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Self-management of Age-Related Macular Degeneration and Quality of Life
A Randomized Controlled Trial
Barbara L. Brody, MPH;
Anne-Catherine Roch-Levecq, PhD;
Anthony C. Gamst, PhD;
Kellie Maclean, BA;
Robert M. Kaplan, PhD;
Stuart I. Brown, MD
Arch Ophthalmol. 2002;120:1477-1483.
Objective To assess the effectiveness of an age-related macular degeneration (AMD) self-management program, consisting of health education and enhancement of problem-solving skills, to improve quality of life as shown by measures of mood and function.
Methods Two hundred thirty-one community-dwelling cognitively intact volunteers (mean age, 80.6 years) with advanced macular degeneration were randomly assigned to a 12-hour self-management program (n = 86), a series of 12 hours of tape-recorded health lectures (n = 74), or to a waiting list (n = 72).
Main Outcome Measures The primary outcome measure was emotional distress (Profile of Mood States). Secondary outcome measures included function (National Eye Institute Visual Function Questionnaire), social support (Duke Social Support Index), outlook on life (Life Optimism Test–Revised), and self-confidence to handle AMD-specific challenges in daily life (AMD Self-Efficacy Questionnaire). Clinical depression was determined in accord with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Axis I, Fourth Edition, Research Version.
Results The self-management group showed significant improvement in measures of mood and function compared with controls. These changes were significantly greater for the depressed than for the nondepressed subjects. Decreased emotional distress was associated with increased self-efficacy, while improvements in function were associated with increases in self-efficacy and perceived social support.
Conclusions These findings suggest that the AMD self-management program was an effective intervention to enhance well-being in older persons with poor eyesight due to AMD, particularly in those who were initially depressed.
From the Department of Ophthalmology (Drs Roch-Levecq and Brown and Mss Brody and Maclean); Department of Family and Preventive Medicine, Divisions of Biostatistics (Dr Gamst) and Health Care Sciences (Dr Kaplan and Ms Brody); and the Department of Neurosciences (Dr Gamst), University of California–San Diego, La Jolla.
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