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A Randomized Controlled Trial

Barbara L. Brody, MPH; Anne-Catherine Roch-Levecq, PhD; Ronald G. Thomas, PhD; Robert M. Kaplan, PhD; Stuart I. Brown, MD

Arch Ophthalmol. 2005;123:46-53.

Objective  To assess the effectiveness at the 6-month follow-up of an age-related macular degeneration (AMD) self-management program consisting of health education and enhancement of problem-solving skills in improving quality of life as shown by measures of mood and function.

Methods  Six-month follow-up data were analyzed from 214 of 252 older adult volunteers (mean age, 80.8 years) with advanced AMD who had been randomly assigned to a 12-hour self-management program (n = 82), a series of 12 hours of tape-recorded health lectures (n = 66), or a waiting list (n = 66). The primary outcome measure was emotional distress (Profile of Mood States). Secondary outcome measures included function (National Eye Institute Visual Function Questionnaire), self-confidence to handle AMD-specific challenges in daily life (AMD Self-efficacy Questionnaire), and depression status on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Results  At the 6-month follow-up, participants in the self-management program reported significantly less emotional distress (P=.008), better function (P=.05), and increased self-efficacy (P=.006) compared with control subjects. The latter effects were more pronounced in the depressed than in the nondepressed subjects. Finally, the incidence of clinical depression at the 6-month follow-up was significantly lower in the self-management group (P=.05) than in the control group.

Conclusion  The sustained positive effects at the 6-month follow-up provide support for the effectiveness of the AMD self-management program in reducing distress and disability, improving self-efficacy, and preventing depression in poorly sighted elderly patients with AMD.

Author Affiliations: Divisions of Biostatistics (Dr Thomas) and Health Care Sciences (Dr Kaplan), Departments of Ophthalmology (Ms Brody and Drs Roch-Levecq and Brown), Family and Preventive Medicine (Ms Brody and Drs Thomas and Kaplan), and Neurosciences (Dr Thomas), University of California, San Diego, La Jolla.

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