MyVisionTest News Archive
Feb 16, 2010
Low vision self-management program improves outcomes
A self-management program dericted at persons with age-related vision loss can improve overall health and low vision rehabilitation outcomes, according to a new study.
Chronic Disease Self-Management Programs (CDSMP) assist people in managing their disease/symptoms, as well as the emotional and daily consequences of living with a chronic condition.
The overall aim of CDSMP programs is mastery of fundamental self-management tasks, with frequent opportunities provided to practice and receive feedback on performance of various tasks, as a way of fostering increased illness management self-efficacy, the putative mediator of the CDSMP's effects. Specific topics typically include exercising safely, coping with difficult emotions, and using cognitive symptom management techniques.
Research supports the peer-led Chronic Disease Self-Management Program (CDSMP), which aims to enhance self-efficacy or confidence to execute illness management behaviors, regardless of specific diagnosis. Research suggests that peer-led chronic illness self-management programs result in small to moderate, short-term (4 to 6 month) effects on health outcomes, primarily subfacets of health status and possibly hospitalization, with no apparent effect on overall mental or physical health status or health care expenditures. A Cochrane review of RCTs of peer-led chronic illness self-management programs reached similar conclusions.
Use of self-management in low vision services is limited, but a recent systematic review of education programmes for macular degeneration found three protocols reported in four studies (n = 532). Effect sizes for the outcomes ranged from small to very large (0.14 to 1.21). Reported benefits include decreasing depression and anxiety, improved use of low vision aides and improved everyday functioning.
Methods and Results
A two-armed randomised controlled trial of older adults (n = 77) with age-related vision loss (ARVL) compared 'usual care' provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains.
The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the self-management group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks follow-up.
Discussion and Conclusions
The addition of the self-management programme to usual care (UC) resulted in better general and vision-specific outcomes. With the exception of adjustment to vision loss and mental health, these differences were still apparent at 12 weeks’ follow-up. Participation in life situations, as measured with the ACS, is of particular importance. The observed decline experienced by participants who received UC over the short period of the study (20-24 weeks) is alarming. The addition of self-management appears to not only arrest decline but also increase participation in life situations.
In the present study, the greatest magnitude of change reported by the UC plus vision self-management group was domain-specific self-efficacy (Age-Related Vision Loss Self-Efficacy Questionnaire). In comparison, those who received UC demonstrated only small improvements. It is acknowledged that self-management programmes aim to increase self-efficacy; however, this dramatic increase accompanied by improvements in activity participation and depression levels further supports the assertion that self-efficacy is critical in mediating outcomes.
The investigators conclude that addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL.
WHAT IT MEANS TO YOU: Self-management techniques represent an important step forward in care of persons with chronic disease. While many multi-disciplinary low vision programs have long incorporated some features of self-management, broader recognition of effective self-management techniques will hopefully increase and expand their use by the low vision care community.
Read more...
Br J Ophthalmol. 2010 Feb;94(2):223-8.
Tags: low vision, ADL skills, depression
A self-management program dericted at persons with age-related vision loss can improve overall health and low vision rehabilitation outcomes, according to a new study.Chronic Disease Self-Management Programs (CDSMP) assist people in managing their disease/symptoms, as well as the emotional and daily consequences of living with a chronic condition.
Research supports the peer-led Chronic Disease Self-Management Program (CDSMP), which aims to enhance self-efficacy or confidence to execute illness management behaviors, regardless of specific diagnosis. Research suggests that peer-led chronic illness self-management programs result in small to moderate, short-term (4 to 6 month) effects on health outcomes, primarily subfacets of health status and possibly hospitalization, with no apparent effect on overall mental or physical health status or health care expenditures. A Cochrane review of RCTs of peer-led chronic illness self-management programs reached similar conclusions.
Use of self-management in low vision services is limited, but a recent systematic review of education programmes for macular degeneration found three protocols reported in four studies (n = 532). Effect sizes for the outcomes ranged from small to very large (0.14 to 1.21). Reported benefits include decreasing depression and anxiety, improved use of low vision aides and improved everyday functioning.
Methods and Results
A two-armed randomised controlled trial of older adults (n = 77) with age-related vision loss (ARVL) compared 'usual care' provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains.
The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the self-management group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks follow-up.
Discussion and Conclusions
The addition of the self-management programme to usual care (UC) resulted in better general and vision-specific outcomes. With the exception of adjustment to vision loss and mental health, these differences were still apparent at 12 weeks’ follow-up. Participation in life situations, as measured with the ACS, is of particular importance. The observed decline experienced by participants who received UC over the short period of the study (20-24 weeks) is alarming. The addition of self-management appears to not only arrest decline but also increase participation in life situations.
In the present study, the greatest magnitude of change reported by the UC plus vision self-management group was domain-specific self-efficacy (Age-Related Vision Loss Self-Efficacy Questionnaire). In comparison, those who received UC demonstrated only small improvements. It is acknowledged that self-management programmes aim to increase self-efficacy; however, this dramatic increase accompanied by improvements in activity participation and depression levels further supports the assertion that self-efficacy is critical in mediating outcomes.
The investigators conclude that addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL.
WHAT IT MEANS TO YOU: Self-management techniques represent an important step forward in care of persons with chronic disease. While many multi-disciplinary low vision programs have long incorporated some features of self-management, broader recognition of effective self-management techniques will hopefully increase and expand their use by the low vision care community.
Read more...
Br J Ophthalmol. 2010 Feb;94(2):223-8.
