional well-being (EWB) subscales were generated with Rasch analysis. Based on these calibrations, CAT simulations were conducted on 1000 cases, with 'high' and 'moderate' precision stopping rules (standard error of measurement [SEM] 0.387 and 0.521, respectively). We examined the average number of items needed to satisfy the stopping rules and the corresponding percentage item reduction, level of agreement between person measures estimated from the full IVI item bank and from the CAT simulations, and item exposure rates (IER). RESULTS For the overall IVI-CAT, 5 or 9.7 items were required, on average, to obtain moderate or high precision estimates of vision-related quality of life, corresponding to 82.1 and 65.4% item reductions compared to the paper-pencil IVI. Agreement was high between the person measures generated from the full IVI item bank and the IVI-CAT for both the high precision simulation (mean bias, - 0.004 logits; 95% LOA - 0.594 to 0.587) and moderate precision simulation (mean bias, 0.014 logits; 95% LOA - 0.828 to 0.855). The IER for the IVI-CAT in the moderate precision simulation was skewed, with six EWB items used > 40% of the time. CONCLUSION Compared to the paper-pencil IVI instrument, the IVI-CATs required fewer items without loss of measurement precision, making them potentially attractive outcome instruments for implementation into clinical trials, healthcare, and research. Final versions of the IVI-CATs are available.
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17
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Senra H, Macedo AF, Nunes N, Balaskas K, Aslam T, Costa E. Psychological and Psychosocial Interventions for Depression and Anxiety in Patients With Age-Related Macular Degeneration: A Systematic Review. Am J Geriatr Psychiatry 2019; 27:755-773. [PMID: 31005495 DOI: 10.1016/j.jagp.2019.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To review the current literature on psychosocial and psychological interventions to prevent and treat depression and anxiety in patients with age-related macular degeneration (AMD). METHODS The authors conducted a systematic review of literature evaluating psychosocial and psychological interventions for depression and anxiety in patients with AMD. Primary searches of PubMed, Cochrane library, EMBASE, Global Health, Web of Science, EBSCO, and Science Direct were conducted to include all articles published up to April 21, 2018. RESULTS Of a total of 398 citations retrieved, the authors selected 12 eligible studies published between 2002 and 2016. The authors found nine randomized controlled trials (RCT), and three non-randomized intervention (NRI) studies. RCT studies suggested that interventions using group self-management techniques and individual behavioral activation plus low vision rehabilitation can be effective to treat and prevent depression in patients with AMD, and one study suggested that a stepped-care intervention using cognitive-behavioral techniques can be effective to manage anxiety and depression over time. NRI studies highlighted a positive effect of self-help and emotion-focused interventions to reduce depression. CONCLUSION Clinical practice with patients with AMD can rely on some tailored cognitive-behavioral therapeutic protocols to improve patients' mental health, but further clinical trials will generate the necessary evidence-based knowledge to improve those therapeutic techniques and offer additional tailored interventions for patients with AMD.
