Age-related macular degeneration: A randomized clinical trial of a self-management intervention

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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; post⁠) in comparison with wait-list controls (pre⁠; post⁠). Intervention participants also experienced improved (p=.02) self-efficacy (pre⁠; post⁠) in comparison with controls (pre⁠; post⁠). Further, intervention participants increased their use of vision aids (p<.001; pre⁠, post⁠). 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.