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Affiliation(s)
- Hugo Senra
- Institute of Psychiatry, Psychology and Neuroscience (HS), King's College London, London
| | - António Filipe Macedo
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden; Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal
| | - Nuno Nunes
- Centre of Psychology, Faculty of Psychology and Educational Sciences (NN, EC), University of Porto, Porto, Portugal
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Tariq Aslam
- Division of Pharmacy and Optometry (TA), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Royal Eye Hospital (TA), Central Manchester Foundation Trust, Manchester, UK
| | - Emilia Costa
- Centre of Psychology, Faculty of Psychology and Educational Sciences (NN, EC), University of Porto, Porto, Portugal
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18
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Tey CS, Man REK, Fenwick EK, Aw AT, Drury V, Chiang PPC, Lamoureux EL. Effectiveness of the "living successfully with low vision" self-management program: Results from a randomized controlled trial in Singaporeans with low vision. PATIENT EDUCATION AND COUNSELING 2019; 102:1150-1156. [PMID: 30712946 DOI: 10.1016/j.pec.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the effectiveness of the "Living Successfully with Low Vision" (LSLV) self-management program to improve patient-reported outcomes in Singaporeans. METHODS In this randomized controlled trial, 165 participants with low vision (LV) were recruited and assigned to usual care (LV aid training only; N = 82) or LSLV program (N = 83). The LSLV program focuses on problem solving, coping mechanism and anticipation/preparation for future needs. The primary outcome was vision-related quality of life (VRQoL; measured using the Impact of Vision Impairment [IVI] questionnaire), while secondary outcomes included health-related quality of life; mental health; and self-efficacy, assessed at baseline, 2-weeks and 6-months post-intervention. Within- and between-group comparisons were conducted using paired t-tests and repeated measures analysis of covariance, respectively. RESULTS A total of 128 individuals (77.6%) completed all assessments. At 2 weeks, LSLV participants alone experienced a significant within-group improvement in the mean IVI Emotional score (P = 0.05) but not at 6 months. No other within- or between-group effects were observed. CONCLUSION While SM programs have shown promising results in the management of many chronic diseases, our findings suggest that the LVSM program was not an effective approach for LV rehabilitation in Singapore. PRACTICE IMPLICATION Other evidence-based strategies to improve QoL in patients with LV may be warranted.
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Affiliation(s)
- Ching Siong Tey
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Ai Tee Aw
- Singapore National Eye Centre, Singapore
| | - Vicki Drury
- Singapore National Eye Centre, Singapore; Curtin University, Perth, Australia
| | | | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore.
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19
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Tan AC, Man R, Wong CW, Lee SY, Lamoureux EL, Ang M. Randomized controlled trial evaluating a novel community eye care programme for elderly individuals with visual impairment. Clin Exp Ophthalmol 2018; 46:593-599. [PMID: 29282844 DOI: 10.1111/ceo.13140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
Abstract
IMPORTANCE The novel intervention was effective at improving compliance to appropriate tertiary eye care after community eye screening. BACKGROUND Elderly individuals from low socio-economic background with visual impairment (VI) often do not attend tertiary care, even if significant eye diseases are detected while in the community. We evaluate a novel incentive care scheme (ICS) to improve compliance to appropriate follow-up after community eye screening. DESIGN Randomized controlled trial in a population-based setting was conducted. PARTICIPANTS A total of 140 elderly individuals with VI (visual acuity <6/12, mean age ± SD = 66.6 ± 8.9 years, 46.4% female) were included. METHODS Participants were randomized to either ICS (N = 72) or usual care (UC; N = 68). ICS incorporated patient education, social support and financial assistance to assist individuals in attending tertiary eye care. UC comprised of a standard referral letter and advice. MAIN OUTCOME MEASURE Primary outcome included compliance to eye care referral. Secondary outcomes included best-corrected visual acuity and vision-related quality of life assessed at baseline and 3 months. RESULTS Participants receiving the ICS intervention had higher rates of compliance to tertiary eye care attendance compared to UC (31.9% vs. 16.2%, respectively, P = 0.027). While we observed an overall significant improvement in best-corrected visual acuity at 3 months in both groups (P < 0.05), we found no significant differences in Rasch-transformed vision-related quality of life scores between groups (all P > 0.05). Identified barriers for tertiary healthcare access included patient attitudes and financial- and health-related barriers. CONCLUSION AND RELEVANCE Our pilot RCT found that ICS improved adherence to appropriate tertiary eye care referrals after community eye screening in elderly people with VI.
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Affiliation(s)
- Anna Cs Tan
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Ryan Man
- Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore
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Lionis C, Midlöv P. Prevention in the elderly: A necessary priority for general practitioners. Eur J Gen Pract 2017; 23:202-207. [PMID: 28762840 PMCID: PMC5806089 DOI: 10.1080/13814788.2017.1350646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022] Open
Abstract
Prevention is viewed as a key issue for general practice, yet there is a lack of evidence regarding general practitioners' interventions in both middle-aged and elderly people. This is despite the fact that recommendations and key indicators for monitoring the use of clinical preventive strategies aimed at these groups are available and that both the World Health Organization and European Commission endorse the importance of interventions for healthy and active ageing. This paper draws on two keynote presentations given at the 2015 autumn meeting of the European General Practice Research Network (EGPRN) in Edirne, Turkey (17-20 October 2015). According to the EU2020 strategy, general practitioners should design and implement prevention services and programmes to promote healthy and active ageing. Their primary focus should be on interventions on multimorbid patients, either by improving prescribing and adherence to medical plans or by targeting to fall and frailty prevention and vaccination uptake.
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Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of CreteCreteGreece
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Skåne University HospitalMalmöSweden
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21
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van der Aa HPA, Margrain TH, van Rens GHMB, Heymans MW, van Nispen RMA. Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis. Ophthalmic Physiol Opt 2017; 36:584-606. [PMID: 27580757 DOI: 10.1111/opo.12313] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To systematically assess the literature on psychosocial interventions to improve mental health (i.e. depression, anxiety, mental fatigue, loneliness, psychological stress and psychological well-being) in visually impaired adults (≥18 years). METHODS The databases Medline, Embase and Psychinfo were searched for relevant studies, which were categorised into randomised controlled trials (RCTs), non-RCTs and before and after comparisons (BA). The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Standardised mean differences (SMD) were calculated to quantitatively summarise the outcomes of the RCTs and non-RCTs in a meta-analysis. Meta-regression was used to explore sources of heterogeneity in the data. RESULTS The search identified 27 papers (published between 1981 and 2015), describing the outcomes of 22 different studies (14 RCTs, four non-RCTs, and four BAs). Pooled analyses showed that interventions significantly reduced depressive symptoms (SMD -0.30, 95% confidence interval (CI) -0.60 to -0.01), while effects on anxiety symptoms, mental fatigue, psychological stress and psychological well-being were non-significant. Meta-regression analyses showed homogeneity in effect sizes across a range of intervention, population, and study characteristics. Only a higher age of participants was associated with less effective results on depressive symptoms (b = 0.03, 95% CI 0.01 to 0.05), psychological stress (b = 0.07, 95% CI 0.01 to 0.13) and psychological well-being (b = -0.03, 95% CI -0.05 to 0.01). However, after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant, while the influence of age on psychological well-being remained. CONCLUSIONS There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision. More well-designed trials are needed with specific attention for interventions tailored to the needs of elderly patients.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Tom H Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Ger H M B van Rens
- Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.,Department of Ophthalmology, Elkerliek Hospital, Helmond, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and the EMGO+ institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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22
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Kamga H, McCusker J, Yaffe M, Sewitch M, Sussman T, Strumpf E, Olivier S, Wittich W, Moghadaszadeh S, Freeman EE. Self-care tools to treat depressive symptoms in patients with age-related eye disease: a randomized controlled clinical trial. Clin Exp Ophthalmol 2017; 45:371-378. [DOI: 10.1111/ceo.12890] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/24/2016] [Accepted: 11/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Mark Yaffe
- McGill University; Montreal Quebec Canada
| | | | | | | | - Sébastien Olivier
- Maisonneuve-Rosemont Hospital; Montreal Quebec Canada
- Department of Ophthalmology; University of Montreal; Montreal Quebec Canada
| | - Walter Wittich
- School of Optometry; University of Montreal; Montreal Quebec Canada
| | | | - Ellen E Freeman
- Maisonneuve-Rosemont Hospital; Montreal Quebec Canada
- Department of Ophthalmology; University of Montreal; Montreal Quebec Canada
- School of Epidemiology, Public Health, and Preventive Medicine; University of Ottawa; Ottawa Ontario Canada
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23
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Yarar F, Cavlak U, Başakcı Çalık B. Applying the International Classification of Functioning, Disability, and Health in children with low vision: differences between raters. Turk J Med Sci 2016; 46:1694-1699. [PMID: 28081311 DOI: 10.3906/sag-1506-152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 02/21/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM This study was conducted to analyze the agreement between International Classification of Functioning, Disability, and Health (ICF) raters and to show its applicability in children with low vision. MATERIALS AND METHODS Twenty children (mean age: 11.70 ± 1.92 years) were included. To evaluate the independency of the sample, the Northwick Park Activities Daily Living questionnaire was used. The Low Vision Quality of Life Scale was used to evaluate quality of life. An ICF core set was developed to be used in this study. The core set consisted of 13 items for body functions, 3 items for body structures, 36 items for activity and participation, and 12 items for environmental factors. RESULTS High agreement was found between two raters in terms of subparameters of the ICF core set for activity and participation (r = 0.880, P = 0.000). CONCLUSION The findings indicate that the raters showed strong agreement in terms of the ICF core set used in this study. This shows that the core set can be used to evaluate activity and participation of children with low vision.
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Affiliation(s)
- Feride Yarar
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Uğur Cavlak
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Bilge Başakcı Çalık
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
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Fenwick EK, Man REK, Rees G, Keeffe J, Wong TY, Lamoureux EL. Reducing respondent burden: validation of the Brief Impact of Vision Impairment questionnaire. Qual Life Res 2016; 26:479-488. [DOI: 10.1007/s11136-016-1395-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2016] [Indexed: 02/01/2023]
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25
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Cimarolli VR, Casten RJ, Rovner BW, Heyl V, Sörensen S, Horowitz A. Anxiety and depression in patients with advanced macular degeneration: current perspectives. Clin Ophthalmol 2015; 10:55-63. [PMID: 26766899 PMCID: PMC4699633 DOI: 10.2147/opth.s80489] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD.
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Affiliation(s)
| | - Robin J Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry W Rovner
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Department of Psychiatry, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Vera Heyl
- Institute of Special Education, University of Education, Heidelberg, Germany
| | - Silvia Sörensen
- Warner School of Education and Human Development, University of Rochester, Rochester, NY, USA; Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, NY, USA
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Latham K, Baranian M, Timmis M, Pardhan S. Emotional Health of People with Visual Impairment Caused by Retinitis Pigmentosa. PLoS One 2015; 10:e0145866. [PMID: 26713624 PMCID: PMC4705104 DOI: 10.1371/journal.pone.0145866] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/09/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To understand the emotional difficulties associated with living with the ocular condition Retinitis Pigmentosa, and to examine the functioning of a self-report instrument used to assess this construct. Methods The difficulty of goals and tasks in the emotional health domain of the Dutch ICF Activity Inventory were rated by 166 people with Retinitis Pigmentosa in a cross-sectional study. Demographic factors were also assessed. Results Responses to the 23 emotional health tasks were Rasch analysed and could be used to form either one 20 item overview scale with some multidimensionality, or three unidimensional subscales addressing feelings (4 items), communicating visual loss (5 items) and fatigue (7 items). The most difficult individual tasks related to communicating visual loss to other people, and dealing with feelings such as frustration, anxiety and stress. The use of mobility aids and female gender were associated with increased difficulty with emotional health, explaining 19% of the variance in the overview scale. Conclusions The emotional health domain of the Dutch ICF Activity Inventory is a valid tool to assess emotional difficulties arising from visual loss. Interventions to aid people with Retinitis Pigmentosa deal with emotional difficulties should particularly address communicating vision loss effectively to others and coping with negative feelings.
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Affiliation(s)
- Keziah Latham
- Visual Function and Physiology Research Group, Anglia Ruskin University, Cambridge, United Kingdom.,Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom
| | - Mohammad Baranian
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom.,Sport and Exercise Science Research Group, Anglia Ruskin University, Cambridge, United Kingdom
| | - Matthew Timmis
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom.,Sport and Exercise Science Research Group, Anglia Ruskin University, Cambridge, United Kingdom
| | - Shahina Pardhan
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, United Kingdom
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Fenwick EK, Ong PG, Sabanayagam C, Rees G, Xie J, Holloway E, Cheng CY, Wong TY, Lim B, Tan PC, Lamoureux EL. Assessment of the psychometric properties of the Chinese Impact of Vision Impairment questionnaire in a population-based study: findings from the Singapore Chinese Eye Study. Qual Life Res 2015; 25:871-80. [DOI: 10.1007/s11136-015-1141-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/24/2022]
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